Fluid Calculation in Newborn

Fluid
calculation
in
newborn Prepared by- Anshika
M.Sc Nursing 1st year
Objectives
 Introduce fluid calculation in
newborn
 Indications of IV fluid therapy
 Choice of fluids electrolyte.
 Administration of IV fluids
 Monitoring of babies receiving IV
fluid.
 Adjusting IV Fluid with enteral
feeding
 Summary
 Conclusion
Introduction
 Maintenance of fluid and
electrolyte balance is an integral
aspect of neonatal care.
 Breast milk is sufficient to
maintain fluid balance in most
clinically stable newborns in
SNCU who can be fed orally.
 However, sick newborns require
intravenous fluids and
electrolytes for sustenance
Indications of IV fluid therapy
 Any sick baby not
tolerating enteral feeds
 Shock
 Severe perinatal
asphyxia
 Abdominal distension
(suspected congenital
GI anomalies,
Necrotising
enterocolitis)
Choice of fluids Electrolyte
 10% dextrose is used in the
first 48 hours of life.
 Sodium supplementation is
not required in the first 48
hours unless intravascular
expansion is necessary as in
shock.
 After 48 hours if the baby is
passing urine 6-8 times a day,
use commercially available
IV fluid such as Isolyte P.
Administration of IV fluid
1. In micro drip infusion set, e.g.
Pedia Drip Set.
Note: One ml is equal to 60

micro drops.
In this device, number of drops
per minute is equal to ml of fluid
per hour e.g. if a baby needs
6ml/hr provide 6 micro
drops/minute. Adjust drop rate
carefully and check it
periodically to ensure delivery
of correct amount of fluid.
2. Syringe pump is a more
reliable way to deliver small
volume of fluids and
medications in sick babies.
 In this device a pressure
monitoring line (PMO) is

connected to a syringe
containing fluid which is then
connected to the IV cannula.
 Fill PMO line with infusate
to ensure rapid delivery of

medication to the baby.
ROLE OF NURSES
1. Use aseptic precautions including sterile gloves while filling
syringe pump or micro-drip set with fluid or giving IV medications.
2. Calculate fluid requirement for 24 hours. The burette of micro-drip

set should contain fluid for no more than 8 hours and should be
refilled in every nursing shift.
3. Maintain strict input/output chart and review it every 8 hours.

Include the volume of medications and IV flushes in the total fluid
calculations.
4. Secure the IV cannula properly with a skin friendly adhesive tape.

CONTD…..
5. Before infusing IV fluid, check:
 The expiry date of the fluid
 The seal of the infusion bottle or bag for its intactness

That the fluid is clear and free from any visible particle
6. Change syringe, PMO line and micro-drip infusion set and fluid
bag every 24 hours to avoid contamination and nosocomial
infection; discard any unused fluid.
Volume of IV fluids to be given
Monitoring of babies receiving IV
fluids
 Inspect the infusion site every hour.
 Check the volume of fluid infused

and compare to the prescribed
volume, record all findings every 2
hrs in the fluid monitoring chart.
 Measure blood glucose every nursing

shift i.e. 8 hourly.
 Weight - Weigh the baby daily,

preferably using electronic weighing
scale in the morning.
CONTD…
 Urine output - Urine output can be roughly estimated by
counting the frequency of passage of urine, or more
accurately by weighing wet nappies on electronic
weighing scale or using urobag.
Oliguria is defined as urine output <1ml/kg/hr over a 6

hour period beyond 48 hours of age.
 Gastric aspirate is replaced by half normal saline and

bilious aspirate by Ringer lactate/NS on volume basis
every 8 hours.
QUESTION
 Date: 10/6/24
 Name: Baby of M
 ID No.-123456789
 Weight- 1510 gms
 Day of Life- 4
 Total Fluid requirement-
 Total Volume-
 IV fluid as __________.
 Fluid rate- __________.
Adjusting IV Fluid with enteral feeding
Initiation of oral feeding:

 As soon as the baby's clinical condition improves, begin
breastfeeding provided there is no abdominal distension.

 If the baby cannot be breastfed, give expressed breast milk using
cup feeding or tube feeding.

 If the baby is tolerating cup or tube feeds, increase the volume of
feeds by 20- 40ml/kg/day (lower range for VLBW), while

decreasing the volume of IV fluid to maintain the total daily fluid
volume according to the baby's daily requirement.
 Discontinue the infusion of IV fluid when the baby is receiving 100
ml/kg/day or about two- thirds of the daily fluid volume as oral

feeds and has no abdominal distension or vomiting
Summary
 Fluid calculation in
newborn is essential
for maintaining
hydration and
electrolyte balance.
 It is typically based on
newborn’s weight,
age, and clinical
condition.
Conclusion
Fluid balance can alter
with disease and illness so
it is important to be aware
of how much fluid is in the
body, taking steps such as
measuring urea and
electrolyte level and how
to balance fluid in the
body.
RECAPTUALIZATION
 Baby's respiratory
distress settled on day
3 and he was started on
minimal feeds. Today
on day 4 he is on 5 ml
2 hourly feeds of EBM.
How will you adjust
the IV fluid?

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Fluid

Note: One ml is equal to 60

monitoring line (PMO) is

to ensure rapid delivery of

2. Calculate fluid requirement for 24 hours. The burette of micro-drip

3. Maintain strict input/output chart and review it every 8 hours.

4. Secure the IV cannula properly with a skin friendly adhesive tape.

 The seal of the infusion bottle or bag for its intactness

 Check the volume of fluid infused

 Measure blood glucose every nursing

 Weight - Weigh the baby daily,

Oliguria is defined as urine output <1ml/kg/hr over a 6

 Gastric aspirate is replaced by half normal saline and

Initiation of oral feeding:

breastfeeding provided there is no abdominal distension.

cup feeding or tube feeding.

feeds by 20- 40ml/kg/day (lower range for VLBW), while

ml/kg/day or about two- thirds of the daily fluid volume as oral

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