- Neonates requiring IV fluid therapy include those with lethargy/refusal to feed, breathing difficulties, shock, severe asphyxia, or abdominal issues. The aims of fluid therapy are to identify babies needing IV fluids, calculate daily intake, administer measured volumes, and monitor babies receiving IV fluids. Fluid requirements vary based on weight and age, and monitoring includes checking infusion sites, volumes, blood glucose, weight, urine output, and electrolyte levels to properly adjust fluid intake.

1. FLUID MANAGEMENT IN NEONATES

2. AIMS OF FLUID THERAPY
• TO IDENTIFY BABIES WHO NEED IV FLUIDS
• TO CALCULATE DAILY FLUID AND ELECTROLYTE
INTAKE
• TO ADMINISTER IV FLUIDS WITH MEASURED
VOLUME SET / INFUSION PUMP
• TO MONITOR BABIES RECEIVING IV FLUIDS
• TO ADJUST IV FLUIDS WITH ENTERAL FEEDING

3. WHICH TYPE OF BABIES REQUIRE IV FLUID THERAPY ?
• NEONATES WITH LETHARGY AND REFUSAL TO FEED
• MODERATE TO SEVERE BREATHING DIFFICULTY
• BABIES WITH SHOCK
• BABIES WITH SEVERE ASPHYXIA
• ABDOMINAL DISTENSION WITH BILIOUS OR BLOOD STAINED
VOMITING

4. CHANGES IN BODY WATER AND ELECTROLYTE COMPOSITION
DURING INTRAUTERINE AND EARLY POSTNATAL LIFE
GESTATIONAL AGE (WEEKS)
Component 24 28 32 36 40 1 To 4 Weeks
After Term
Birth
Total Body Water (%) 86 84 82 80 78 74
Extracellular Water (%) 59 56 52 48 44 41
Intracellular Water (%) 27 28 30 32 34 33
Sodium (m Eq/Kg) 99 91 85 80 77 73
Potassium (m Eq/Kg) 40 41 40 41 41 42
Chloride (m Eq/Kg) 70 67 62 56 51 48

5. WATER
LOSS
SENSIBLE INSENSIBLE
Kidney GIT Skin
70%
Respiratory
Tract
30%

6. DAILY PHYSIOLOGICAL LOSSES OF FLUIDS….
• VISSIBLE WATER LOSS(VWL): 85 Ml/100 kcal
 URINE:80 mL / 100 kcal
 STOOL: 0-10 mL / 100 kcal
• INSENSIBLE WATER LOSS (IWL): 40 mL / 100 kcal
 SKIN: 70%
 BREATHING: 30%
• EXCESSIVE IWL
 LOW HUMIDITY( OPEN CARE SYSTEM)
 HIGH AIR CURRENTS
 HIGH AMBIENT TEMPERATURE/ FEVER
 COLD STRESS
 USE OF RADIAANT WARMER ( 50%)
 PHOTOTHERAPY(40%)
 RESPIRATORY DISTRESS
 SEIZURES

7. INSENSIBLE WATER LOSS:
Insensible Water Loss according to
Birth Weight on Day 5
BIRTH WEIGHT IWL (ml/Kg/day)
<1000 gm 60-80
1000-1500 gm 40-60
>1500 gm 20

8. INSENSIBLE WATER LOSS:
PREVENTION > CURE (REPLACEMENT)
IWL  Preterm>term
Reasons : Immaturity Of Skin Barrier
Respiratory Distress
Greater Skin Blood Flow
Larger Body Water
*Essential Fatty Acid Deficiency
MEASURES : Incubator Humidification Systems
Plexiglas Heat Shields
Thin Plastic Blankets
Semipermeable Membranes
Water Proof Topical Agents

9. FLUID REQUIREMENTS OF NEONATES(ML/KG BODY WEIGHT
DAY OF LIFE BIRTH WEIGHT
1
2
3
4
5
6
7
>1500 g <1500 g
60
75
90
105
120
135
150
80
95
110
125
140
150
150

