Based on a consideration of the sources of water loss, an average parenteral fluid design for an infant receiving no oral feeding should provide about 40 mL of water per 100 cal metabolized for insensible loss and 5080 mL/100 cal for urine, with about 5 mL/100 cal for stool water, resulting in a total volume of 100125 mL/100 cal for the maintenance fluid losses under baseline conditions per 24 hours. LBW infants will require considerably more fluid because of an increasing insensible loss. Neonates weighing less than 1000 g may need 160 mL/kg per 24 hours and those over 1000 g may require 110130 mL/kg per 24 hours. With premature infants, a fluid intake170 mL/kg per 24 hours is associated with an increased risk of congestive cardiac failure, patent ductus arteriosus, and necrotizing enterocolitis.
Serial measurements of body weight are a useful guide to total body water in infants. Fluctuations over a 24-hour period are primarily related to loss or gain of fluid, 1 g body weight being approximately equal to 1 mL water. Errors will occur if changes in clothing, dressings, and tubes are not accounted for and if scales are not regularly calibrated.
The assessment of hydration status in every newborn surgical patient is essential for the infant’s outcome. This can best be obtained by changes in body weight, measurement of urine flow rate, concentration of urine, hematocrit, and total serum protein. Estimation of serum electrolytes, urea, sugar, and serum osmolarity gives a good indication of the hydration status.
REFERENCES
1. Harrison MR, Golbus MS, Filly RA. The unborn patient: prenatal diagnosis and treatment. Orlando, FL: Grune and Stratton, 1984: xxiii, 455 p.
2. Hirose S, Farmer DL. Fetal surgery for myelomeningocele.Clin Perinatol2009;36: 4318, xi.
3. Wu S, Johnson MP. Fetal lower urinary tract obstruction.Clin Perinatol2009;36: 37790, x.
4. Adzick NS. Open fetal surgery for life-threatening fetal anomalies.Semin Fetal Neonatal Med2010;15: 18.
5. Deprest JA, Devlieger R, Srisupundit Ket al.Fetal surgery is a clinical reality.Semin Fetal Neonatal Med2010;15: 5867.
6. Hirata GI, Medearis AL, Platt LD. Fetal abdominal abnormalities associated with genetic syndromes.Clin Perinatol1990; 17:
675702.
7. Alfirevic Z, Neilson JP. Antenatal screening for Down’s syndrome.BMJ2004;32: 81112.
8. Berkley EM, Goens MB, Karr S, Rappaport V. Utility of fetal echocardiography in postnatal management of infants with prenatally diagnosed congenital heart disease. Prenat Diagn 2009;29: 6548.
9. Nelle M, Pavlovic M, Carrel T et al. Prenatal diagnosis and treatment planning of congenital heart defects-possibilities and limits.World J Pediatr2009;5: 1822.
References 101
10. Raboei EH. The role of the pediatric surgeon in the perinatal multidisciplinary team.Eur J Pediatr Surg2008;18: 31317.
11. Patel P, Farley J, Impey L, Lakhoo K. Evaluation of a fetomaternal-surgical clinic for prenatal counselling of surgical anomalies.Pediatr Surg Int2008;24: 3914.
12. Wald NJ, Rodeck C Hackshaw AK, Rudnicka A. SURUSS in perspective.Semin Perinatol2005;29: 22535.
13. Lee RS, Cendron M, Kinnamon DD, Nguyen HT. Antenatal hydronephrosis as a predictor of postnatal outcome: a meta- analysis.Pediatrics2006;118: 58693.
14. Langer JC. Abdominal wall defects. World J Surg2003; 27:
11724.
15. Moir CR, Ramsey PS, Ogburn PLet al. A prospective trial of elective preterm delivery for fetal gastroschisis.Am J Perinatol 2004;21: 28994.
16. Adzick NS, Flake AW, Harrison MR. Recent advances in prenatal diagnosis and treatment. Pediatr Clin North Am 1985; 32:
110316.
17. Cook R. The low birth weight baby. In: Lister J (ed).Neonatal surgery. London: Butterworths, 1990: 7788.
18. Takayama JI, Teng W, Uyemoto J et al. Body temperature of newborns: what is normal?Clin Pediatr (Phila) 2000;39:
50310.
