Fluid & Electrolyte Management

Dear colleagues! Please share your experience regarding 2 issues about infusion in preterm infants. Unfortunately there are no solid guidelines but questions of fluid supplementation and parenteral nutrition are obviously important for premature patients. There are considerable differences in proposed volumes of fluid requirement per day in literature. For example, Avery’s Diseases of the Newborn (10th edition from 2018, freshest one) provides following numbers: From the other hand, European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2016 Update states that “Typically fluids are initiated at about 70–80 ml/kg/ d…

how do you guys manage hypernatremia in collodion babies, we have a three-month-old with hypernatremia and hyperaldosteronism and hyperreninemia and oliguria, any suggestion on how to manage?

I visited Hot Topics last year and one of the best lectures (according to me!) was held by Judy Aschner, about the use of sodium bicarbonate being principally useless (and could even have adverse effects). Please click here to read an excellent review article on the topic by Aschner and Poland. Unfortunately only the abstact is available for free, but the article is worth to order! As many other units, we have a strong tradition to consider the use buffer, if pH is less than 7.25 and BE less than -5 (at least in in ELBW infants) The article by Aschner and Poland has been subjected to some debate in our units. The major argument in favour of buffer is that we do…

How do you manage fluids in the ELBW - 500g infant? We start at 100 ml/kg/d and increase by ~20 ml/kg daily. Despite plastic wrap in DR, humidified incubators, etc we often have significant hypernatremia usually by 24 hours, sometimes > 150, sometimes > 160. Is this a sodium problem or a water problem or (probably) both? These little guys have lots of transepidermal water loss especially in the first 2 days. They also get Na Acetate via UAC giving sometimes 1.5-2 mEq/kg/d of Na in that first day when the kidneys (from what I read) can excrete free water but cannot filter an excess sodium load well. And some lit suggests retention of birth weigh…

Dear all, can anyone post any guideline to guide us to manage a 7 day old neonate with hypercalcaemia. Trying to get hold off very specific information about when to start Fursemide (the cut off level for cCa), the dose and when to start bisphosphonates? Thank you. BW, Lenka

Hi, Just a quick question. In low birth and preterms admitted in NICU, and who have weight fluctuations in first few days, ideally daily weight or birth weight should be used for calculating 24 hour fluid requirements.

Dear colleagues! Could you clarify for me please where you measure hemoglobin and hematocrit for transfusion? Central or peripheral lines (venous, arterial) or in capillary bed by heelstick? I failed to find much info about that. For example this paper https://doi.org/10.1053/j.semperi.2008.10.006 (pretty old one 2009) states that "central measurements are preferred". If so is the any difference between UAC and UVC hemoglobin and hematocrit? Many thanks!

Please, I need a protocol for treatment of neonatal hypernatremia ..

Dear colleagues! Greetings from Belarus! We're updating our clinical protocols. Please share with us your experience of Fresh Frozen Plasma (FFP) transfusion in non-surgical NICU. Do you use it only in case of bleeding, or bleeding and abnormal coagulation tests should be combined? Or abnormal tests alone is a good reason for FFP (e.g. in ELBW infants). What is bleeding -- fresh IVH III or minor pulmonary hemorrhage also matters? Which thresholds of coagulation tests you use? I've found useful paper on the issue. A table from it with coagulation parameters is attached to this post. Please have a look and tell briefly do you use the same numbers? Clin Perinatol. 201…

hi .. i have questions to ask regarding uptodate -evidence based - fluid therapy in any sick ( especialy ventilated babies ) .. what we do in our unit is to push fluid by 30 cc more everyday for stable babies (60 -90-120 in 1st 2nd 3rd day: Term baby ) and to advance by 20cc in sick ventilated babies ( 60-80-100 in 1st 2nd 3rd day:Term baby ) . ive read articls about the proved benifits of fluid restriction ( esp ventiated babies ) also (this was very interesting) ,that if you delay Na supplemantation until after baby loss wt ( physiological expected ) and then add Na , this practise associated with better outcome . in our unit : we use 10% dextrose in first…