Fluids, Electrolyte, and Nutrition Management in Neonates

Posted by e-Medical PPT Monday, August 20, 2012
Things to consider:
Normal changes in TBW, ECF
All babies are born with an excess of TBW, mainly ECF, which needs to be removed
Adults are 60% water (20% ECF, 40% ICF)
Term neonates are 75% water (40% ECF, 35% ICF) : lose 5-10 % of weight in first week
Preterm neonates have more water (23 wks: 90%, 60% ECF, 30% ICF): lose 5-15% of weight in first week

Normal changes in Renal Function
Adults can concentrate or dilute urine very well, depending on fluid status
Neonates are not able to concentrate or dilute urine as well as adults - at risk for dehydration or fluid overload
Renal function matures with increasing:
 gestational age
 postnatal age

Insensible water loss (IWL)
Insensible” water loss is water loss that is not obvious: through skin (2/3) or respiratory tract (1/3)
 depends on gestational age (more preterm: more IWL)
 depends on postnatal age (skin thickens with age: older is better --> less IWL)
 also consider losses of other fluids: Stool (diarrhea/ostomy), NG/OG drainage, CSF (ventricular drainage), etc

Assessment of fluid and electrolyte status
Lab evaluation:
Serum electrolytes and plasma osmolarity
Urine output
Urine electrolytes, specific gravity (not very useful if the baby is on diuretics - lasix etc), FENa
Blood urea, serum creatinine (values in the first few days reflect mom’s values, not baby’s)
ABG (low pH and bicarb may indicate poor perfusion)

Fluids and Electrolyte in common neonatal conditions
RDS: Adequate but not too much fluid. Excess leads to hyponatremia, risk of BPD. Too little leads to hypernatremia, dehydration
BPD: Need more calories but fluids are usually restricted: hence the need for “rocket fuel”. If diuretics are used, w/f ‘lyte problems. May need extra calcium.
PDA: Avoid fluid overload. If indocin is used, monitor urine output.
Asphyxia: May have renal injury or SIADH. Restrict fluids initially, avoid potassium. May need fluid challenge if cause of oliguria is not clear.
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