Insensible Water Loss in Newborn Infants

Doyle, Lex W.; Sinclair, John C.

doi:10.1016/s0095-5108(18)31008-x

Cited by 25 publications

(19 citation statements)

References 72 publications

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“…11 23 However, in these early studies, the measurement of insensible water loss was based on insensible weight loss estimated by intermittent or continuous weighing of the infants, with allowance made for water intake in food and water of oxidation, plus water lost in urine and stool. It has been pointed out by Doyle and Sinclair24 that the measurements made in these studies were subjected to systematic errors because the accuracy of the estimate of insensible water loss depended on the estimates of water intake and water lost in urine and stool and the validity of the assumptions about water of oxidation. Other sources of error included absorption of water on to the weighing apparatus, and the potential hygroscopic properties of materials used for clothing or bedding.…”

Section: Discussionmentioning

confidence: 99%

Oxygen consumption and resting energy expenditure during phototherapy in full term and preterm newborn infants

Fok

Lim

et al. 2001

Archives of Disease in Childhood - Fetal and Neonatal Edition

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Objectives-To determine the eVect of phototherapy on the oxygen consumption and resting energy expenditure of term and preterm newborn infants. Methods-A total of 202 infants (gestation 30-42 weeks; body weight 1270-4100 g) requiring phototherapy for the treatment of neonatal hyperbilirubinaemia were enrolled in a randomised crossover study. In random sequence, the oxygen consumption and resting energy expenditure were measured twice in each infant by indirect calorimetry, once at the end of six hours of continuous phototherapy and once after a control period of at least six hours without phototherapy. Anterior abdominal wall temperature was servocontrolled at 36.5°C throughout the study. Results-At the end of six hours of continuous phototherapy, oxygen consumption (mean (SD): 6.21 (1.35) v 6.26 (1.51) ml/kg, p = 0.555) and resting energy expenditure (178.11 (37.62) v 180.37 (43.14) kJ/kg/24 h, p = 0.382) did not diVer significantly from those measured after the control period. There were also no significant diVerences in heart rate, respiratory rate, or rectal temperature. Subgroup analysis of those of gestation < 37 weeks or < 34 weeks also showed no eVect of phototherapy on either oxygen consumption or resting energy expenditure. Conclusion-Phototherapy has no eVect on the metabolic rate of thermally stable term or preterm infants. (Arch Dis Child Fetal Neonatal Ed 2001;85:F49-F52) Keywords: phototherapy; oxygen consumption; resting energy expenditure; preterm Phototherapy may aVect the energy metabolism and oxygen consumption of newborn infants by a number of mechanisms. The photo-oxidation of bilirubin in the skin is an oxygen consuming process, and it has been shown that photo-energy accelerates the oxidation of fatty acids.1 The metabolic eVect of phototherapy, however, appears to be mediated mainly through changes in the infant's thermal environment. Part of the photo-energy, especially that near the infrared range, is converted into heat energy which increases the environmental and skin temperature of the infant. Overheating may increase metabolic rate as a result of elevation of the body temperature and increase in insensible water loss. A profound increase in evaporative water loss is seen when sweating is elicited by a rise in body temperature in newborns. 4 Even without apparent sweating, infants undergoing phototherapy exhibit a significant increase in peripheral blood flow 5 and transepidermal insensible water loss. A rise in body temperature may also increase respiratory rate and minute ventilation, 5 6 leading to increased respiratory water loss.5 7 The increase in evaporative water loss through the skin and respiratory tract consumes a substantial amount of heat energy in the form of latent heat of evaporation, and the increase in muscle activity caused by increased respiratory rate and the discomfort resulting from overheating also increases metabolic rate. 8It has been estimated that, in newborns, approximately 2.42 J of heat is dissipated for each gram of water evaporated.9 10 Th...

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Section: Discussionmentioning

confidence: 99%

Oxygen consumption and resting energy expenditure during phototherapy in full term and preterm newborn infants

Fok

Lim

et al. 2001

Archives of Disease in Childhood - Fetal and Neonatal Edition

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“…In addition, there was a small rise in plasma sodium concentration (2 mmol/L). Probably the lambs became dehydrated due to water evaporation from the skin and lungs (16).…”

Section: Discussionmentioning

confidence: 99%

Changes in Renal Function and Blood Volume in the Newborn Lamb Delivered by Cesarean Section

Gibson

Lumbers

1994

Pediatr Res

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To determine the cause of the transient natriuresis in lambs within 1-2 h of birth, renal function and blood volume (BV) were measured in nine chronically catheterized fetal sheep aged 139-145 d before and after delivery by cesarean section. After delivery, sodium excretion increased &fold. This was due to a transient rise in glomerular filtration rate (by 39 + 21%, p < 0.02) and a fall in fractional reabsorption of sodium by the proximal tubule from 63.4 2 2.5% to 53.4 + 3.4% @ < 0.01). The distal tubule failed to compensate fully for this fall, because fractional reabsorption by the distal tubule rose from 35.5 2 2.4% to only 41.6 2 2.2% @ < 0.05). The extent of the natriuresis did not depend on the lamb's initial BV per kg at birth. However, the amount of fluid excreted and the clearance of sodium during a 45-min period within the first 1-1.25 h after birth were approximately equal to the fall in BV that occurred during this time. Thus, most of the fall in After birth, human infants have a transient increase in urine flow rate (1). Similarly, lambs delivered by cesarean section at 139-145 d have a transient natriuresis and disruption of glomerulotubular balance (2). It has been suggested that volume expansion of the newborn, resulting from placental blood transfusion, may contribute to this diuresis (3). We postulated that lambs with larger BV relative to their weights would show a greater natriuresis than lambs with smaller BV per kg body weight. It should be noted that because it was not possible to measure partitioning of the fetal BV between the fetal body and the placenta before birth, it could not be determined whether placental transfusion occurred with delivery.

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“…It has been shown that hypothermia can delay the initiation of spontaneous breathing and lead to respiratory distress and hypoxia [134,135] . Hypothermia may also alter the circulatory changes which characterize adaptation from intra-uterine to extra-uterine environment, resulting in persistent pulmonary hypertension [136,137] .…”

Section: Temperature Control In the Drmentioning

confidence: 99%

The First Golden Minutes of the Extremely-Low-Gestational-Age Neonate: A Gentle Approach

Vento¹,

2008

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An increasing body of evidence has revealed that interventions performed during resuscitation of extremely-low-gestational-age neonates (ELGANs) may have a direct influence on the immediate survival and also on long-term morbidity. It has been proposed that interventions in the delivery room and/or hypothermia could trigger changes constitutive of chronic lung disease. New approaches in the first minutes of life using more gentle parameters of intervention are being studied. Thus, titrating inspiratory fraction of oxygen, the use of non-invasive ventilation to reduce trauma to the lung, the use of polyethylene/polyurethane wrapping to avoid hypothermia and delaying cord clamping altogether constitute promising initiatives. The first minutes of life are a valuable window for intervention. However, whilst these practice changes make sense and there are emerging data to support them, further evidence including long-term follow up is needed to definitively change resuscitation procedures in ELGANs.

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Insensible Water Loss in Newborn Infants

Cited by 25 publications

References 72 publications

Oxygen consumption and resting energy expenditure during phototherapy in full term and preterm newborn infants

Oxygen consumption and resting energy expenditure during phototherapy in full term and preterm newborn infants

Changes in Renal Function and Blood Volume in the Newborn Lamb Delivered by Cesarean Section

The First Golden Minutes of the Extremely-Low-Gestational-Age Neonate: A Gentle Approach

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