Study note

Monitoring hydration in neonates receiving intravenous fluids

THE CONTEXT

Neonatal fluid therapy should be reassessed every 12–24 hours using serial weight measurements, clinical examination, and urine output.

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Term neonates usually lose 1–3% of birth weight daily, with a cumulative loss of 7–10% in the first week.

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Preterm neonates usually lose 2–3% of birth weight daily, with a cumulative loss of 10–15% in the first week.

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Failure to lose weight during the first week may indicate excessive fluid administration.

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Excessive early weight loss, failure to regain birth weight by the stipulated age, or failure to gain weight afterward suggests a fluid deficit.

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The usual physical signs of dehydration are unreliable in neonates.

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At 10% dehydration, equivalent to 100 mL/kg, infants may have sunken eyes and fontanel, cold and clammy skin, poor skin turgor, and oliguria.

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At 15% dehydration or more, equivalent to at least 150 mL/kg, infants have signs of shock such as hypotension, tachycardia, and weak pulses.

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A well-hydrated neonate passes urine at 1–3 mL/kg/hr.

NEETx

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