Developed by Newborn Services for use in the Neonatal Intensive Care Unit. Click here to open the Glucose calculator to determine glucose intake. Do not add electrolytes on Day 1. Do not add Ca++ routinely in relatively well infants only likely to be on short term IV fluids. (This is most babies as the sicker, longer term babies will be on IVN Example of a IV fluid calculation. These are the two methods for calculating pediatric maintenance fluid rates, applied in the case of a child weighing 26 kg. 1) Daily volume formula: (100 mL for each of the first 10 kg) + (50 mL for each kg between 11 and 20) + (20 mL for each additional kg past 20 kg) = 1,000 mL + 500 mL + 120 mL = 1,620 mL
For children 11-20 kg the daily fluid requirement is 1000 mL + 50 mL/kg for every kg over 10. For children >20 kg the daily fluid requirement is 1500 mL + 20 mL/kg for every kg over 20, up to a maximum of 2400 mL daily. Please note that this calculation does not apply to newborn infants (ie, from 0 to 28 days after full term delivery). Holliday. Malcolm Holliday, MD, (d. 2014) was a pediatric nephrologist and physiologist. Dr. Holliday's original work studying inherited tubular disorders and congenital renal defects eventually led him to become professor of pediatrics and chief of the Division of Pediatric Nephrology at University of California San Francisco, a position he held for over two and a half decades of his 60 year career If a neonate weighs less than birth weight, utilise birth weight in all fluid calculations, unless specified by the medical team. 500 mL fluids bags should be used within the neonatal population - both term and preterm. Intravenous Fluids +/- additives should be changed every 24 hours including patient stock bags Usage instructions. Start by entering the date of birth, gestation and weight in the form above. Calculations should update as the weight is entered. This application is intended for use primarily by the Paediatric Infant and Perinatal Emergency Retrieval Service clinicians. Detailed usage instructions, including instructions on creating a.
Careful fluid and electrolyte management is essential for the well being of the sick neonate. Inadequate administration of fluids can result in hypovolemia, hypersomolarity, metabolic abnormalities and renal failure. In the near term and term neonate excess fluid administration results in generalized edema and abnormalities of pulmonary function Fluids 1/2NS +/- Hep NS +/- Hep D5 D6 D7 D7.5 D8 D9 D10 D10 + lytes D15 D20 D5 1/4NS D5 1/2NS mL 1/2NS +/- Hep NS +/- Hep D5 D6 D7 D7.5 D8 D9 D10 D10 + lytes D15 D20 D5 1/4NS D5 1/2NS m
Medical professional use many calculations every day to keep babies healthy and strong in the neonatal intensive care unit ().You don't need to know how to do this math when your baby is in the NICU—the doctors and nurses will manage these calculations for your baby—but many parents like to know anyway. If you want to give it a try, grab your calculator and start crunching some numbers In neonates and infants who are not feeding and require intravenous fluids, hypoglycaemia should be avoid by maintaining a GIR of 4-6 mg/kg/min. Low glucose levels in neonates can result in neurological disorders. The management of neonatal hypoglycaemia depends upon the gestational age of the baby and the general health after delivery. The total maintenance fluid calculation is the same as for the intravenous requirement, you just divide it by 8 instead of 24 as you calculate to give a cup feed every 3 hours. Here I have written out some examples of how IV fluids are calculated according to the body weight and age of the baby
Review Calculations, including • IV drip rate • mL/hr IV rate • Number of milliliters to obtain ordered dose • Fluid calculations • Dosage and fluid 24-hour calculations Review laboratory tests used to monitor medication therapy, including • Hematocrit • Peaks and troughs • Serum bilirubi The maintenance fluids calculator (MIVF calculator) uses the Holliday-Segar method and the 4-2-1 rule to determine the daily and hourly need for fluids in children.As well as finding out these pediatric maintenance fluids, you can also work out the proper size of the pediatric fluid bolus to be given in times of need 1.2.1 Use body weight to calculate IV fluid and electrolyte needs for term neonates, children and young people. 1.2.2 Consider using body surface area to calculate IV fluid and electrolyte needs if accurate calculation of insensible losses is important (for example, if the weight is above the 91st centile, or with acute kidney injury, known.
