Neonatology Book

Fluids

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Premature Infant Fluid Requirements

Aka: Premature Infant Fluid Requirements
  1. See Also
    1. Neonatal Fluid Management
    2. Term Infant Fluid Requirements
    3. Neonatal Feeding
    4. Breast Feeding
    5. Bottle Feeding
    6. Preterm Feeding Schedules
  2. Management: Fluid Requirements
    1. Weight >1500 grams
      1. Day 1-2: 80 ml/kg/day
      2. Day 3-15: 110 ml/kg/day
      3. Day >15: 130 ml/kg/day
    2. Weight >1250 grams
      1. Day 1-2: 90 ml/kg/day
      2. Day 3-15: 120 ml/kg/day
      3. Day >15: 130 ml/kg/day
    3. Weight >1000 grams
      1. Day 1-2: 100 ml/kg/day
      2. Day 3-15: 130 ml/kg/day
      3. Day >15: 140 ml/kg/day
    4. Weight >750 grams
      1. Day 1-2: 105 ml/kg/day
      2. Day 3-15: 140 ml/kg/day
      3. Day >15: 150 ml/kg/day
    5. Weight <1000 grams
      1. Adjust fluid requirements for insensible water loss
      2. Fluid requirements may range up to 200 ml/kg/day
  3. Management: Glucose containing solutions
    1. General
      1. Small Premature Infants may not metabolize D10W
        1. Risk of Hyperglycemia and Glucosuria
      2. Titrate from D5W to D10W
      3. Follow Glucose intake in grams/kg/hour
    2. Protocol
      1. D5W 4 ml/kg/h = D10W 2 ml/kg/h (0.2 g/kg/h Glucose)
      2. D5W 6 ml/kg/h = D10W 3 ml/kg/h (0.3 g/kg/h Glucose)
      3. D5W 8 ml/kg/h = D10W 4 ml/kg/h (0.4 g/kg/h Glucose)
      4. D5W 10 ml/kg/h = D10W 5 ml/kg/h (0.5 g/kg/h Glucose)
  4. Management: Electrolyte Requirements
    1. Sodium: 2-3 meq/kg/day (maximum of 4-8 meq/kg/day)
      1. Start replacement on Day 2 to 3 of life
      2. Monitor serum & Urine Sodium
    2. Potassium: 2-3 meq/kg/day
      1. Start on Day 2 to 3 if no renal disease
    3. Calcium
      1. Acute replacement: 30-45 mg/kg/day
      2. Chronic replacement: 100-150 mg/kg/day

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