CALCULATION OF FLUID VOLUME ALTERATION IN NEW BORN

INTRODUCTION:
Most sick, hospitalized children and neonates require intravenous (IV) fluids for
meeting the fluid and caloric requirements for their basal metabolic processes
while they are recovering from illness and cannot be fed enterally. These
intravenous fluids are composed of water, glucose, sodium and potassium.

IMPORTANCE of fluid calculation:

It helps to:
 Maintain hydration.
 Prevent electrolyte imbalances, starvation ketoacidosis and protein
catabolism.

They cannot be substituted for nutrition over long periods of time and most
patients on maintenance intravenous fluids can lose upto 0.5 – 1% of their body
weight per day.

PREVALENCE AND LOSS OF BODY WATER:

Principles of fluid and electrolyte balancing include the following:

 Total body water (TBW) equals intracellular fluid (ICF) plus extracellular fluid
(ECF)
 ECF equals intravascular fluid (plasma and lymph in the vessels) plus interstitial
fluid (between cells)

NEONATAL fluid requirement

 Neonates have a shift of fluids from intracellular to extracellular

compartment after birth, which leads to postnatal dieresis and
physiological weight loss in the first week of life (upto 10% of body
weight in term neonates and upto 15% in preterm neonates). In addition,
neonatal kidneys have limited capacity for solute and water load handling,
which leads to salt and water dieresis in the first 48- 72 hours.

 Therefore the fluids for neonates for the first 48 hours are without any
electrolytes (10% dextrose for the initial 48 hours). Total fluids
administered are increased on a daily basis by 10-15 ml/kg/day
increments, upto a maximum of 150 mL/kg/day by the end of 1 week of
life. sodium and potassium are added in intravenous fluids from day 3 of
life.

 (Days) < 1000 g 1000- 1500 g >1500 g 

1 80 80 60
2 100 95 75 
3 120 110 90
4 130 120 105
5 140 130 120
6 150 140 135
7 160 150 150

ASSESSING FLUID AND ELECTROLYTE STATUS:

Numerous conditions can affect neonatal fluid and electrolyte balance, as well as
renal function. The presence of several of these can be suspected on the basis of
information found during the prenatal and neonatal history.

1. MATERNAL HISTORY:

 A newborn's fluid and electrolyte status partially reflects the mother's

status. For example, excessive administration of oxytocin or hypotonic
IVF to the mother can cause hyponatremia in the neonate at birth.
 Placental dysfunction (eg, due to hypertension in pregnancy) can
adversely affect intrauterine growth.
 Infants who exhibit growth retardation at birth (< 10th percentile for
gestational age) may grow poorly unless their nutritional needs are
specifically addressed after birth.
 The severity and duration of the poor intrauterine malnutrition
influences the degree of postnatal catch-up growth.
 Poorly controlled maternal diabetes may be associated with renal vein
thrombosis. This can adversely affect an infant's renal function.
 Antenatal steroids may increase skin maturation, thereby decreasing
IWL and the risk of hyperkalemia.

2. NEWBORN HISTORY:

 The presence of oligohydramnios may be associated with congenital renal

dysfunction, such as renal agenesis, polycystic kidney disease, or posterior
urethral valves.
 Severe in utero hypoxemia or birth asphyxia may lead to acute tubular
necrosis.
  In the infant, posterior urethral valves can be suspected when spontaneous
urination is lacking or when a weak urinary stream and dribbling are
present. Frequently, the bladder is full.
 The environment in which an infant is cared for affects fluid loss.
 An environment with high ambient humidity decreases IWL, whereas the
use of a radiant warmer or phototherapy may significantly increase an
infant's IWL.
 In infants who are intubated, inadequate humidification of the inspired gas
may also lead to increased IWL.