Intravenous fluid prescribing for an infant should be based on the water requirement (ie 100 mL/kg/day up to 10kg and then adjust as clinically indicated (eg restrict to 2/3 maintenance) Fluid Restriction. 2/3 maintenance rates should be used in most unwell children unless they are dehydrated With Newborn Fluid Therapy, the health professional can easily calculate the venoclisis to young children with no mistakes, with an easy tutorial for better learning. It also provides the information on glucose grams, Infusion rate (in ml/h, drips/min or microdrips/min), glucose and potassium concentrations, to make your prescription safer
Management of neonatal fluid and electrolyte therapy is challenging, as several factors (eg, gestational age, physiological changes in kidney function, and total body water changes) and the clinical setting need to be accounted for while caring for neonates, especially preterm infants. Fluid and electrolyte therapy in newborns, including the. These two IV solutions are also the primary IV solutions of choice to provide for hourly maintenance fluid requirements in neonates and very young infants (< 4-6 months). Hourly Fluid Requirements calculated based on the 4-2-1 Rule provide the minimum 5mg/kg/min of glucose needed by the infant brain The volume of fluid that we want is that fraction multiplied by the ratio of sodium that we have divided by the sodium that we want, as shown below. Free water deficit = 165 X (0.6)(15) - (0.6)(15) = 0.9 liters. 150 To calculate the fluid requirements of this patient, one has to again give this child maintenance
Calculations in mcg/minute. Follow these four steps to easily calculate your patient's accurate drug dosage. Find out what's in your I.V. bottle (drug concentration or number of mL of fluid). Determine in which units your drug is measured (units/hour, mg/hour, or mcg/kg/minute). Know the patient's weight in kg if your calculation is weight based Most non-surgical neonates on IV fluids therefore receive a graduated regimen of IVF. Typically, the expected fluid needs are: Thereafter 100-150 ml/kg/day. Summary of neonatal fluid management: 2. establish source of fluid losses to determine electrolyte needs. 3. fluid boluses are frequently necessary, but beware of inducing shunting Calculate the initial IV fluids that should be administered. Then calculate the total fluid requirement for replacement over the following 24-hour period. Resuscitation fluids. Bolus = 20 mL/kg x 15 kg = 300 mL over <10 minutes. 24-hour fluid requirement. Fluid deficit = 10% x 15kg x 10 = 1500 mL Maintenance intravenous fluids (IVFs) are used to provide critical supportive care for children who are acutely ill. IVFs are required if sufficient fluids cannot be provided by using enteral administration for reasons such as gastrointestinal illness, respiratory compromise, neurologic impairment, a perioperative state, or being moribund from an acute or chronic illness . 1. Calculate Fluid Deficit Fluid deficit = 5 (%dehydration) X 10 (weight in kg) X 10 = 500mL. If choosing to replace the deficit over 24 hours, this equates to 20mL/hr (rounding for ease of measuring
For fluids in diabetic ketoacidosis: DKA Fluid Calculator Special Any decision to stop IV therapy, (e.g. when transferring a patient to a ward area or undergoing a procedure such as X-ray etc) must be authorised by a Senior Nurse or Doctor IV Fluid Therapy Calculations • Once the overall fluid rate per hour has been calculated, taking into consideration maintenance, deficit and on-going loss, this information can be entered into an infusion pump if this is available. If not a drip rate needs to be calculated in mL/minute: • e.g. A dog needs 116mL/hour • 116mL/hour/60 = 1. North West Neonatal Operational Delivery Network Dobutamine for intravenous infusion (Smart pump enabled) Drug Dosage & Route of Administration Route Dosage Frequency (times daily) IV Infusion Initially 5microgram/kg/minute then adjust according to response. Dose range: 1-20microgram/kg/minute Continuous Infusion Use of Dobutamin
