Please note that some guidelines may be passed their review date. The review process is currently paused. It is recommended that you also refer to more contemporaneous evidence.
Intravenous (IV) infusions may be required for infants who cannot commence enteral feeds.
These recommendations for IV infusions are to guide the care of infants admitted to a special care nursery (SCN) who cannot commence enteral feeds shortly after birth.
These guidelines are not for use in a neonatal intensive care unit (NICU). Such infants will usually have problems of mild/moderate RDS and/or prematurity (> 30 weeks' gestation).
Infants awaiting transfer to a higher dependency unit or with specialised problems (such as bowel obstruction with vomiting) should have fluid management as indicated for their specific condition or as discussed with an appropriate specialist.
The goal of treatment is to maintain hydration and avoid biochemical disturbances, particularly hypoglycaemia and hyponatraemia.
Fluid infused
Fluid volume | Fluid infused | ||
|---|---|---|---|
| ml/hr | ml/kg/d | ||
| 0-24 hrs | Bwt x 2.5 | 60 | 10% dextrose |
| 25-48 hrs | Bwt x 2.5 | 60 | 10% dextrose |
| 49-72 hrs | Bwt x 3 | 72 | 10% dextrose + NaCl + KCl* |
| > 72 hrs | Bwt x 4 | 96 | 10% dextrose + NaCl + KCl* |
* Ordered as 10 per cent dextrose 500 mL and 6.5 mL 20 per cent NaCl and 10 mL 7.5 per cent KCl (giving 22 mmol NaCl and 10 mmol KCl per 500 mL)
Investigations
| 0-24 hrs | Check BSL: If < 2.6 mmol/l refer to management of hypoglycaemia |
|---|---|
| 25-48 hrs | Monitor serum Na+, K+ |
| 49-72 hrs | Check urine output adequate (> 1 mL/kg/hr) before adding electrolytes |
| 73-96 hrs | Check Na+, K+ if still nil by mouth |
| > 96 hrs | Consider transfer to a level 3 centre for parenteral nutrition (TPN) if still nil by mouth |
Introducing enteral feeding
Consider change in clinical condition, for example, resolution of respiratory distress, conscious state.
For term infants
When introducing enteral feeds for term infants:
- Halve IV infusion rate. Offer sucking feeds on demand or at least four-hourly. After two or three sucked feeds IV access may be bunged off and feeding performance assessed. If intravenous access is not required as a route for medications the cannula should be removed as soon as possible. While the bunged off line is in place flush short extension tubing every six hours with 0.5 mL 0.9 per cent sodium chloride (ordered on the infants medication sheet). Check at least six-hourly for signs of phlebitis/extravasation and integrity of cannula and extension set.
For infants less than 36 weeks' gestation
For infants < 36 weeks' gestation:
- Start at 30 mL/kg/d; reduce IV infusion rate to maintain desired total infusion.
- Increase enteral intake by 30-40 mL/kg/d. IV infusion can usually cease when > 90 mL/kg/d enteral intake achieved. Thereafter enteral intake is gradually increased to 150 mL/kg/d total.
Inputs (while nil by mouth)
|
|
Volume |
Glucose |
Na |
K |
Energy |
|
|---|---|---|---|---|---|---|
| mL/kg/d | mg/kg/min | mmol/kg/d | mmol/kg/d | KJ/kg/d | KCal/kg/d | |
| 0-24 hrs | 60 | 4 | - | - | 100 | 24 |
| 25-48 hrs | 60 | 4 | - | - | 100 | 24 |
| 49-72 hrs | 72 | 5 | 3 | 1.5 | 125 | 30 |
| > 72 hrs | 96 | 6.6 | 4 | 2 | 160 | 38 |
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Version history
First published: May 2015
Review by: May 2018