FLUID AND ELECTROLYTE MANAGEMENT:

1. MANAGEMENT GOALS:

 Fluid and electrolyte management is achieved with constant assessment

of fluid intake and output, as well as monitoring of basic laboratory
chemistries.
 Primary goals are to maintain the appropriate ECF volume, ECF and
ICF osmolality, and ionic concentrations.
 The initial loss of ECF over the first week must be allowed, as reflected
by weight loss, while maintaining normal intravascular volume and
tonicity, as reflected by heart rate, urine output, and electrolyte and pH
values. Subsequently, maintain water and electrolyte balance while
supplying requirements for body growth.
 The clinical approach must be individualized, relying on norms for
gestational age and birth weight for guidance.

2. TOTAL FLUID REQUIREMENTS:

 Total fluid requirements equal maintenance requirements (IWL plus

urine plus stool water) plus growth requirements.
 In the first few days, IWL is the largest component of lost fluids.
 Later, as the renal solute load increases, the amount of water the
kidneys need to excrete this load increases (80-120cal/kg/day equal
15-20mOsm/kg/day, which means that 60-80mL/kg/day are needed
to excrete wastes).
 Stool requirement is usually 5-10mL/kg/d. As infants add tissue, they
also need to add water to maintain normal ECF and ICF volumes.
 Because weight gain is 70% water, an infant growing 30-40g/day
requires an additional 20-25mL/day of water.

 3. FACTORS THAT MODIFY FLUID REQUIREMENTS:

 As the skin matures postnatal, the insensible water loss (IWL)

decreases.
 Elevated body and environmental temperatures increase IWL.
 Radiant warmers increase IWL by 50%, phototherapy may increase
IWL, and the use of a plastic heat shield reduces IWL by 10-30%.
 Environmental humidification decreases IWL from the skin and
respiratory mucosa by as much as 30%.
 Skin breakdown and skin defects (eg, omphalocele) proportionally
increase IWL to the affected area.
 Infants exposed to antenatal steroids have lower IWL as well as
better diuresis.

4. ELECTROLYTE REQUIREMENTS:

 For the first 24 hours, supplemental sodium, potassium, and chloride are not
usually required.
 Starting at age 24 hours, assuming that urine production is adequate, the
infant needs 1-2mEq/kg/day of potassium and 1-3 mEq/kg/day of sodium.
 Extremely premature infants who develop metabolic acidosis may benefit
from sodium acetate administration instead of sodium chloride.
 Some evidence suggests that metabolic acidosis in preterm infants is
primarily due to inadequate urinary acidification by NH 4+ excretion and loss
of bicarbonate.
 During the active growth period after the first week, the need for potassium
may increase to 2-3mEq/kg/day, and the need for sodium and chloride may
increase to 3-5mEq/kg/day.
 Some of the smallest preterm infants have sodium requirements of as much
as 6-8mEq/kg/day because of the decreased capacity of the kidneys to retain
sodium.

Methods of fluid and electrolytes composition

 Intravenous fluids should be increased in the presence of (a) Increased

weight loss (>3%/day or a cumulative loss >20%), (b) Increased serum
sodium (Na>145 mEq/L) (c) Increased urine specific gravity>1.020 or urine
osmolality >400 mosm/L, (d) Decreased urine output (3 ml/kg/hr).

 Sodium and potassium should be started in the IV fluids after 48 hours, each
in a dose of 2-3 meq/kg/day. Calcium may be used in a dose of 4 ml/kg/day
 (40 mg/kg/day) of calcium gluconate for the first 3 days in certain high-risk
situations (see protocol on hypocalcemia). Dextrose infusion should be
maintained at 4-6 mg/kg/min. 10% dextrose may be used in babies ≥1250
grams and 5% dextrose in babies with birth weight.

 Gavage or tube feeding

Tube feeding is given by either naso-or gastric route. Nasal tubes are easier
to stabilize. The displacement of oral tubes is common in lager infants.
Nasal tubes may interfere with respiration especially in the very tiny preterm
infants. Intermittent gavage feeding allows assessment of gastric residue
upon periodic aspiration which reflects the gastric emptying capacity.
Gastric emptying time is shorter with human milk and may be decreased by
prone or lateral position. Inadequate gastric emptying, incompetent lower
oesophageal sphincter and small stomach capacity increase the risk of
aspiration and apnea. Feeds may need to be given hourly or 2 hourly to
reduce their volume. Continuous infusion may have some adverse metabolic
effects. Trenspyloric feeding has been used in the smallest and sickest
infants.

