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FEN - Fluids Electrolyte and Nutrition Management in...

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Fluids, Electrolyte, and Nutrition Management in Neonates N. Ambalavanan MD Neonatologist October 1998
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FEN Management in Neonates Essentials of life:   Food ( Nutrition ) water ( Fluid/electrolyte ) shelter ( control of environment - temperature etc ) Essentials of neonatal care:   Fluid, electrolyte, nutrition management ( All babies ) Control of environment ( All babies ) Respiratory /CVS/CNS management ( some babies ) Infection management ( some babies )
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Why is FEN management important? Many babies in NICU need IV fluids They all don’t need the same IV fluids  (either in quantity or composition) If wrong fluids are given, neonatal kidneys  are not well equipped to handle them Serious morbidity can result from fluid and  electrolyte imbalance
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Fluids and Electrolytes Main priniciples: Total body water  (TBW) = Intracellular fluid (ICF)  + Extracellular fluid (ECF) Extracellular fluid  (ECF) = Intravascular fluid ( in  vessels  : plasma, lymph) + Interstitial fluid  ( between cells ) Main goals: Maintain appropriate ECF volume, Maintain appropriate ECF and ICF osmolality and  ionic concentrations
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Things to consider: Normal changes in TBW, ECF All babies are born with an excess of TBW,  mainly ECF, which needs to be removed Adults are 60% water ( 20% ECF , 40% ICF) Term neonates are 75% water ( 40% ECF , 35%  ICF) : lose 5-10 % of weight in first week Preterm neonates have more water (23 wks:  90%,  60% ECF , 30% ICF): lose 5-15% of  weight in first week
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Things to consider: Normal changes in Renal Function Adults can concentrate or dilute urine very  well, depending on fluid status Neonates are not able to concentrate or  dilute urine as well as adults - at risk for  dehydration or fluid overload Renal function matures with increasing: gestational age postnatal age
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Things to consider: Insensible water loss (IWL) “Insensible” water loss is water loss that is  not obvious (makes sense?): through skin  (2/3) or respiratory tract (1/3) depends on gestational age ( more preterm:  more IWL ) depends on postnatal age ( skin thickens with  age: older is better --> less IWL ) also consider losses of other fluids: Stool  (diarrhea/ostomy), NG/OG drainage, CSF  (ventricular drainage), etc 
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Assessment of fluid and electrolyte status History :  baby’s F&E status partially reflects  mom’s F&E status ( Excessive use of oxytocin,  hypotonic IVF can cause hyponatremia ) Physical Examination : Weight: reflects TBW. Not very useful for  intravascular volume ( eg. Long term paralysis and  peritonitis can lead to increased body weight and  increased interstitial fluid but decreased intravascular  volume.  Moral  : a puffy baby may or may not have  adequate fluid where it counts: in his blood vessels )
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