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Review
. 2024 Apr 1;36(2):198-203.
doi: 10.1097/MOP.0000000000001308. Epub 2023 Nov 14.

Fluid and electrolyte management in the neonate and what can go wrong

Jeffrey L Segar  1 , Jennifer G Jetton  2
Affiliations
Review

Fluid and electrolyte management in the neonate and what can go wrong

Jeffrey L Segar et al. Curr Opin Pediatr. .

Abstract

Purpose of review: This review highlights recent advances in understanding fluid and electrolyte homeostasis during the newborn period, including heightened recognition of fluid overload and acute kidney injury contributing to poor clinical outcomes. Particular attention is given towards the care of extremely preterm infants.

Recent findings: Emerging data demonstrate (i) disproportionally large transepidermal water loss in the extremely preterm population, (ii) the relationship between postnatal weight loss (negative fluid balance) and improved outcomes, (iii) the frequency and negative effects of dysnatremias early in life, (iv) the role of sodium homeostasis in optimizing postnatal growth, and (v) the deleterious effects of fluid overload and acute kidney injury.

Summary: As clinicians care for an increasing number of preterm infants, understanding progress in approaches to fluid and electrolyte management and avoidance of fluid overload states will improve the care and outcomes of this vulnerable population. Further translational and clinical studies are needed to address remaining knowledge gaps and improve current approaches to fluid and electrolyte management.

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Conflict of interest statement

Conflicts of Interest: None

Figures

Figure 1.
Figure 1.
Postnatal changes in sodium (Na) homeostasis in infants born at 22-23-week GA. A Total body weight. B Sex-specific body weight z-scores. C Total Na intake via parenteral and enteral routes. D Urine Na excretion. E Na balance, calculated as Na intake minus urine Na excretion. For all panels, n = 10–11 females + 11–12 males for each data point. *p < 0.05 versus zero by one-sample t-test. From: Segar JL, Grobe CC,Grobe JL. Maturational changes in sodium metabolism in periviable infants. Pediatr Nephrol 2021;36:3693–3698.
Figure 2.
Figure 2.
Transepidermal water loss (TEWL ± SD; g/m2 h) in 22–23 week infants (n=11) at a relative humidity of 50%. Dashed line represents the level of TEWL in 24–25 week infants. From: Ågren J, Segar JL, Söderström F, Bell EF. Fluid management considerations in extremely preterm infants born at 22–24 weeks of gestation. Semin Perinatol. 2022;46:151541.
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