COMMON ELECTROLYTE PROBLEMS:

1. HYPONATREMIA:

 Hyponatremia is defined as a serum sodium level of less than

130mEq/L. Usually, this is not a cause for concern until the serum
sodium has dropped to less than 125mEq/L. Remember that
hyponatremia usually results from excessive free water intake relative
to insensible and sensible water loss. However, inadequate sodium
intake can contribute to the development of hyponatremia, especially in
the extremely premature infant with increased sodium loss.

2. HYPERNATREMIA:

 Hypernatremia is defined as a serum sodium level greater than

150mEq/L. Usually, this is not a cause for concern until the serum
sodium level has risen to greater than 155mEq/L. Hypernatremia is
commonly seen in the first few days of life in ELBW preterm infants
and most often occurs when free-water intake is inadequate to
compensate for very high IWL.
 3. HYPOKALEMIA:

 Hypokalemia is defined as a serum potassium level of less than

3.5mEq/L. Unless the patient is receiving digoxin therapy, hypokalemia
is rarely a cause for concern until the serum potassium level is less than
3.0mEq/L. Hypokalemia often results from chronic diuretic use and
unreplaced electrolyte loss from NG drainage. Electrocardiographic
manifestations of hypokalemia include a flattened T wave, prolongation
of the QT interval, or the appearance of U waves.
 Severe hypokalemia can produce cardiac arrhythmias, ileus, and
lethargy. When significant, this condition is treated by slowly replacing
potassium either intravenously or orally.

4. HYPERKALEMIA:

 Hyperkalemia is defined as a serum potassium level of greater than

6mEq/L measured in a nonhemolyzed specimen. Hyperkalemia is of
far more concern than hypokalemia, especially when serum potassium
levels exceed 6.5 mEq/L or if electrocardiographic changes have
developed.

OLIGURIA:
 Oliguria, a common fluid problem, is defined as a urine output of less
than 1mL/kg/h. Oliguria can be caused by various conditions that can
be classified as prerenal, renal, or postrenal problems.
 Urine output is often less than 1mL/kg/h during the first 12-18 hours
after birth. Most healthy term babies urinate within the first 12 hours;
however, a small number of healthy infants may not urinate until 24-
36 hours after birth.
 Persistent oliguria beyond 36 hours should be evaluated in an
otherwise healthy infant.

NUTRITIONAL REQUIREMENTS:
Nutrient requirements include the following:

 Energy (measured as cal/kg/day)

 Carbohydrates
 Water
 Minerals and trace elements
 Protein
 Vitamins
 Fat
 1. ENERGY NEEDS:

 The exact energy needs of a given neonate depend on several factors,

including gestational age, postnatal age, weight, route of energy
intake, growth rate, activity, and thermal environment. Infants who
are ill or experiencing stressful situations (sepsis, surgery, BPD) have
higher energy requirements.

The total energy needs of a growing, enterally fed premature infant without any
acute illness are listed as follows:

 Resting expenditure - 50cal/kg/day

 Minimal activity - 4-5cal/kg/day
 Occasional cold stress - 10cal/kg/day
 Fecal loss (10-15% of intake) - 15cal/kg/day
 Growth (4.5 cal/g of growth) - 45cal/kg/day
 Total required to produce a 10g/day weight gain - 125cal/kg/day

2. CARBOHYDRATE:

 IV dextrose provides most of the energy in TPN. The caloric content

of aqueous dextrose is 14.28kJ/g of glucose, which is equal to
142.8kJ/100mL of D10W. As a result of the high osmolarity of
concentrated dextrose solutions, the maximum dextrose
concentration that can be delivered safely through a peripheral vein is
12.5%. With central venous access, a dextrose concentration up to
15% is often used, and in special situations (eg, when fluids need to
be restricted), a concentration of as much as 25% may be used.