19. Silverman WA, Sinclair JC. Temperature regulation in the newborn infant.N Engl J Med1966;274: 1468.
20. Muraji T, Tsugawa C, Nishijima Eet al.Gastroschisis: a 17-year experience.J Pediatr Surg1989;24: 3435.
21. Laptook AR, Watkinson M. Temperature management in the delivery room.Semin Fetal Neonatal Med2008;13: 38391.
22. Hey EN. The relation between environmental temperature and oxygen consumption in the new-born baby. J Physiol 1969;
200: 589603.
23. MacDonald MG, Mullet MD, Seshia MMK (eds)Avery’s neona- tology: pathophysiology and management of the newborn, 6th edn. Philadelphia: Lippincott Williams and Wilkins, 2005: xviii, 1748 p.
24. Walker J, Cudmore RE. Respiratory problems and cystic adenomatoid malformation of lung. Arch Dis Child 1990;
65(7 Spec No): 64950.
25. Askin DF. Interpretation of neonatal blood gases, Part I:
Physiology and acid-base homeostasis.Neonatal Netw 1997;
16: 1721.
26. Kamlin CO, Dawson JA, O’Donnell CPet al.Accuracy of pulse oximetry measurement of heart rate of newborn infants in the delivery room.J Pediatr2008;152: 75660.
27. Philippart AI, Sarnaik AP, Belenky WM. Respiratory support in pediatric surgery.Surg Clin North Am1980;60: 151932.
28. Cotten M, Clark RH. The science of neonatal high-frequency ventilation.Respir Care Clin N Am2001;7: 61131.
29. Ford JW. Neonatal ECMO: Current controversies and trends.
Neonatal Netw2006;25: 22938.
30. McCabe AJ, Wilcox DT, Holm BA, Glick PL. Surfactanta review for pediatric surgeons.J Pediatr Surg2000;35: 1687700.
31. Soll RF. Inhaled nitric oxide in the neonate.J Perinatol2009;
29(Suppl. 2): S637.
32. Khan AM, Lally KP. The role of extracorporeal membrane oxygenation in the management of infants with congenital diaphragmatic hernia.Semin Perinatol2005;29: 11822.
33. Boloker J, Bateman DA, Wung JT, Stolar CJ. Congenital diaphragmatic hernia in 120 infants treated consecutively with permissive hypercapnea/spontaneous respiration/elective repair.
J Pediatr Surg2002;37: 35766.
34. Taguchi T. Current progress in neonatal surgery.Surg Today 2008;38: 37989.
35. Barrington KJ, Finer NN. Inhaled nitric oxide for preterm infants: a systematic review.Pediatrics2007;120: 108899.
36. Henderson-Smart DJ, De Paoli AG, Clark RH, Bhuta T. High frequency oscillatory ventilation versus conventional venti- lation for infants with severe pulmonary dysfunction born at or near term. Cochrane Database Syst Rev 2009; (3):
CD002974.
37. Heymann MA, Rudolph AM. Control of the ductus arteriosus.
Physiol Rev1975;55: 6278.
38. McNamara DG. Value and limitations of auscultation in the management of congenital heart disease.Pediatr Clin North Am 1990;37: 93113.
39. Askin DF. Interpretation of neonatal blood gases, Part II:
Disorders of acid-base balance. Neonatal Netw 1997; 16:
239.
40. Cowett RM, Farrag HM. Selected principles of perinatal- neonatal glucose metabolism.Semin Neonatol2004;9: 3747.
41. Ward Platt M, Deshpande S. Metabolic adaptation at birth.
Semin Fetal Neonatal Med2005;10: 34150.
42. Pierro A, Eaton S. Metabolism and nutrition in the surgical neonate.Semin Pediatr Surg2008;17: 27684.
43. Maisels MJ. Jaundice. In: MacDonald MG, Seshia MMK, Mullett MD (eds).Neonatology. Philadelphia: Lippincott Williams and Wilkins, 2005: 768847.
44. Hung PY, Chen CC, Chen WJet al. Long-term prognosis of patients with biliary atresia: a 25 year summary. J Pediatr Gastroenterol Nutr2006;42: 1905.
45. Sell LL, Cullen Ml, Whittlesey GCet al. Hemorrhagic complica- tions during extracorporeal membrane oxygenation: prevention and treatmentJ Pediatr Surg1986;21: 108791.