The fluid type that is usually used for maintenance is 500ml. 0.9% saline + 5% dextrose with 10mmol KCl (all in the same bag) - there are different concentrations of potassium available if required . Maintenance fluids in neonates . Fluid requirements . Day 1: 60ml/kg/day . Day 2: 90ml/kg/day . Day 3: 120ml/kg/day . Day 4 and after: 150ml/kg/ . Ordered: D5 0.33% NaCl IV at 65 mL / h with erythromycin 500 mg IV q6h to be infused over 40 min. You will use a volume control set and flush with 15 mL Treatment of neonatal hyponatremia is with 5% D/0.45% to 0.9% saline solution IV in volumes equal to the calculated deficit, given over as many days as it takes to correct the sodium concentration by no more than 10 to 12 mEq/L/day (10 to 12 mmol/L/day) to avoid rapid fluid shifts in the brain Newborn Fluid Therapy. Fluid therapy is the procedure in wich intravenous or oral fluid is given to patients (of all ages) When dehydrated, or in all kinds of clinical situations when it's necessary to offer the patient fluid, glucose or electrolytes. In order to calculate the maintenance fluid for a newborn, one needs to know the fluid. For most neonates, routine IV supplementation is not warranted. However, for neonates with severe hyperbilirubinemia, IV fluid administration may be useful and is recommended. Use of IVIG may be useful in Rh or ABO disease. Restrict use to select neonates in the NICU with high bilirubin values or rapid rate of rise (at high risk for exchang
MONITORING OF FLUID AND ELECTROLYTE STATUS • Body weight: Serial weight measurements can be used as a guide to estimate the fluid deficit in newborns. Term neonates loose 1-3% of their birth weight daily with a cumulative loss of 5- 10% in the first week of life. Preterm neonates loose 2-3% of their birth weight daily with a cumulative loss. Fluids for Sepsis Guidance from the Surviving Sepsis Campaign 2016 • The recommendation, for the initial fluid resuscitation from sepsis-induced hypoperfusion, is to infuse at least 30 mL/kg of intravenous crystalloid fluid within the first three hours. • Fluids should be administered for hypotension, lactate ≥ 4 mmol/L or septic shock The tool below is intended for the use of clinicians trained and experienced in the care of newborn infants. Using this tool, the risk of early-onset sepsis can be calculated in an infant born > 34 weeks gestation. The interactive calculator produces the probability of early onset sepsis per 1000 babies by entering values for the specified. Neonatal Hypernatremia. Hypernatremia is a serum sodium concentration > 150 mEq/L ( > 150 mmol/L), usually caused by dehydration. Signs include lethargy and seizures. Treatment is cautious hydration with IV saline solution. ( Hypernatremia in adults is discussed elsewhere.
Fluid deficits can be calculated by using the following formulas 5 (1 lb of water = 454 mL; 1 kg of water = 1000 mL): Percentage dehydration × body weight (lb) × 454 × 0.80 g. or. Percentage dehydration × body weight (kg) × 1000 × 0.80 g. The fluid deficit is multiplied by 0.80 because we want to give 75% to 80% of a patient's total. Neonatal Nurse Educator S.T.A.B.L.E. Lead Instructor Eastern Maine Medical Center Bangor, Maine Theresa S. Davis, APRN-BC, MSN, PNP Neonatal Outreach Coordinator The Medical Center of Central Georgia Macon, Georgia Marion E. DeLand, BScN, RNC Neonatal Nurse Educator Women's College Campus of Sunnybrook & Women's College Health Sciences Centr A presentation on Fluid & Electrolyte in Newborn for post graduates. Recorded from one of PG Teaching lectures.#Fluids #Electrolytes #Newbor
Formula to calculate a child's 24-hour fluid maintenance requirement 100 ml/kg for first 10 kg of body weight 50 ml/kg for second 10 kg of body weight 20 ml/kg for each additional kg of body weight 10. A 7 month-old infant who weighs 11 kg is to receive intravenous fluids at 2/3 the maintenance rate. What should be th Fluid and electrolyte balance in the pediatric patient. Journal of Intravenous Nursing, 21(3), 153-159. (still current) Hay WW Jr (2005) Intravenous nutrition of the very preterm neonate. Acta Paediatr Suppl. 94(449):47-56. (still current) Hartnoll, G. (2003). Basic principles and practical steps in the management of fluid balance in the newborn One of the primary objectives of maintenance parenteral fluid therapy is to provide water to meet physiologic losses (insensible loss + urine loss). In a study published in 1957, in the Journal Pediatrics, Malcolm Holliday and William Segar developed a simple scheme which could be easily remembered to calculate the maintenance water needs in. Maintenance Fluids. Maintenance fluids are given to compensate for ongoing losses and are required for all patients. 