3. FAT:

 At least 3% of the total energy should be supplied as essential fatty

acids (EFA). This can be accomplished by providing a fat emulsion
(eg, Intralipid, Liposyn), 0.5g/kg/day 3 times per week. Fat
emulsions provide about 37.8-42kJ/g.

4. PROTEIN:

 Term infants need 1.8-2.2g/kg/day along with adequate nonprotein

energy for growth. Preterm VLBW infants need 3-3.5g/kg/day along
with adequate nonprotein energy for growth. Usually, providing
more than 4g/kg/day of protein is not advisable. Infants under stress
or who have cholestasis are usually limited to 2.5g/kg/day of protein
because the severity of TPN-induced cholestasis may depend on the
duration of TPN and the amount of amino acids infused.
 5. MINERALS (OTHER THAN SODIUM, POTASSIUM, CHLORIDE):

 Once protein intake has been started, calcium and phosphorous

should be added to TPN. Calcium and phosphorous need to be
concurrently administered for proper accretion. Take care to ensure
that solubility is not exceeded; if this happens, calcium and
phosphorous may spontaneously precipitate. Supplemental
magnesium should be added to TPN once protein has been added.

6. VITAMINS AND TRACE ELEMENTS:

 Vitamins A, D, E, and K are fat soluble. Vitamins B-1, B-2, B-6, B-

12, C, biotin, niacin, pantothenate, and folic acid are water soluble.
 Vitamin supplementation should be started as soon as protein is
added to TPN. The addition of a commercially available neonatal
vitamin preparation provides appropriate quantities of all vitamins,
except possibly vitamin A. Vitamin A supplementation in ELBW
infants has been shown to reduce death and BPD.

7. GLUCOSE INTAKE:

 The neonatal liver normally produces 6-8 mg/kg/min of glucose. This

is approximately the basal requirement of a newborn infant.
 Hypoglycaemia is severe if it persists despite an intake of >10
mg/kg/min. Calculate the glucose intake: See also the Glucose
Calculator

RECOMMENDED VOLUMES (ML/KG/DAY):

Day 0-1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7+

<37 60 75 90 105 120 150 180

weeks

37 60 75 90 105 120 120 150

weeks+
FLUID AND ELECTROLYTE MANAGEMENT IN THE NEWBORN:
 Careful fluid and electrolyte management is essential for the well being of
the sick neonate.
 Inadequate administration of fluids can result in hypovolemia,
hypersomolarity, metabolic abnormalities and renal failure.
 In the near term and term neonate excess fluid administration results in
generalized edema and abnormalities of pulmonary function.
 Excess fluid administration in the very low birth weight infant is associated
with patent ductus arteriosis and congestive heart failure, intraventricular
hemorrhage, necrotizing enterocolitis and bronchopulmonary dysplasia.
 A rational approach to the management of fluid and electrolyte therapy in
term and preterm neonates requires the understanding of several physiologic
principles.

1. PHYSIOLOGY:

A. Body Composition and Surface Area:

 The body composition of the fetus changes during gestation with a
smaller proportion of body weight composed of water as gestation
progresses.
 The preterm fetus or neonate is in a state of relative total body water
and extracellular fluid excess. After birth this excess water must be
mobilized and excreted.
 A proportion of the diuresis observed in both term and preterm
infants during the first days of life should be regarded as
physiologic.
 The surface area of the newborn is relatively large and increases
with decreasing size. Therefore, insensible water losses will be
greatest with small size and decreased gestational age.
B. Hormonal Effects:
 The Renin-angiotensin system is very active in the first week of
neonatal life resulting in increased vascular tone and elevated levels
of aldosterone
 Increased aldosterone levels enhance distal tubular reabsorption of
sodium resulting in an impaired ability to excrete a large, or acute,
sodium load.
 Arginine vasopressin (AVP, ADH) levels rise after birth. AVP
secretion is increased in response to stress, such as birth, asphyxia,
 RDS, positive pressure ventilation, pneumothorax and intracranial
hemorrhage.
C. Renal Hemodynamics:
 After birth, renal blood flow increases in response to increased
blood pressure (renin-angiotensin) with a secondary increase in
glomerular filtration rate.
 However, the neonatal kidney is less efficient at excreting an acute
sodium or water load than the kidney of an infant or child.

