Temperature regulation Skin-to-skin contact with the mother can help with thermoregulation. incubator due to their inability to maintain core body temperature.<unk>  newborns are at increased risk of hypothermia due to decreased brown fat stores. Plastic wraps, heated pads, and skin-to-skin contact decrease risk of hypothermia immediately after delivery. One or more of these interventions may be employed, though combinations incur risk of hyperthermia. Warmed incubators in the NICU aid in thermoregulation for<unk>  infants. Fluid and electrolyte balance Frequent clinical monitoring of volume status and checking of serum electrolytes (up to three times daily) is appropriate to prevent dehydration, fluid overload, and electrolyte imbalance.<unk>  newborns have an increased body surface to weight ratio, increasing risk for insensible fluid losses and dehydration. Humidified incubators and skin emollients can lessen insensible fluid loss in<unk>  newborns. However, fluid overloading is not benign; it is associated with increased risk of congestive heart failure, necrotizing enterocolitis, and mortality. A degree of fluid restriction mitigates these risks.<unk>  newborns are at risk for electrolyte imbalances due to the relative immaturity of the nephrons in their kidneys. The kidneys are not equipped to handle large sodium loads. Therefore, if normal saline is given, the sodium level may become elevated, which may prompt the clinician to give more fluids. Sodium restriction has been shown to prevent fluid overload. Potassium must also be monitored carefully, as immature aldosterone sensitivity and sodium-potassium pumping increases risk for hyperkalemia and cardiac arrhythmias.<unk>  newborns are frequently found to have a persistently patent ductus arteriosus (PDA). If present, it is important to evaluate whether the PDA is causing increased circulatory volume, thus posing risk for heart failure. Signs of clinically significant PDA include widened pulse pressure and bounding pulses. In newborns with significant PDA, fluid restriction may avoid the need for surgical or medical therapy to close it. Approach to nutrition As their gastrointestinal systems are typically unready for enteral feeds at the time of birth,<unk>  infants require initial parenteral infusion of fluids, macronutrients, vitamins, and micronutrients. Energy needs Decreased activity compared to normal weight newborns may decrease energy requirements, while comorbidities such as bronchopulmonary dysplasia may increase them. Daily weight gain can reveal whether a<unk>  newborn is receiving adequate calories. Growth of 21 g/kg/day, mirroring in utero growth, is a target for<unk>  and ELBW neonates. Enteral sources Upon transitioning to enteral nutrition, human milk is preferable to formula initially in<unk>  newborns because it speeds up development of the intestinal barrier and thereby reduces risk of necrotizing enterocolitis, with an absolute risk reduction of 4%. Donor human milk and maternal expressed breast milk are both associated with this benefit. One drawback of human milk is the imprecision in its calorie content. The fat content in human milk varies greatly among women; therefore, the energy content of human milk cannot be known as precisely as formula. Each time human milk is transferred between containers, some of the fat content may stick to the container, decreasing the energy content. Minimizing transfers of human milk between containers decreases the amount of energy loss. Formula is associated with greater linear growth and weight gain than donor breast milk in<unk>  infants. Individual nutrient considerations<unk>  newborns are at increased risk for hypoglycemia due to decreased energy reserves and large brain mass to body mass ratio. Hypoglycemia may be prevented by intravenous infusion of glucose, amino acids, and lipids. These patients are also at risk of hyperglycemia due to immature insulin secretion and sensitivity. However, insulin supplementation is not recommended due to the possible adverse effect of hypoglycemia, which is more dangerous.<unk>  newborns have increased need for amino acids to mirror in utero nutrition. Daily protein intake above 3.0 g/kg is associated with improved weight gain for<unk>  infants. ELBW newborns may require as much as 4 g/kg/day of protein. Due to the limited solubility of calcium and phosphorus in parenteral infusions,<unk>  infants receiving parenteral nutrition will be somewhat deficient of these elements and will require clinical monitoring for osteopenia. Hematology One Cochrane review showed administration of erythropoietin (EPO) decreases later need for blood transfusions, and also is associated with protection against necrotizing enterocolitis and intraventricular hemorrhage. EPO is safe and does not increase risk of mortality or retinopathy of prematurity.
Low birth weight
Low Birth Weight
Preterm birth
Breech birth
Gestational age
Stillbirth
Multiple birth
Small for gestational age