Fluids - Fluid and Glucose requirements
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Recommended Volumes (ml/kg/day)
|Day 0-1||Day 2||Day 3||Day 4||Day 5||Day 6||Day 7+|
- Fluid volumes administered in NICU after the first week are high to ensure good caloric intake and growth in preterm infants. Term infants have a lower requirement for fluids and calories.
- Infants admitted to Starship Hospital (surgical or medical services) should have fluids prescribed according to Starship Hospital guidelines (available via the intranet).
- The volume administered will depend on the clinical condition of the infant, with fluid restriction indicated with asphyxia, renal impairment or PDA.
- Infants receiving phototherapy, or with high insensible losses, may require higher fluid intakes.
- In general, fluid management in the first few days is adjusted primarily on serum sodium values and changes in weight.
- There is evidence that restricting fluid volumes in preterm infants in the first few days of life reduces the incidence of patent ductus arteriosus and necrotising enterocolitis, and may decrease mortality rates.1
- Restricting sodium intake in preterm infants in the first few days may also reduce the incidence of chronic lung disease.2,3,4,5
The neonatal liver normally produces 6-8 mg/kg/min of glucose. This is approximately the basal requirement of a newborn infant.
Glucose intake (mg/kg/min) = % Glucose x Volume
Glucose intake (mg/kg/min) = % Glucose x Hourly Rate
Weight (Kg) x 6
|Intake (ml/kg/day)||5% Glucose||10% Glucose||12.5% Glucose|
|mg/kg/min of Glucose|
To get concentrated glucose solutions: See also the Fluid and Electrolytes calculator
|Solution||10% Glucose||50% Glucose|
|12.5%||450 ml||30 ml|
|15%||420 ml||60 ml|
|20%||400 ml||135 ml|
|Solution||5% Glucose||50% Glucose|
|7.5%||450 ml||30 ml|
Glucose solutions of >10% are best administered through central venous lines. Peripheral IVs do not last long, and extravasation can result in tissue damage.
Insensible Water Loss
This varies greatly with gestation and depends on the thermal environment. It decreases markedly over the first few days. Very preterm infants should be placed in humidified incubators in a neutral thermal environment as soon as practical after birth.
If there are significant gastric aspirates, replace these ml for ml with 0.9% NaCl plus 10mmolKCl per 500ml.
Chest and/or Peritoneal Drains
- If there are significant fluid losses from these, measure the volume and replace with 4% albumin as indicated.
- Monitor serum albumin concentrations.
- Monitor the composition of the fluid being lost as this may assist with calculating requirements
- Restrict intake to insensible water loss + urine output.
- Monitor fluid balance, serum electrolytes and weight carefully.
- In early Acute Tubular Necrosis, consider a pre-renal cause. Fractional excretion of sodium may help sort
FE Na+≥2.5% in term infants suggests renal failure.
FE Na+<2.5% in term infants suggests pre-renal failure.
FE Na+ is high in preterm infants because of tubular immaturity.
FE Na+ = Urine [Na] x Serum Creatinine
Serum [Na+] x Urine Creatinine x 100%
- Bell EF, Acarregui MJ. Restricted versus liberal water intake for preventing morbidity and mortality in preterm infants. Cochrane Database of Systematic Reviews 2001, Issue 3. Art. No.: CD000503. DOI: 10.1002/14651858.CD000503.
- Hartnoll G, Betremieux P, Modi N. Randomised controlled trial of postnatal sodium supplementation on oxygen dependency and body weight in 25-30 week gestational age infants. Arch Dis Child Fetal Neonatal Ed 2000;82(1):F19-23.
- Hartnoll G, Betremieux P, Modi N. Randomised controlled trial of postnatal sodium supplementation on body composition in 25 to 30 week gestational age infants. Arch Dis Child Fetal Neonatal Ed 2000;82(1):F24-8.
- Hartnoll G, Betremieux P, Modi N. Randomised controlled trial of postnatal sodium supplementation in infants of 25-30 weeks gestational age: effects on cardiopulmonary adaptation. Arch Dis Child Fetal Neonatal E. 2001;85(1):F29-32.
- Costarino AT Jr, Gruskay JA, Corcoran L, Polin RA, Baumgart S. Sodium restriction versus daily maintenance replacement in very low birth weight premature neonates: a randomized, blind therapeutic trial. J Pediatr 1992;120(1):99-106.
Did you find this information helpful?
- Date last published: 31 January 2007
- Document type: Clinical Guideline
- Services responsible: Neonatology
- Owner: Newborn Services Clinical Practice Committee
- Editor: Sarah Bellhouse
- Review frequency: 2 years
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