Neonatal feeding routes and initial intravenous fluid therapy
THE CONTEXT
The route and amount of neonatal fluid administration depend on gestational age, birth weight, illness, day of life, and clinical fluid balance.
Selecting a feeding route
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Otherwise well neonates weighing at least 1000 g or born at 28 weeks or later can receive enteral breast milk.
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Neonates weighing between 1000 and 1800 g or born at 28–33 weeks require alternate feeding methods using a gastric tube or paladai.
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Neonates weighing at least 1800 g or born at 34 weeks or later can accept direct breastfeeding.
Indications for intravenous fluids
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Small or sick neonates need intravenous fluids initially. Neonates born before 28 weeks should receive them routinely.
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Respiratory distress, significant asphyxia, feed intolerance, and hemodynamic instability are indications for intravenous fluids regardless of weight or gestation.
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A peripheral intravenous line is the most common route. Fluid volume depends on birth weight, day of life, and whether clinical assessment indicates adequate hydration, excess fluid, or fluid deficit.
Fluid prescription for birth weight at least 1500 g
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Infants receiving intravenous fluids must excrete a solute load of about 15 mOsm/kg/day. At a urine osmolarity of 300 mOsm/L, this requires a minimum urine volume of 50 mL/kg/day.
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Initial fluids should be 10% dextrose without electrolytes, providing a glucose infusion rate of 4–6 mg/kg/min.
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With insensible water loss of 20 mL/kg, the initial fluid requirement is 60–80 mL/kg/day.
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As growth and enteral feeding increase the solute load, additional water is needed for solute excretion, fecal losses, and growth. Increase fluids by 15–20 mL/kg/day to a maximum of 150 mL/kg/day by the seventh day.