Water, Sodium, Potassium and Chloride
The sudden disruption of excessive placental supply with fluids and electrolytes is challenging for neonatal physiology during the period of postnatal adaptation. Different from many other nutrients, the body experiences large changes in daily requirements during the first 7-14 postnatal days, and on the other hand does not tolerate conditions of excess and deficiency very well. Imbalances of fluid and electrolytes are common in neonates, which - in addition - might be further aggravated by NICU treatment procedures. Therefore, fluid and electrolyte management can be one of the most challenging aspects of neonatal care of the premature infant. An understanding of the physiological adaptation process to extrauterine life - and how immaturity effects that transition - is the basis which is needed to understand and manage fluid and electrolyte balance in premature infants. This chapter addresses the physiology of postnatal adaptation and other aspects of fluid and electrolyte management (concerning potassium, sodium and chloride) of the preterm infant. © 2014 S. Karger AG, Basel.
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ABSTRACT: AimWhen a new high amino acid parenteral nutrition (PN) solution was introduced to our hospital, a design error led to decreased phosphate levels. This prompted us to examine the effect of three different PN solutions on plasma phosphate, plasma calcium and weight increases on extremely preterm infants.Method This was a retrospective study of 186 infants with a gestational age of less than 28 weeks during their first month of life. They were divided into three groups based on the PN they received during hospitalisation. Group one received high levels of phosphate and low levels of amino acids. Group two received low levels of phosphate and high levels of amino acids. Group three received high levels of both phosphate and amino acids.ResultsThe lowest plasma phosphate values varied significantly between groups one (1.80 ± 0.46 mmol/L), two (1.05 ± 0.48 mmol/L) and three (1.40 ± 0.37 mmol/L) (p < 0.001), but no significant difference in weight increase was seen (p = 0.497).Conclusion The phosphate content of the PN influenced plasma phosphate and plasma calcium levels, but increasing the levels of both phosphate and amino acids did not improve weight gain during the first month of life.This article is protected by copyright. All rights reserved.
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ABSTRACT: The "Evaluation of the Evidence to Support Practice Guidelines for the Nutritional Care of Preterm Infants: The Pre-B Project" is the first phase in a process to present the current state of knowledge and to support the development of evidence-informed guidance for the nutritional care of preterm and high-risk newborn infants. The ultimate systematic reviews that will provide the underpinning for guideline development will be conducted by the Academy of Nutrition and Dietetics' Evidence Analysis Library (EAL). To accomplish the objectives of this first phase, the Pre-B Project organizers established 4 working groups (WGs) to address the following themes: 1) nutrient specifications for preterm infants, 2) clinical and practical issues in enteral feeding of preterm infants, 3) gastrointestinal and surgical issues, and 4) current standards of infant feeding. Each WG was asked to 1) develop a series of topics relevant to their respective themes, 2) identify questions for which there is sufficient evidence to support a systematic review process conducted by the EAL, and 3) develop a research agenda to address priority gaps in our understanding of the role of nutrition in health and development of preterm/neonatal intensive care unit infants. This article is a summary of the reports from the 4 Pre-B WGs.
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