6 Maintenance fluids are frequently given through an intravenous line, but can also be given orally if the patient is able to tolerate oral therapy. Sensible losses, which include urine output and fecal water, make up the majority of ongoing losses, with additional contributions. Appropriate maintenance intravenous fluids are administered. In neonates with sclerema, exchange transfusion with fresh whole blood may be contemplated. There is no role of intravenous immunoglobulin therapy in neonatal sepsis. TABLE -II: Supportive care of a septic neonate 1. Provide warmth, ensure consistently normal temperature 2
For instance, a 1 kg infant, who receives 100 mL of fluid, passing 60 mL of urine and losing 20 g weight over a 24-hour period, would have an IWL of 60 mL/kg/24 hour. Using the data collected, and the formula above, one can calculate IWL for an infant on a daily basis that can be used to calculate the daily fluid requirement (d) Based on desired fluid intake and desired GIR, the concentration of dextrose in the IV infusate can be decided. (e) Example (i) Let the neonate's fluid intake be 80 mL/kg/day (ii) This is 80/1440 = 0.055 mL/kg/min (iii) If 10% dextrose is given, then the GIR is : 0.055 x 100 = 5.5 mg/kg/mi neonate Often contains • Dextrose and Amino acids oUsually Dextrose 5-10% + Amino acids ~3-4% When consider initial fluids for neonate, gives between 2-3 g/kg/day of amino acids Can also contain • Heparin, calcium, multi -vitamins 1
4. Administer IV over a minimum of 15 minutes to avoid the possibility of seizures. Standard NICU administration time is 30 minutes. Special Considerations and Calculations 1. NOT to be mixed with any other drug 2. Adjust dose as indicated for renal dysfunction 3. Peak: 30-60 min.; half-life: 2-4 hrs. 4 Neonatology Guidelines The Neonatology Guidelines for NICU KEMH and NICU PCH are now on the Child and Adolescent Health Service website and be accessed by clicking the link below New NICU TPN Starter Protocol (Indicated on Day of life 1 for neonates < or = 1500 grams) • TPN Starter Protocol consists of three orders that are co-infused. 1. TPN Starter bag (Dextrose 10% / Trophamine 6% / Calcium Gluconate 2.33 mEq / Heparin 125 unit/250 mL) -Rate: 2.1 mL/kg/hr (50mL/kg/day) -This is a highly concentrated starter bag. The infusion rate must NOT excee Neonatal calculator: Standard fluid choices by age added to calculator; Neonatal & Paediatric calculators: Added the text 'vial contents' to Drug columns to clarify that the text under each drug name is not the dose; 5.1.7: Neonatal & Paediatric calculators: Note added to the key to the effect that all drug doses are calculated for the IV route. effective in avoiding excessive IWL in preterm neonates being nursed under the radiant warmers. Guidelines for fluid and electrolyte therapy Day 1: Term babies and babies with birth weight > 1500 grams. A full term infant on intravenous fluids would need to excrete a solute load of about 15 mosm/kg/day in the urine
Fluid, electrolyte, and nutrition management is important because most infants in a neonatal intensive care unit (NICU) require intravenous fluids (IVFs) and have shifts of fluids between intracellular, extracellular, and vascular compartments. Therefore, careful attention to fluid and electrolyte balance is essential Insertion Of Umbilical Lines (UAC, UVC) Neonatal Clinical Guideline V3.0 Page 8 of 16 Note arterial line dips into iliac Fig.1. 4 (Drawn from post-mortem venogram image by J Clegg, RCH) Umbilical vein anatomy: TO CALCULATE INSERTION LENGTH: UAC = 3 UAC T6 x weight + 9 + stump UVC = 1.5 x weight +5.5 + stump Use in emergency length ~ 5c Treatments to promote colonic hydration: enteral fluid therapy versus intravenous fluid therapy and magnesium sulphate. Lopes MAF, Walker BL, White NA et al.EVJ 2002, 34 (5) 505 -9. A physiological approach to fluid and electrolyte therapy in the horse. Rose RJ. EVJ 1981, 13 (1): 7-14. Fluid therapy in horses with gastrointestinal disease Parenteral Nutrition Calculator; Vasopressor Charting; IV Fluid Charting; Oxygenation Index And MAP; GIR from IV Fluid; IV Fluid from GIR; Hypernatremic Dehydration; Learning. ABG Analysis; Empiric Antibiotic Therapy In Newborn Care Units; Special Care of Low Birth Weight Babies; IV Fluid Charting In Newborns; Hypernatremic Dehydration In.