Intravenous Infusion for SCN Admissions

Introduction
Fluid Infused
Investigations
Introducing enteral feeding
Inputs ( while nil by mouth)

Introduction

These recommendations are to guide the care of infants admitted to SCN (NOT NICU) who cannot commence enteral feeds shortly after birth. Such infants will usually have problems of mild/moderate RDS and/or prematurity (>30weeks gestation).

Infants awaiting transfer to a higher dependency unit or with specialised problems (eg 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/hr	ml/kg/d
0-24hrs	Bwt x 2.5	60	10% Dextrose
25-48hrs	Bwt x 2.5	60	10% Dextrose
49-72hrs	Bwt x 3	72	10% Dextrose + NaCl + KCl*
>72hrs	Bwt x 4	96	10% Dextrose + NaCl + KCl*

* Ordered as 10% Dextrose 500 ml & 6.5 mL 20% NaCl &10 mL 7.5% KCl (giving 22 mmol NaCl and 10 mmol KCl per 500mL)

Investigations

0-24hrs	Check BSL: If<2.6mmol/l ﾮ refer to <a href="/nets/handbook/index.cfm?doc_id=631#management"/> management of hypoglycaemia
25-48hrs	Monitor serum Na⁺, K⁺
49-72hrs	Check urine output adequate (>1mL/kg/hr) before adding electrolytes
73-96hrs	Check Na⁺, K⁺ if still nil by mouth
>96hrs		Consider transfer to a level 3 centre for Parenteral Nutrition if still nil by mouth

Introducing enteral feeding

Consider change in clinical condition e.g. resolution of respiratory distress, conscious state.

For term infants

Halve IV infusion rate. Offer sucking feeds on demand or at least 4^th 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 6 hours with 0.5mL 0.9% Sodium Chloride (ordered on the infant’s medication sheet). Check at least 6 hourly for signs of phlebitis/extravasation and integrity of cannula and extension set.

For infants <36 wks gestation</li/><36 weeks gestation

Start at 30 mL/kg/d; reduce IV infusion rate to maintain desired total infusion.

Increase enteral intake by 30 to 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
0-24hrs	60	4	-	-	100	24
25-48hrs	60	4	-	-	100	24
49-72hrs	72	5	3	1.5	125	30
>72hrs	96	6.6	4	2	160	38

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