Dear friends,

I have never been able to undersatnd the fluid balance calculation in a neonate:confused:...When do we say positive balanve and when negative and what are the implications and what do we do to manage this. eg If a neonate is +/-ve 100mls but satble other wise with a urine output of >1ml/kg/hr

I would appreciate any kind of input to explain this to me in detail

thanks for your help.

Hi!

Well, I think I get the theory but know that this can be tricky IRL , therefore I look at more than just a pos/neg figure of fluid balance. Before deciding about feeding, infusions, diuretics etc-etc.

I think you already know this, the balance is (fluids in)-(fluids out). Usually we know how we feed and infuse, but the fluid losses (perspiratio, evaporation, urine, feces) can be difficult to assess as a precise number.

Of course, the balance has some impact, but I also try to assess other clinical signs (edema), the weight, ultrasound (such as contractility, venous filling in critically) etc as well.

In addition, even a positive fluid balance may not mean an increased cardiovascular load, since fluids commonly enter the extravascular/interstitial space, for example in very sick infants.

Fluid management in the NICU, a topic for a book!

Hi!

Well, I think I get the theory but know that this can be tricky IRL , therefore I look at more than just a pos/neg figure of fluid balance. Before deciding about feeding, infusions, diuretics etc-etc.

I think you already know this, the balance is (fluids in)-(fluids out). Usually we know how we feed and infuse, but the fluid losses (perspiratio, evaporation, urine, feces) can be difficult to assess as a precise number.

Of course, the balance has some impact, but I also try to assess other clinical signs (edema), the weight, ultrasound (such as contractility, venous filling in critically) etc as well.

In addition, even a positive fluid balance may not mean an increased cardiovascular load, since fluids commonly enter the extravascular/interstitial space, for example in very sick infants.

Fluid management in the NICU, a topic for a book!

You are absolutely right! Although you may think it's as easy as 1+1=2 .. unfortunately , we only see the tip of the iceberg. In other words, Urine output!

Kind regards