RISK FOR NEONATAL FLUID IMBALANCES

GROUP II
Name Reg No
JOKINDU RONALD 2023/MNS/019/PS
KAUDHA MARTHA MILLIAN 2023/MNS/022/PS
TWONGINGYEIRWE DOREEN KAGINA 2023/MNS/028/PS
NAMULEMA ANGELLA 2023/MNS/029/PS
SASIRABO OLIVIA 2023/MNS/030/PS
UWIHOREYE JOSEPH 2023/MNS/028/PS

Supervisor
Dr. Migisha Richard
 Assignment
• The neonate is at special risk of developing fluid
imbalances.
• Discuss
 Newborn fluid composition
At birth (full term)
75% of newborn weight is fluid
Extracellular 40%
Intracellular 35%
Preterm
Bwt; 80-85% water
Split in ratio of 2:1 intracellular and extracellular
Urine output within 24-48hrs limited to 0.5ml/kg/hr due to
poor renal perfusion. This resolves with improved cardiac
activity
 Risks for neonatal fluid imbalances
Renal Immaturity: glomeruli & nephrons are immature t birth
resulting in a reduced GFR & limited concentration ability (due to
lack of renal medulla osmotic gradient and absence of medullary
tubules).

Limited fluid reserves; Neonates have limited fluid reserves

compared to older children and adults. This means that even
small losses of fluids can lead to significant imbalances
Risks for neonatal fluid imbalances

• Insufficient antidiuretic hormone generation from the

posterior pituitary gland
• Birth injuries as in instrumental deliveries
• Poorly developed posterior pituitary gland

• Aldosterone resistance: Partial hormonal resistance to

aldosterone is notable in some neonates which affects the
body fluid volume/balance.
• Aldosterone is responsible for Na and H20 homeostasis.
Therefore the partial unresponsiveness in neonates results into
Na waste.
Risks for neonatal fluid imbalances
• Increased Insensible Water Loss: Neonates
have a relatively larger body surface area in
proportion to their weight.

• Poorly developed skin

• Respiratory losses
Risks for neonatal fluid imbalances
• Increased metabolic activity; depletion of water in
the process.

• Heart: Up to six months of age, the neonate’s

immature myocardium can result in a decreased
ability to respond to hemodynamic changes.
Risks for neonatal fluid imbalances
• Maternal history (placental dysfunction, diabetes
mellitus, oligohydroamnios)

• Others: newborn health status (such as

congenital anomalies)
 References
• Raina, R., Sethi, S.K., Wadhwani, N., Vemuganti, M., Krishnappa, V. and Bansal, S.B.,
2018. Fluid overload in critically ill children. Frontiers in Pediatrics, 6, p.306.
• Fusch, C. and Jochum, F., 2014. Water, sodium, potassium and chloride. Nutritional Care
of Preterm Infants, 110, pp.99-120.
• Andreoli, S.P., 2004, April. Acute renal failure in the newborn. In Seminars in perinatology
(Vol. 28, No. 2, pp. 112-123). WB Saunders.
• Nemerofsky, S.L. and Campbell, D.E., 18 Special Situations in the NICU. Fluid and
Electrolytes in Pediatrics, p.369.
• Selewski, D.T., Akcan-Arikan, A., Bonachea, E.M., Gist, K.M., Goldstein, S.L., Hanna, M.,
Joseph, C., Mahan, J.D., Nada, A., Nathan, A.T. and Reidy, K., 2019. The impact of fluid
balance on outcomes in critically ill near-term/term neonates: a report from the AWAKEN
study group. Pediatric research, 85(1), pp.79-85.
• Segar, J.L., Chock, V.Y., Harer, M.W., Selewski, D.T., Askenazi, D.J., Guidelines, N.B.S.
and Publications Committee, 2021, August. Fluid management, electrolytes imbalance
and renal management in neonates with neonatal encephalopathy treated with
hypothermia. In Seminars in Fetal and Neonatal Medicine (Vol. 26, No. 4, p. 101261). WB