This document discusses intravenous fluid management in newborns. It notes that total body water is highest at birth, around 75% for term infants and 80% for preterm infants. During the first week, excess fluid is lost primarily through urine as extracellular fluid decreases. Preterm infants lose more, around 10-15% of body weight. Intravenous fluids are given to sick newborns or those under 30 weeks gestation. The type and amount of fluids given depends on factors like weight and postnatal age. Fluid needs increase in situations like fever or phototherapy and decrease in conditions causing fluid retention. Monitoring includes weight, urine output, and laboratory tests to avoid dehydration or fluid overload.

1. i
INTRAVENOUS Fluids.

2. Things to consider:
• Normal changes in the TBW and ECF
• Changes in the salt and water balance
• Normal changes in the renal function
• Insensible water losses.

3. Body fluid composition in the Fetus
and Newborn
• TBW= ICF+ECF(intravasular and interstitial)
• As gestational age increases TBW and ECF
decreases while ICF increases
• At birth TBW=75% of body weight in term
infants and 80% in preterm infants.

4. TBW- changes according to age

5. Perinatal changes
• During first week to 10 days of life reduction in
body weight is due to reduction in the ECF
• Term infants weight loss = 5%-10% with in 3-5
days of life.
• Preterm Infant lose about 10%-15% of body
weight with in 5 days of life.

6. Sodium balance in the newborn
• Major cation and Anion of ECF are sodium and
chloride respectively.
• Major Cation of ICF- potassium and Anions
are protein, organic acids and phosphate.
• Sodium balance is maintained by 3Na-2K
pump .
• Plasma Osmolality ranges from 285-295
mOsmos/kg
• Osmolality= 2(Na)+1/8(Glucose)+BUN/2.8

7. Sodium balance in the newborn
• Renal sodium loses are inversely proportional
to gestational age of the child
• Term infants have fractional excretion of Na-
1% with transient increase on day 2 and
• Preterm infants <35 wks have a negative
sodium balance and hyponatremia during first
2-3 wks of life

8. Sodium balance in the newborn
• Increased urinary sodium losses seen in
-Hypoxia
-Respiratory Distress
-Hyperbilirubinemia
-ATN
-Polycythemia
-Diuretics

9. Renal concentration and diluting
Capacity
• Adults can concentrate urine upto 1500mOsm/kg
of plasma water and dilute as low as 50mOsm/kg
of plasma water.
• Concentrating capacity is 800mOsm/kg in term
infants and 600mOsm/kg in preterm , so require
more urine volume to excrete solutes
• Diluting capacity is 50mOsm/kg in term infants
and 70mOsm/kg in preterm
• Newborns have reduction in GFR and decreased
activity of transporters in the early distal tubule

10. Insensible loss of Water.
• Maturity of the Infant(BSA/Kg)
• Open Warmer bed
• Phototherapy
• Hyperthermia
• Tachypnea
• Reduced by -Enclosed incubator
-Humidified Air
-Sedation
-Decreased Activity
-Hypothermia

11. Who require IV Fluids
• Infant <30 weeks, & <1200 gm
• Sick Term Newborns and children
-Severe Birth Asphyxia
-Apnea
-RDS
-Sepsis
-Seizure
-Hemodynamic Instability
-GI malformations
-Shock

12. How Much Fluid to be Given:
Neonates
Birth Weight Day
1
Day
2
Day
3
Day
4
Day
5
Day
6
Day
7
<1000 g 80 100 120 130 140 150 160
1000-1500 g 70 90 110 120 130 140 150
>1500 g 60 75 90 105 120 135 150

13. How Much Fluid to be Given:
Infants and >1 year
Maintenance IV F -Holiday- Segar method
First 10kg 100ml/kg
(4ml/kg/hr)
Next10-20kg Add 50ml/kg
(2ml/kg/hr)
>20kg Add 20ml/kg
(1ml/kg/hr)

14. How Much Fluid to be Given
Maintenance IV Fluids-
Bed side Calculation
Age Ml/kg/day
<1 yr 120
1-2 yr 110
2-3yr 100
3-4yr 90
4-5yr 80
5-6yr 70
>6-yrs 60

15. Type of Fluid
.1st 48 hrs- <1000g: 5% Dextrose
>1000g: 10% Dextrose
· 48hrs- 28 days : 10% DN/6
(80ml NS+ 420ml 10% Dextrose)
. 28 days-6 yrs : 5% DN/4
. 6 Yrs-12 yrs : 5% DN/2
. >12 yrs : 5% DNS

16. Composition of IV fluids
IV fluid Dextr Na K Cl lactate ca MOsm/l
NS - 154 - 154 - - 308
RL - 131 5 111 29 2 270
1/2NS - 77 - 77 - - 154
5%D 50 - - - - - 278
10%D 100 - - - - - 556
5%DNS 50 154 - 154 - - 585
5%
50 77 - 77 - - 415
DNS/2
5%
DNS/4
50 34 - 34 - - 347
Isolyte P 50 29 20 29 - - 368
5%
50 25 - 25 - -
DNS/6

17. Extra Fluid
• Warmer –add 10ml/kg/day
• Phototherapy-add 10ml/kg/day
• Fever- increase fluid requirement by 12% per
degree rise above 37.8 degree C
• Tachypnea- increase fluid requirement 10-30%

18. Extra Fluid
• NEC and other condition with 3rd space loss
• ELBW and VLBW Neonates
• Vomiting
• Gastroenteritis
• Shock
• Burns
• Tachypnea
• DKA

19. Less Fluid
• Birth Asphyxia
• Meningitis
• Intra Ventricular Hemorrhage
• PDA(cardiac failure)
• Oliguria/Anuria
• SIADH
• Edema

20. Special Situations
• Oliguria-Insensible water loss + measured
urine output + deficit
• Anuria-Insensible water loss + deficit
• Dehydration- Maintenance + Deficit + ongoing
losses.

21. Monitoring
Parameter Freque
ncy
Normal
value
Fluid deficit signs Fluid overload signs
Bed side.
1.Clinical 8hrly - Loss of skin turgor,
dry mucosa,
tachycardia
Puffiness of eyes,
sudden increase in liver
size , basal rales
2.Weight Daily Weight loss Sudden weight gain
3.Urine Volume 6-8 hrly 1-3
ml/kg/hr
<1 ml/kg/hr >3 ml/kg/hr
4.Urine Specific Gravity 6-8 hrly 1008-1015 >1015 <1004
Laboratory
1. Urine Osmolality 12hr 100-300 >450 <100
2. Plasma osmolality Daily 285 >300 <270
3.Serum Na 24-48hr 135-145 - -
4.Serum K 24-48hr 4-5 - -
5. Blood urea 24-48hr 20-40 - -
6. Serum Creatinine 24-48hr 0.6-1.2 - -