Objective: To determine the adequacy of fluids provided to sick
appropriate and small for gestational age preterm neonates and
compliance with prescribed fluids. Design: Prospective exploratory
study. Setting: Level III neonatal intensive care unit, KBNIMS,
Kalaburagi. Participants: Neonates between 28 to 34 weeks of gestation, on exclusive intravenous fluids at 12 hours of life were enrolled and followed up till day 7 of life. Intervention: Sick neonates 28–34 wks gestations were started on exclusive intravenous fluids. Babies < 1500 greceived fluids at 80 ml/kg/day and ≥1500 g at 60 ml/kg/day on day 1. Fluids were then increased by 20 ml/kg/d till day 5 upto a maximum of 160 ml/kg/d by day 7, provided acceptable levels of weight loss, serum sodium, urine output and urine specific gravity were achieved. Feeds were introduced when baby was hemodynamically stable. Outcome measures: Total fluids prescribed and received, weight ,serum sodium, any discrepancy in prescribed and received fluids, the frequency of PDA, NEC, IVH, jaundice and polycythemia, were assessed. Results: 100 consecutive neonates with mean birth weight of 1302 g and gestational age of 31.4 wks were studied. Thirty neonates were small for gestational age (SGA). The cumulative median weight loss was 8.6% and AGA neonates lost more weight than SGA (9.3% vs 4%, p = 0.006). There was no significant difference between the fluids prescribed and received and serum sodium levels. SGA neonates received more fluids than AGA neonates. On 85 occasions out of 609 times there was discrepancy in the fluids prescribed and received. All morbidities were similar in AGA and SGA neonates. Conclusions: Our current fluid policy resulted in appropriate fluid and electrolyte balance with no significant increase in morbidities of sick preterm neonates.
Keywords: SGA: small for gestational age; LGA: Large for
gestational age; PDA: Patent Ductus Arteriosus; NEC: Necrotising
Enterocolitis; IVH: Intra Ventricular Haemorrhage