D. Sodium Homeostasis:
 Sodium is required for fetal growth with an accretion rate of 1.2
mEq/kg/day between 31-38 weeks.
 Sodium retention is aided by increased aldosterone levels in
newborns.
 In preterm infants <34 weeks sodium reabsorption is decreased, the
fractional excretion of Na may exceed 5%. However, the preterm
infant is unable to rapidly increase sodium excretion in response to
high sodium levels or a large sodium load.
E. Water Handling:
 Both term and preterm infants are able to excrete dilute urine.
Conversely, preterm infants are able to concentrate urine to ~ 600
mOsm/L and the term infant to ~ 700 mOsm/L.
 Therefore, both preterm and term neonates generally have the
capacity to regulate their intravascular volume within a range of fluid
intakes.

2. BASED ON THE ABOVE PRINCIPLES:

A. One should expect a 10-15% weight loss over the first 5-7 days of
life (up to 20% in infants <750 g).
B. Infants which experience significant intrapartum stress will be slow
to void and will therefore require less fluid over the first 24-48 hours.
C. The small or extremely immature infant <1000 g will experience
increased insensible water losses (IWL). IWL = (I-O) - (± Δwt).
D. As the preterm and term infant is able to regulate urine output in
response to hypovolemia, urine output will reflect intravascular
volume. In other words, the infant will generally not maintain
inappropriately high urine output in the face of intravascular volume
depletion.
 Recommendations

1. Initiate fluid therapy at 60-80 ml/kg/d with D10W, (80-150 ml/kg/d for infants ≤
26 weeks).
2. Infants <1500 g should be covered with a saran blanket and strict Input &Ouput
should be followed. For infants < 26 weeks the saran blanket should be applied
directly upon the infant to minimize IWL.
3. Infants <1000 g should have electrolytes and weights recorded every 6-8 hours;
every 12 hours for infants 1000-1500 grams.
4. For serum Na+ >145 mEq/L, increase infusate by ~10 mL/kg/d without Na+ in the
infusate.
5. Increase fluids for urine output <0.5 mL/kg/hr by ~10 mL/kg or, in infant ≤ 26
weeks, calculate IWL and change fluids accordingly.
6. Infuse Na+ free fluids (including flushes) until serum Na+ <145 and good urine
output is established (post diuretic phase). Then add 3-5 meq/kg/d Na+.
7. Add KCl (2-3 meq/kg/d) to IV fluids after urine output is well established and K+
<5 mEq/L (usually 48-72 hours).
8. Increase fluid administration gradually over the first week of life to 120-130
cc/kg/d by day 7, allowing for expected physiologic weight loss.

Special Cases

While the above guidelines are more directed toward the LBW infant, especially
<1000 g, they are generally applicable to most neonates; however, there are
instances where these guidelines should be modified. Some of the more common
modifications are noted below:

