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Topics: Infant, Water, Electrolyte Pages: 10 (1724 words) Published: August 28, 2014
Best Practice & Research Clinical Anaesthesiology 24 (2010) 365e374

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Best Practice & Research Clinical
Anaesthesiology
journal homepage: www.elsevier.com/locate/bean

6

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

Keywords:
blood transfusion
colloid
crystalloids
fluid therapy
hypoglycaemia
hyperglycaemia
neonate

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: isabelle.murat@trs.aphp.fr (I. Murat).
1521-6896/$ e see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.bpa.2010.02.014

366

I. Murat et al. / Best Practice & Research Clinical Anaesthesiology 24 (2010) 365e374

Table 1
Body composition and morphometric data in children (ICF: intracellular fluid; ECF: extracellular fluid). Premature
Body weight (BW kg)
Body surface area (BSA m2)
BSA/BW
Total body water (% BW)
ECF (% BW)
ICF (% BW)

Full-term

1 yr

3 yr

9 yr

Adult

1.5
0.15
0.1
80
50
30

3
0.2
0.07
78
45
33

10
0.5
0.05
65
25
40

15
0.6
0.04
60
20
40

30
1
0.03

70
1.7
0.02

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...
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