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Question :

Posted On : 24 Sep 2008

In NICU whenever a neonate when initially NBM{NIL BY MOUTH}and when he is started on feeds as he improves it is a common practice that the same amount of feed is deducted from daily fluid. To elaborate if a neonate having total fluid requirement of suppose 250 ml on a particular day with NBM status AND THE BABY to planned to start on feed of 3cc 3 hrly {total feed24 cc in 24 hr}then 24 cc are subtracted from 250 and remaining fluid given over 24 hrs. Is it a correct method.There is significant difference between caloric content o f D10 Percent and feeds{formula or EBM}. The calculations should be based on caloric need.

Expert Answer :

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Answer Discussion :

saeedelsadek

most commonly used practice,seems satisfactory.

16 years ago

mohd elsayed mohd mohd

yes on caloric rquirement we can modigy iv fluid type

16 years ago

pediatriconcall

Thank you for your inquiry. Your question is absolutely correct. But more than calories it is the fluid requirement of the baby. As you know, every baby in the first few days is catabolic - and it is every neonatologist`s dream to turn the catabolism into anabolism as soon as possible, Though you give IV fluids or TPN - the maximum which a sick neonatate {I am guessing here that we are not talking of a well neonate} is given is 10 percent sugar - either dextrose or glucose of some sort. The point you have highlighted here is relevant - in that the calories need to be managed, but the oral fluids and feeds are always better - because among other things like sodium, potassium, magnesium etc we are not sure what else we are missing in IV Fluids and TPN - so oral feeds are better and in general the caloric content of these can be increased as they tolerate full feeds by HMF {Human Milk Fortifier} or MCT oil or Pre-term formula as the baby tolerates full feeds. But you cannot do everything in one go. I hope that answers your question.

Dr R Kishore Kumar
Neonatalogist

16 years ago

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