الفهرس 
Fluid and Electrolyte ManagementOnly 14 pages are availabe for public view
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Abstract
Advances in obstetrics and neonatal intensive care have resulted in a marked increase in the number of very immature and other critically ill infants who survive. Nutrition is becoming a key factor not only for the growth of these infants during their hospital stay but also for life-long well being. In addition, a few emerging concepts about conditionally essential amino acids, long chain polyunsaturated fatty acids and probiotics are likely to become important modalities in future care of these infants.
As the threshold of viability becomes younger, management of fluid and electrolyte aberrations will only become more challenging. Although preservation of blood in the baby is of outmost importance, serial laboratory evaluations remain the cornerstone of fluid and electrolyte management during the immediate newborn period. Risks are associated with dehydration as well as volume overload, with hypo- as well as hyperglycemia.
Present recommendations are designed to provide nutrients to approximate the rate of growth and composition of weight gain for a normal fetus of the same post-conceptional age and to maintain normal concentrations of blood and tissue nutrients.
Parenteral nutrition is safe and effective supportive treatment when used with adequate monitoring , not be used indiscriminately without careful consideration of indicatons as well as alternatives strategies for nutritional management. Choice of peripheral versus centeral vein delivery is best based on an individual infant’s clinical and nutritional needs rather than on the ease or difficulty of a particular technique providing.
Recent studies have demonstrated that it is appropriate to provide a more aggressive introduction of PN in order to promote positive nitrogen balance and growth. Parenteral Lipid emulsion can be infused separately or in mixed parenteral system with a.a. and glucose. Glucose infusion rate must be limited to 4 mg/Kg/min and increased daily by increments of 2 to 2.5 mg/kg/min up to 8mg/Kg/min, the initial rate of protein intake is 0.5 to 1 g/kg/d in the preterm infant weighing less than 1 kg and 1 to 2 g/kg/d for all others. Protein is advanced by 0.5 to 1 g/kg/d increments until 3 g/kg/d of protein intake is reached. Lipid emulsion should be infused in VLBW infants at a rate of 0.5-1mg/Kg/day and advanced by 0.5-1g/Kg/d increments until 3.5g/Kg/d is reached.
TPN certainly permits faster weight gain but beyond that , although it appears to be well tolerated, trials demonstrating long term benefits of parenteral nutrition are not evident to date. Continued improvements in TPN formulation, and its constituent elements, will doubtless be made, perhaps at a greater prescripton cost .
Trophic or minimal enteral feeding is safe and well tolerated at a rate dependent on gestational age , degree of illness , and other clinical factors , so minimizing the potential adverse effects of PN . Enteral nutrition in addition to total parenteral nutrition should enhance the postnatal weight loss , an earlier return to birth weight, and improved overall growth , and outcome , than TPN alone . Some units provide small enteral feeds to stable preterm infants >1200 g on day 1 and monitor them closely .
Human milk is the preferred feeding for all infants including premature and sick new borns , with rare exceptions . When direct breast feeding is not possible , a baby may still be fed breast milk , by expressing the mother’s milk . Alternative methods such as tube , cup , spoon or DROPper are required until premature and sick new borns are strong or mature enough to suck effectively .
Addition of human milk fortifiers (HMF) from birth to growing pre-term infants weighing <1500 g at birth who receive human milk until a weight of 1800-2000 g has been reached , Consider changing preterm to standard formula and stopping adding HMF to expressed breast milk when babies reach 1800 grams in weight , their use should be restricted to infants <32 weeks gestation or <1500 g birth weight who fail to gain weight desbite adequate breast milk feeding.
Standard infant formulas (usually providing 20 kcal per 30 mL) and maternal breast milk may be inadequate for premature neonates, who need a higher concentration of nutrients, premature infant formulas provide a higher calorie content (up to 24 kcal per 30 mL), and powdered or liquid fortifiers can be mixed with expressed breast milk to yield concentrations up to 23 to 24 kcal per 30 mL with an improved calcium/phosphate ratio. Dietary supplements and corn syrup solids containing glucose polymers may be added to boost specific nutrient intake, such as medium-chain triglycerides. Care should be taken with concentrated formulas to avoid high osmolar loads by limiting them to no more than 30 kcal per 30 mL
Early discharge of pre-term infants when the babies are gaining weight, height , maintaining temperature , are competent at suckling, feeding and physiologically mature, and with family and community readiness to provide the necessary support for their home care , to provide breast feeding counselling to mothers of LBW infants , and to use the HMF with mother who have difficulties in breast feeding LBW infants .