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Key messages

  • Intravenous infusion may be required to maintain hydration of the neonate not having enteral feeds.
  • These guidelines are only for infants admitted to special care nursery (SCN) not an NICU.
  • Infusion aims to maintain hydration and avoid biochemical disturbances, particularly hypoglycaemia and hyponatraemia.
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    In June 2023, we commenced a project to review and update the Maternity and Neonatal eHandbook guidelines with a view to completion in 2024. Please be aware that pending this review, some of the current guidelines may be out of date. In the meantime, we recommend that you also refer to more contemporaneous evidence.

    Intravenous (IV) infusions may be required for infants who cannot commence enteral feeds.

    These recommendations for IV infusions are to guide the care of infants admitted to a special care nursery (SCN) who cannot commence enteral feeds shortly after birth.

    These guidelines are not for use in a neonatal intensive care unit (NICU). Such infants will usually have problems of mild/moderate RDS and/or prematurity (> 30 weeks' gestation).

    Infants awaiting transfer to a higher dependency unit or with specialised problems (such as bowel obstruction with vomiting) should have fluid management as indicated for their specific condition or as discussed with an appropriate specialist.

    The goal of treatment is to maintain hydration and avoid biochemical disturbances, particularly hypoglycaemia and hyponatraemia.

    Fluid infused

     
    Fluid volume
    Fluid infused
     
     ml/hrml/kg/d 
    0-24 hrsBwt x 2.56010% dextrose
    25-48 hrsBwt x 2.56010% dextrose
    49-72 hrsBwt x 37210% dextrose + NaCl + KCl*
    > 72 hrsBwt x 49610% dextrose + NaCl + KCl*

    * Ordered as 10 per cent dextrose 500 mL and 6.5 mL 20 per cent NaCl and 10 mL 7.5 per cent KCl (giving 22 mmol NaCl and 10 mmol KCl per 500 mL)

    Investigations

    0-24 hrs Check BSL: If < 2.6 mmol/l refer to  management of hypoglycaemia
    25-48 hrs Monitor serum Na+, K+
    49-72 hrs Check urine output adequate (> 1 mL/kg/hr) before adding electrolytes
    73-96 hrs Check Na+, K+ if still nil by mouth
    > 96 hrs Consider transfer to a level 3 centre for parenteral nutrition (TPN) if still nil by mouth

    Introducing enteral feeding

    Consider change in clinical condition, for example, resolution of respiratory distress, conscious state.

    For term infants

    When introducing enteral feeds for term infants:

    • Halve IV infusion rate. Offer sucking feeds on demand or at least four-hourly. After two or three sucked feeds IV access may be bunged off and feeding performance assessed. If intravenous access is not required as a route for medications the cannula should be removed as soon as possible. While the bunged off line is in place flush short extension tubing every six hours with 0.5 mL 0.9 per cent sodium chloride (ordered on the infants medication sheet). Check at least six-hourly for signs of phlebitis/extravasation and integrity of cannula and extension set.

    For infants less than 36 weeks' gestation

    For infants < 36 weeks' gestation:

    • Start at 30 mL/kg/d; reduce IV infusion rate to maintain desired total infusion.
    • Increase enteral intake by 30-40 mL/kg/d. IV infusion can usually cease when > 90 mL/kg/d enteral intake achieved. Thereafter enteral intake is gradually increased to 150 mL/kg/d total.

    Inputs (while nil by mouth)

     

    Volume

    Glucose

    Na

    K

    Energy

      mL/kg/d mg/kg/min mmol/kg/d mmol/kg/d KJ/kg/d KCal/kg/d
    0-24 hrs 60 4 - - 100 24
    25-48 hrs 60 4 - - 100 24
    49-72 hrs 72 5 3 1.5 125 30
    > 72 hrs 96 6.6 4 2 160 38

    Get in touch

    Clinical Guidance Team
    Safer Care Victoria

    Version history

    First published: May 2015
    Review by: May 2018

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