46. Downard CD, Jaksic T, Garza JJet al.Analysis of an improved survival rate for congenital diaphragmatic hernia.J Pediatr Surg 2003;38: 72932.
47. Anthony ML, Hardee E. Extracorporeal membrane oxygenation.
Saving tiny lives. Crit Care Nurs Clin North Am 2000; 12:
21117.
48. Gregory G. Anaesthesia for premature infants. In: Gregory GA (ed).Paediatric anaesthesia. New York: Churchill Livingston, 1983: 879.
49. Linck DA, Donze A, Hamvas A. Neonatal peripherally inserted central catheter team. Evolution and outcomes of a bedside- nurse-designed program.Adv Neonatal Care2007;7: 229.
50. Racadio JM, Doellman DA, Johnson ND et al. Pediatric peripherally inserted central catheters: complication rates related to catheter tip location.Pediatrics2001;107: E28.
51. Vegunta RK, Loethen P, Wallace LJ et al. Differences in the outcome of surgically placed long-term central venous cathe- ters in neonates: neck vs groin placement.J Pediatr Surg2005;
40: 4751.
52. Foo R, Fujii A, Harris JAet al.Complications in tunneled CVL versus PICC lines in very low birth weight infants.J Perinatol 2001;21: 52530.
53. Klein MD, Rood K, Graham P. Central venous catheter sepsis in surgical newborns.Pediatr Surg Int2003;19: 52932.
54. Wardle SP, Kelsall AW, Yoxall CW, Subhedar NV. Percutaneous femoral arterial and venous catheterisation during neonatal intensive care. Arch Dis Child Fetal Neonatal Ed 2001;85:
F11922.
55. Bhatia J. Fluid and electrolyte management in the very low birth weight neonate.J Perinatol2006;26(Suppl. 1): S1921.
102 Preoperative assessment
56. Friis-Hansen B. Water distribution in the foetus and newborn infant.Acta Paediatr Scand Suppl1983;305: 711.
57. Meio MD, Sichieri R, Soares FV, Moreira ME. Total body water in small- and appropriate- for gestational age newborns.J Perinat Med2008;36: 3548.
58. Statter MB. Fluids and electrolytes in infants and children.
Semin Pediatr Surg1992;1: 20811.
59. Roy RN, Sinclair JC. Hydration of the low birth-weight infant.
Clin Perinatol1975;2: 393417.
60. Engle WD, Baumgart S, Schwartz JGet al.Insensible water loss in the critically ill neonate. Combined effect of radiant-warmer power and phototherapy.Am J Dis Child1981;135: 51620.
61. Bell EF, Gray JC, Weinstein MR, Oh W. The effects of thermal environment on heat balance and insensible water loss in low- birth-weight infants.J Pediatr1980;96(3 Pt 1): 4529.
62. Fanaroff AA, Wald M, Gruber HS, Klaus MH. Insensible water loss in low birth weight infants.Pediatrics1972;50: 23645.
63. Hammarlund K, Sedin G, Stromberg B. Transepidermal water loss in newborn infants. VIII. Relation to gestational age and
post-natal age in appropriate and small for gestational age infants.Acta Paediatr Scand1983;72: 7218.
64. Bhandari V, Brodsky N, Porat R. Improved outcome of extremely low birth weight infants with Tegaderm application to skin.
J Perinatol2005;25: 27681.
65. Shaffer SE, Norman ME. Renal function and renal failure in the newborn.Clin Perinatol1989;16: 199218.
66. Rodriguez-Soriano J, Aguirre M, Oliveros R, Vallo A. Long-term renal follow-up of extremely low birth weight infants.Pediatr Nephrol2005;20: 57984.
67. Wilkinson AW, Stevens LH, Hughes EA. Metabolic changes in the newborn.Lancet1962;1: 9837.
68. Winters RW. The body fluids in pediatrics: medical, surgical, and neonatal disorders of acid-base status, hydration, and oxygenation, 1st edn. Boston: Little, 1973: xx, 715 p.
69. Bailey AG, McNaull PP, Jooste E, Tuchman JB.Perioperative crystalloid and colloid fluid management in children: where are we and how did we get here?.Anesth Analg2010;110:
37590.
References 103