Intravenous fluid therapy in neonates below 1500 g
THE CONTEXT
Neonates with birth weight below 1500 g have urine output similar to larger neonates but initially require more fluid because of higher IWL.
Initial fluids and subsequent increases
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On day 1, provide 80 mL/kg/day of 10% dextrose.
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Frocks, caps, and socks reduce IWL under a radiant warmer.
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As the skin matures, IWL decreases and fluid requirements become similar to those of larger neonates.
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The text describes daily increments of 10–15 mL/kg, reaching a maximum of 150 mL/kg/day by the fifth to seventh day.
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The daily fluid table lists 80, 95, 110, 120, 130, 140, and 150 mL/kg/day for infants below 1500 g on days 1 through 7, respectively; 150 mL/kg/day applies from day 7 onward.
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For comparison, the table lists 60, 75, 90, 105, 120, 135, and 150 mL/kg/day for infants weighing at least 1500 g on days 1 through 7, respectively.
Electrolytes and complications
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Add sodium and potassium to intravenous fluids after 48 hours.
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Complications include extravasation, local phlebitis, and fluid overload.
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Intravenous fluid therapy is a significant risk factor for healthcare-associated infections.
Kangaroo positioning
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The infant is positioned between the breasts in a frog-legged position, with the face turned to one side.