FLUID MANAGEMENT IN NEONATES NICU

FLUID MANAGEMENT IN NEONATES NICU

1. FLUID MANAGEMENT IN NEONATES

2. AIMS of fluid therapy TO IDENTIFY BABIES WHO NEED IV FLUIDS TO CALCULATE DAILY FLUID AND ELECTROLYTE INTAKE TO ADMINISTER IV FLUIDS WITH MEASURED VOLUME SET / INFUSION PUMP TO MONITOR BABIES RECEIVING IV FLUIDS TO ADJUST IV FLUIDS WITH ENTERAL FEEDING

3. WHICH TYPE OF BABIES REQUIRE IV FLUID THERAPY ? NEONATES WITH LETHARGY AND REFUSAL TO FEED MODERATE TO SEVERE BREATHING DIFFICULTY BABIES WITH SHOCK BABIES WITH SEVERE ASPHYXIA ABDOMINAL DISTENSION WITH BILIOUS OR BLOOD STAINED VOMITING

4. CHANGES IN BODY WATER AND ELECTROLYTE COMPOSITION DURING INTRAUTERINE AND EARLY POSTNATAL LIFE GESTATIONAL AGE (WEEKS) Component 24 28 32 36 40 1 To 4 Weeks After Term Birth Total Body Water (%) 86 84 82 80 78 74 Extracellular Water (%) 59 56 52 48 44 41 Intracellular Water (%) 27 28 30 32 34 33 Sodium (m Eq /Kg) 99 91 85 80 77 73 Potassium (m Eq/Kg) 40 41 40 41 41 42 Chloride (m Eq /Kg) 70 67 62 56 51 48

5. WATER LOSS SENSIBLE INSENSIBLE Kidney GIT Skin 70% Respiratory Tract 30%

6. Daily physiological losses of fluids …. VISSIBLE WATER LOSS(VWL): 85 Ml/100 kcal URINE:80 mL / 100 kcal STOOL: 0-10 mL / 100 kcal INSENSIBLE WATER LOSS (IWL): 40 mL / 100 kcal SKIN: 70% BREATHING: 30% EXCESSIVE IWL LOW HUMIDITY( OPEN CARE SYSTEM) HIGH AIR CURRENTS HIGH AMBIENT TEMPERATURE/ FEVER COLD STRESS USE OF RADIAANT WARMER ( 50%) PHOTOTHERAPY(40%) RESPIRATORY DISTRESS SEIZURES

7. INSENSIBLE WATER LOSS: Insensible Water Loss according to Birth Weight on Day 5 BIRTH WEIGHT IWL (ml/Kg/day) <1000 gm 60-80 1000-1500 gm 40-60 >1500 gm 20

8. INSENSIBLE WATER LOSS: PREVENTION > CURE (REPLACEMENT) IWL  Preterm>term Reasons : Immaturity Of Skin Barrier Respiratory Distress Greater Skin Blood Flow Larger Body Water *Essential Fatty Acid Deficiency MEASURES : Incubator Humidification Systems Plexiglas Heat Shields Thin Plastic Blankets Semipermeable Membranes Water Proof Topical Agents

9. Fluid requirements of neonates(ml/kg body weight DAY OF LIFE BIRTH WEIGHT     1 2 3 4 5 6 7 >1500 g <1500 g   60 75 90 105 120 135 150   80 95 110 125 140 150 150

10. MONITOR FLIUD THERAPY IN NEONATES…. INSPECT THE INFUSION SITE EVERY HOUR. LOOK FOR REDNESS AND SWELLING AROUND THE INSERTION SITE OF THE CANNULA, WHICH INDICATES THAT THE CANNULA IS NOT IN THE VEIN AND FLUID IS LEAKING INTO THE SUBCUTANEOUS TISSUES. CHECK THE VOLUME OF FLUID INFUSED AND COMPARE TO THE PRESCRIBED VOLUME, RECORD ALL FINDINGS. MEASURE BLOOD GLUCOSE EVERY NURSING SHIFT I.E. 6 – 8 HOURS. IF THE BLOOD GLUCOSE IS LESS THAN 45 mg/DL, TREAT FOR LOW BLOOD GLUCOSE IF THE BLOOD GLUCOSE IS MORE THAN 150 mg/DL ON TWO CONSECUTIVE READINGS: - CHANGE TO A 5% DEXTROSE SOLUTION AND MEASURE BLOOD GLUCOSE AGAIN IN THREE HOURS

11. . IF THE BLOOD GLUCOSE IS LESS THAN 45 mg/DL, TREAT FOR LOW BLOOD GLUCOSE IF THE BLOOD GLUCOSE IS MORE THAN 150 mg/DL ON TWO CONSECUTIVE READINGS: - CHANGE TO A 5% DEXTROSE SOLUTION AND MEASURE BLOOD GLUCOSE AGAIN IN THREE HOURS. WEIGH THE BABY DAILY. IF THE DAILY WEIGHT LOSS IS MORE THAN 5%, INCREASE THE TOTAL VOLUME OF FLUID BY 10 mL/KG BODY WEIGHT FOR ONE DAY TO COMPENSATE FOR INADEQUATE FLUID ADMINISTRATION . HOWEVER , IF THERE IS EXCESSIVE WEIGHT GAIN (3-5%) DECREASE THE FLUID INTAKE BY 15-20 ML/KG/DAY . IF THERE ARE SIGNS OF OVERHYDRATION (E.G. EXCESSIVE WEIGHT GAIN, PUFFY EYES, OR INCREASING OEDEMA OVER LOWER PARTS OF THE BODY), REDUCE THE VOLUME OF FLUID BY HALF. FOR 24 HOURS AFTER THE OVERHYDRATION IS NOTED. CHECK SERUM NA, URINE SPECIFIC GRAVITY & TITRATE FLUID ACCORDINGLY

12. . CHECK FOR URINE OUTPUT: NORMALLY A BABY PASSES URINE 5 – 6 TIMES IN A DAY. IF THERE IS: DECREASED URINE OUTPUT AND WEIGHT LOSS, INCREASE FLUID INTAKE BY 10-20ML/KG, HOWEVER, IF THERE IS DECREASED URINE OUTPUT WITH WEIGHT GAIN, DECREASE DAILY FLUID EVALUATE FOR RENAL FAILURE

13. MONITOR… HYPONATREMIA: ( Serum Sodium <120 mEq / L) HYPERNATREMIA : ( Serum Sodium > 150 mEq / L ) HYPOKALEMIA : ( Serum Potassium < 3.5 mEq / L ) HYPERKALEMIA : Value more than 6 mEq/ L )- common in first 2-3 days of life METABOLIC ACIDOSIS: Due to hypoxia, diarrhea,vomitting & starvation or excess protein intake Blood pH less than 7.3 and plasma bicarbonate below 18 mEq / L) RESPIRATORY ACIDOSIS : Due to decreased elimination of CO2 in the body of poor ventilation Seen by primary rise in PaCO2 above 45 mm Hg and mild elevation of carbonic acid upto 4 mEq / L)

14. PRINCIPLES OF THERAPY: Estimate Calculate Administer Monitor Replacement of Deficits Maintenance Replacement of ongoing losses

15. THANK YOU