1. Postoperative abdominal surgery: Fluid requirements may be twice or three

times that noted above. The more extensive the procedure the greater the needs!
These infants may require 125-150 ml/kg/day immediately postoperative with
subsequent increases as determined by blood pressure measurements and urine
output. Isotonic saline also may be required because of third spacing of fluid into
tissues and other spaces, e.g., the bowel lumen. Strict Input &Output is mandated.
Gastric drainage is replaced 8-12hrs, depending on volume, with isotonic saline.
Colloid also may be needed because of rapid fluid shifts, decreases in arterial
pressure, and increases in capillary filling time (i.e., > 3 sec.).
2. Asphyxiated infants: These infants may have increased secretion of arginine
vasopressin (which is likened to SIADH) and are thought to be at increased risk for
cerebral edema. Their fluid intake should be kept on the low side for 48-72 hrs,
i.e., ≤ 60 ml/kg/day, or until seizures are no longer considered a problem. These
infants require close monitoring of serum sodium and weight. Treatment of
SIADH is by restriction of fluids, not increased sodium intake.
3. Infants of diabetic mothers: These infants receive i.v. glucose because of
increased danger of hypoglycemia; however, they frequently do not receive sodium
and have been found to develop rather substantial hyponatremia at 24 hrs if this is
not added at or before this time. This danger is greater the greater rate of glucose
needed to maintain blood glucose. Addition of sodium should be considered at 16-
18 h.

Nursing practices Provide free access to mother to see her neonates in the
nursery.

 Provide a bed to the mother in the hospital as long as care of the baby.
 Encourage the mother to be involved in the general care of the baby.
 Promote kangaroo mother care.
 Teach the mother manual expression of breast milk with emphasis on the
exact site of pressure. Manual expression 10-12 times in 24 hrs from the
first day.
 Give expressed milk by gavage or katori-spoon.
 Recognize exclusive breast feeding as an important goal in the management
of LBW babies.
 Exclusive breast feeding of the LBW infant at discharged should be
recorded and the rate monitored in the unit as one of the important indicators
of ‘quality care’ .

Summarize
Fluid & electrolyte requirements in newborn

Fluid & Electrolyte Preterm Term Post Term

Glucose 110-120 90-100 -
kcal/kg/day kcal/kg/day
Water 80-100/kg/day -125- -
150ml/kg/day
Sodium -2.5 to 3.5 1-3mEq/kg/ -
mEq/kg/day day
Potassium - 1-2mEq/ Kg/ -
 day
Calcium - 500mg -

Calories
The calorie requirements of children depend upon body size and surface area, rate
of growth, level of physical activity, food habits and climate. In balanced diet, 50%
of calories is provided by carbohydrates, 15% by proteins and 35 % by fat.
Deficiency of calories intake leads to loss of weight, growth failure and protein-
energy malnutrition. An excess intake of calorie results in increased weight gain
and obesity.

RECOMMENDED DIETARY ALLOWANCE OF VITAMINS ( TERM

NEWBORN )

AGE Vit-A Vit-B1 Vit-B2 Nicotinic Vit- Folic Vit- Vit-

acid C acid B12 D
Newbor 350m 55mcq/ 65mcg/ 710mcq/ 25m 25m 0.2mc 200I
n g kg kg kg g g q U

Calories and fluid requirements (PRETERM)

The fluids needs of preterm babies are relatively higher during first week of life.
Their insensible water loss is more due to larger surface area, thin vascular skin
and raised metabolic rate.

 After first week of life, the average maintenance fluid needs during early
infancy vary from 150-200 ml/kg/day to maintain positive water balance.
 The calories needs of non-growing LBW and preterm babies during first
week of life are 60 kcal/kg/day.
 Additional calories are needed for growth (25kcal/kg/day), activity , cold
stress, specific dynamic action of food and fecal loss ( about 10 kcal/kg/day
for each)
 After first 1 to 2 weeks of life most preterm babies require 120-150
kcal/kg/day to maintain satisfactory growth velocity.

Minerals

Preterm babies are prone to hyponatremia because of obligatory renal losses

secondary to an inadequately developed renal conversation mechanism. Recent
studies have suggested that the gut absorption of sodium in these infancy is also
inefficient.
  The special formulas for premature infants should provide 2.5 to 3.5
mEq/kg/day of sodium.
 Very LBW (<1500g) newborns require even higher amounts ( 4 to 8
mEq/kg/day).
 The potassium requirement 2 to 3 mEq/kg/day is similar to that of term
newborns.

