Fluid, electrolyte and nutritional support of the surgical neonate

Abstract

The newborn infant is in a "critical epoch" of development. A healthy term infant grows at a rate of 25-30 g per day over the first 6 months of life, so that weight has doubled by the age of 5 months. This growth clearly requires adequate nutrition, but especially where medical or surgical conditions exist, must also be carefully managed together with fluid and electrolytes. Thus a significant period of inadequate nutrition, or inappropriate fluid and electrolyte administration, may not only affect short-term outcomes, but may also be a risk factor for the long-term menace of stunted mental and physical development. Amongst preterm infants, lower in-hospital growth velocity is associated with impaired neurodevelopmental outcome. Fluids and electrolytes undergo changes during the perinatal period, so an understanding of the perinatal changes in body composition is useful to understand the principles behind the fluid, electrolyte and nutritional management of surgical neonates. As well as providing the components necessary for increase in tissue mass, adequate provision of nutrients is also required to mount an appropriate immune response is extremely important, as infection and sepsis may impair growth and neurodevelopmental outcome.