13. MONITOR FLIUD THERAPY IN NEONATES….
• INSPECT THE INFUSION SITE EVERY HOUR.
• LOOK FOR REDNESS AND SWELLING AROUND THE INSERTION SITE OF
THE CANNULA, WHICH
INDICATES THAT THE CANNULA IS NOT IN THE VEIN AND FLUID IS
LEAKING INTO THE SUBCUTANEOUS TISSUES.
• CHECK THE VOLUME OF FLUID INFUSED AND COMPARE TO THE
PRESCRIBED VOLUME, RECORD ALL FINDINGS.
• MEASURE BLOOD GLUCOSE EVERY NURSING SHIFT I.E. 6 – 8 HOURS.
• IF THE BLOOD GLUCOSE IS LESS THAN 45 mg/DL, TREAT FOR LOW
BLOOD GLUCOSE
• IF THE BLOOD GLUCOSE IS MORE THAN 150 mg/DL ON TWO
CONSECUTIVE READINGS: - CHANGE
TO A 5% DEXTROSE SOLUTION AND MEASURE BLOOD GLUCOSE
AGAIN IN THREE HOURS

14. .
• IF THE BLOOD GLUCOSE IS LESS THAN 45 mg/DL, TREAT FOR LOW BLOOD
GLUCOSE
• IF THE BLOOD GLUCOSE IS MORE THAN 150 mg/DL ON TWO CONSECUTIVE
READINGS: - CHANGE
TO A 5% DEXTROSE SOLUTION AND MEASURE BLOOD GLUCOSE AGAIN IN
THREE HOURS.
• WEIGH THE BABY DAILY. IF THE DAILY WEIGHT LOSS IS MORE THAN 5%,
INCREASE THE TOTAL VOLUME OF FLUID BY 10 mL/KG BODY WEIGHT FOR
ONE DAY TO COMPENSATE FOR INADEQUATE FLUID ADMINISTRATION.
• HOWEVER, IF THERE IS EXCESSIVE WEIGHT GAIN (3-5%) DECREASE THE
FLUID INTAKE BY 15-20 ML/KG/DAY.
• IF THERE ARE SIGNS OF OVERHYDRATION (E.G. EXCESSIVE WEIGHT GAIN,
PUFFY EYES, OR INCREASING OEDEMA OVER LOWER PARTS OF THE BODY),
REDUCE THE VOLUME OF FLUID BY HALF.
• FOR 24 HOURS AFTER THE OVERHYDRATION IS NOTED. CHECK SERUM NA,
URINE SPECIFIC GRAVITY & TITRATE FLUID ACCORDINGLY

15. .
• CHECK FOR URINE OUTPUT:
NORMALLY A BABY PASSES URINE 5 – 6 TIMES IN A DAY.
IF THERE IS:
• DECREASED URINE OUTPUT AND WEIGHT LOSS, INCREASE FLUID
INTAKE BY 10-20ML/KG,
• HOWEVER, IF THERE IS DECREASED URINE OUTPUT WITH
WEIGHT GAIN, DECREASE DAILY FLUID
• EVALUATE FOR RENAL FAILURE

16. MONITOR…
HYPONATREMIA: ( Serum Sodium <120 mEq/ L)
HYPERNATREMIA: ( Serum Sodium > 150 mEq/ L)
HYPOKALEMIA : ( Serum Potassium < 3.5 mEq/ L)
HYPERKALEMIA :
• Value more than 6mEq/ L)- common in first 2-3 days of life
METABOLIC ACIDOSIS:
• Due to hypoxia, diarrhea,vomitting & starvation or excess protein
intake
• Blood pH less than 7.3 and plasma bicarbonate below 18 mEq/ L)
RESPIRATORY ACIDOSIS:
• Due to decreased elimination of CO2 in the body of poor ventilation
• Seen by primary rise in PaCO2 above 45 mm Hg and mild elevation
of carbonic acid upto 4 mEq/ L)

17. PRINCIPLES OF THERAPY:
Estimate
Calculate
Administer
Monitor
Replacement of Deficits
Maintenance
Replacement of
ongoing losses

18. THANK YOU