Intraoperative fluid therapy in neonates

Visram, A.

doi:10.1080/22201181.2016.1140705

Cited by 9 publications

(12 citation statements)

References 85 publications

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“…At birth, the renal tubules have a limited capacity to concentrate urine because of the shorter loops of Henle and reduced tonicity of the medullary interstinum. 4 The limited ability to produce concentrated urine means neonates can become dehydrated easily.…”

Section: Concentrating Abilitymentioning

confidence: 99%

“…In neonates, hypoxaemia, acidaemia, hypercarbia, volume depletion, the need for assisted ventilation, and sepsis are all potent stimulants of persistent ADH release; therefore, fluids are often restricted after surgery. 4 Aldosterone secretion is slow to respond to a high Na load, and therefore, it is recommended that Na be excluded from the maintenance fluid until postnatal diuresis has occurred. After that, supplementation of Na is important to avoid hyponatraemia, as the renineangiotensin-aldosterone system has a limited capacity to retain Na, because the renal tubules are partially unresponsive to aldosterone.…”

Section: Prematuritymentioning

confidence: 99%

“…Neonates receiving total parenteral nutrition or glucose infusions are also at risk of hypoglycaemia if the infusion is stopped before or during anaesthesia. 4,5,8 Long-term exposure to blood glucose concentrations <2.6 mmol L À1 is associated with adverse neurological outcomes.…”

Section: Administration Of Maintenance Fluidmentioning

confidence: 99%

“…6 There is no current consensus on using isotonic solutions as perioperative maintenance fluids in neonates, because of the concerns about the handling of large Na loads and the lack of evidence. 4 However, the results of a recent study in neonates have prompted recommendations that balanced isotonic solutions should be considered as routine maintenance fluids. 9 'Third space' losses Traditionally, 'hird space' losses were replaced with crystalloid solutions at anything between 1 ml kg À1 h À1 for a minor surgical procedure to 50 ml kg À1 h À1 during surgery for necrotising enterocolitis in premature infants.…”

Section: Tonicity Of Intraoperative Maintenance Fluidmentioning

confidence: 99%

“…Recently, the concept of the third space has been questioned, and more restrictive fluid protocols used in adults have been associated with better outcomes. 4,5…”

Section: Tonicity Of Intraoperative Maintenance Fluidmentioning

confidence: 99%

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Management of fluids in neonatal surgery

2018

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Explain the factors that are important in determining the type and amount of fluids given to neonates during surgery. Describe the indications and safeguards of blood and blood product administration in the neonate. Recognise the challenges of assessing whether a neonate requires fluids or is fluid replete. Management of fluids in the neonate undergoing major surgery is complex, and is influenced by the gestational age, postnatal age, physiological maturation of organ systems, type of surgery, concomitant illness, and blood loss. In addition, prematurity increases these challenges, as organ systems are immature and body fluid compositions are different to that of a healthy term baby. Much of the evidence is derived from the critically ill neonate; thus, caution must be exercised in extrapolating these data to the neonate undergoing surgery. Neonatal physiology and cardiorespiratory adaptation at birth Changes in body composition and cardiorespiratory adaptation The transition from fetal life to neonatal life involves significant changes in the body water composition, and depends on the gestational age at birth and the stage of cardiorespiratory adaptation (Fig 1). 1 The proportion of extracellular fluid (ECF) is higher in preterm infants and depends on the level of prematurity. Postnatal diuresis Soon after birth, pulmonary vascular resistance decreases dramatically with a consequent increase in blood flow to the lungs and left atrium. This stimulates the production of atrial natriuretic peptide, which in turn stimulates sodium (Na) and water diuresis from the kidneys, and results in a decrease in the ECF volume. This cardiorespiratory adaptation results in a physiological weight loss of 5e10% in term neonates and up to 15% in Anil Visram BSc FRCA is a consultant in paediatric anaesthesia at the Royal London Hospital. He has interests in neonatal fluids and point-of-care testing.

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Section: Concentrating Abilitymentioning

confidence: 99%

Section: Prematuritymentioning

confidence: 99%

Section: Administration Of Maintenance Fluidmentioning

confidence: 99%

Section: Tonicity Of Intraoperative Maintenance Fluidmentioning

confidence: 99%

“…Recently, the concept of the third space has been questioned, and more restrictive fluid protocols used in adults have been associated with better outcomes. 4,5…”

Section: Tonicity Of Intraoperative Maintenance Fluidmentioning

confidence: 99%

See 3 more Smart Citations