Best Practice & Research Clinical Anaesthesiology 24 (2010) 365e374
Contents lists available at ScienceDirect
Best Practice & Research Clinical
journal homepage: www.elsevier.com/locate/bean
Neonatal ﬂuid management
Isabelle Murat, MD, PhD *, Alexis Humblot, MD, Laure Girault, MD, Federica Piana, MD
Department of Anesthesia, Hôpital d’Enfants Armand Trousseau, 26 avenue du Dr Arnold Netter, 75571 Paris, Cedex 12, France
Perioperative ﬂuid management in paediatrics has been the subject of many controversies in recent years, but ﬂuid management in the neonatal period has not been considered in most reviews and
guidelines.1e3 The literature regarding neonatal ﬂuid management mainly appears in the paediatric textbooks and few recent data are available, except for resuscitation and ﬂuid loading during shock and major surgery. In the context of anaesthesia, many neonates requiring surgery within the ﬁrst month of life have organ malformation and/or dysfunction. This article aims at reviewing basic physiological considerations important for neonatal ﬂuid management and mainly focusses on ﬂuid maintenance and replacement during surgery.
Ó 2010 Elsevier Ltd. All rights reserved.
Physiological considerations: neonates are not just small adults Major physiological changes occur within the ﬁrst days and months of life. They mainly concern body composition, renal function and changes in the cardiovascular system.4 Body composition
Throughout foetal life and during the ﬁrst 2 years of life the distribution of body ﬂuid undergoes a gradual but signiﬁcant change.5 Total body water (TBW) represents as much as 80% of body weight in premature infants, 78% in full-term newborns and 65% in infants of 12 months of age compared to 60% in adults (Table 1). These age-related changes in TBW mainly reﬂect changes in extracellular ﬂuid (ECF) with growth. As the body cells proliferate and organ development progresses, the ECF volume
* Corresponding author. Tel.: þ33 144736299; Fax: þ33 144736244. E-mail address: firstname.lastname@example.org (I. Murat).
1521-6896/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.bpa.2010.02.014
I. Murat et al. / Best Practice & Research Clinical Anaesthesiology 24 (2010) 365e374
Body composition and morphometric data in children (ICF: intracellular ﬂuid; ECF: extracellular ﬂuid). Premature
Body weight (BW kg)
Body surface area (BSA m2)
Total body water (% BW)
ECF (% BW)
ICF (% BW)
decreases proportionally. It represents 50% of body weight in premature infants, 45% in full-term newborns and 25% in infants of 12 months of age compared to 20% in adults. The intracellular ﬂuid compartment increases only moderately during the ﬁrst year of life, representing 33% of body weight at birth and 40% of body weight by the end of the ﬁrst year, and does not change substantially after that. Renal maturation
Maturation of renal function is basically achieved by the end of the ﬁrst month of life. Glomerular ﬁltration increases rapidly from 34 weeks gestational age when kidneys have completed their nephronic structure.6e8 After birth, renal vascular resistances decrease abruptly while systemic vascular resistances and arterial pressure increase. As a consequence, renal blood ﬂow increases dramatically. This explains why glomerular ﬁltration rate, still low during the ﬁrst 24 h of life, rises very rapidly thereafter. During the ﬁrst 6 weeks after birth, the area of cortical and juxtaglomerular nephrons, as well as the volume of glomerular capillaries and the size of glomerular membrane pores also increase. Tubular function is less...
Please join StudyMode to read the full document