Diet/Fluid management/Advancement

For discussion of fluid/electryloytes see Neonatology- Fluids/Lytes

Total Fluids Term baby:
- D10W
- Day of Life 0: 80 cc/kg/d
- DOL 1: 100 cc/kg/d
- DOL 2: 120 cc/kg/d (maintain at 120 cc/kg/d)
- days 2-7 in general: 80-120 cc/kg/d. increase of 10-20 cc/kg/d. Once pt tolerates fluid therapy and UOP is ok (1-2 cc/kg/h), can modify IVF. Can increase glucose 10-15% per day. Na 2-4 meq/kg/d. K 1-2, usually not necessary until day 2-3, document good UOP before starting.

Total fluids Pre-term baby
- preemies, esp<1000g require more fluids and are less tolerant of glucose
- add Calcium (calcium accretion is greatest in 4rd trimester)
- day 1-3: start higher.

- day 3-7: similar to term babies.

Feeding
- Start enteral feedings asap. TPN may begin as early as age 36 h.
- All IDM's without respiratory distress should be fed by nipple or gavage by 2 hours of age.
- Feeds are given q3h (enfamil/similac 20 kcal/oz)
- For PREEMIES: use 24 kcal formula
- if cannot tolerate feeds, start D10W IV infusion
- if IV fluids are started and pt is Preemie, IDM, or asphyxia: add 300 mg/kg Calcium Gluconate
- KCL maintenance requirement is 1-2 meq/kg/d
- If pt requires glucose bolus, give 2 cc/kg of D10W (D10 = 10 g/100cc)
- for Low BP, give NS bolus, if doesn't work, 10cc/kg of 5% albumin. (Hypotension should not usually be treated without other signs of insufficient cardiac output (e.g. poor skin perfusion, metabolic acidosis, anuria).
- If concerned about NEC, start feeds 10 cc q3h, advance slowly.