percentage for premature infants. Environmental factors that impact the amount
of fluids needed may include ambient temperature and humidity, and specific
treatments such as phototherapy. Patient related factors include skin maturity,
birth weight, proportion of body fat, weight loss and urine output. Disease related
factors might include large open wounds (such as patients with an open
abdomen), burns, severe trauma or major surgery.
Suggested rates for initial fluid administration in neonates for each day of
life (DOL) are listed in the table below.
Birth Weight (gm) DOL 1 (ml/kg/d) DOL 2 (ml/kg/d) DOL 3 (ml/kg/d)
<700 100 120 120 - 140
700 - 2500 80 100 120
2500 60 80 100
Electrolytes are not added initialy; D10W is used for maintenance fluid on
DOL 1. On DOL 2, maintenance fluids are changed to D10W 0.2 NS with 20 mEq
KCl/L. On DOL 2 and beyond, urine output and serum sodium are the most
useful parameters to follow in determining the appropriate rate of fluid
administration. Abnormal serum sodium levels are more responsive to changes
in the rate of fluid administration rather than the amount of sodium
supplementation.
Beyond the first week of life, children are given 4 ml/kg/hour for the first 10
kg, 2 ml/kg/hour for the next 10 kilograms and 1 mL ml/kg/hour for any weight
over 20 kilograms. Added to maintenance fluid rates should be volume to