Vitamins

All vitamins are essential for preterm babies. The recommended oral intakes for
vitamins A. vitamins K, thiamin, vitamins B12 and biotin are the same as those
recommended for all full term babies.

 Vitamins D metabolism is inadequately developed in the premature babies.

This is an important contributing factor for development of osteopenia of
prematurity. The prevention of severe bone disease in these babies
necessitates both high oral intakes of calcium and phosphorus and at least
500 iu of vitamin D/Day.
 The requirement of vitamin E in the small premature babies is higher than
that of the term infant because the fat malabsorption of the premature babies
also limits the absorption of vitamin E.
 Vitamin E deficiency may cause a mild hemolytic anemia and mild
generalized edema.
 The dietary intakes of 0.7 iu vitamin E/100 kcal and at least 1.0 iu per gram
of linoleic acid are recommended.

DAILY MAINTENANCE FLUID REQUIREMENT FORMULA:

 0-10 kg : 100 mL/kg/day (100 x kg)

 11-20 kg: 1000 mL (for first 10 kg) + 50 mL/kg/day for each additional kg between
10- 20 kg
 Over 20 kg: 1500 mL (for first 20 kg) + 20 mL/kg/day for each additional kg over 20
kg.

Conclusion
Newborn have a greater need for water and are vulnerable to alterations in fluid
and electrolyte balance. Adequate fluid intake is crucial in maintaining hydration
status. Water, can be used to maintain hydration. Water is often recommended over
juice due to the high sugar content in juices. Fluid requirements in children are
based on body weight according to the Holliday-Segar method. Fluid requirements
are better estimated by weight than age, to take into account the possibility of an
underweight or overweight child.

REFERENCES:
1. Ghai OP. Essential Pediatrics. 5th Edition. New Delhi; Mehta Offset Pvt
Ltd; 2001. P No. 387-423.
2. Parul Dutta. Pediatric Nursing. 1st Edition. New Delhi; Jaypee Brothers
Medical Publishers Pvt. Ltd; 2007. P No.47, 107, 380-410
3. Marlow R Dorothy And Redding A Barbara. Textbook Of Pediatric
Nursing. 6th Edition. New Delhi; WB Saunders Company; 2001
4. Meharbansingh. Neonatology .chapter 12(formula feeding ), page no. 123-
157.
5. Gupta P. Essential pediatric nursing. Jaypee publication; New Delhi, 2008;
p- 199-201, 342.
6. http://www.uichildrens.org/childrens-content.aspx?id=233964
1. Chobli M, Agboton H, Takpara I, Diallo A, Lokoussou A, Avodé G,
Hounbé F, Hage S. Association HELLP syndrome et Paludisme grave . Cah
Anesthesiol 1998 ; 46 (3) : 203-207
2. Chobli M, Avodé G, Agboton H, Takpara I, Diallo A, Lokoussou A,
Hounbé F, Hage S
Le HELLP syndrome en milieu Africain . A propos de trois observations .
Le Bénin Médical Nº 6 bis , 1997 : 92-96
3. Diallo A, Doumbia D, Coulibaly Y, Saharé F, Maïga I, Touré Kaba M,
Dembélé M, Traoré HA , Maïga MK , Touré M2
Un cas de Hellp Syndrome . Mali Médical 2000 . T XV N° 4 ; 36-38
4. Edouard D. Le syndrome HELLP .Vers une définition de la durée du
traitement conservateur . Ann Fr Anesth Reanim 2000 ; 19 : 710-1
5. Yucesoy, G., Ozkan, S., et al. (2005). Maternal and perinatal outcome in
pregnancies complicated with hypertensive disorder of pregnancy: A seven-
year experience of a tertiary care center. Arch Gynecol Obstet, 273(1), 43.
6. Martin, J. N., Jr., Rose, C. H., & Briery, C. M. (2006). Understanding and
managing HELLP syndrome: The integral role of aggressive glucocorticoids
for mother and child. Am J Obstet Gynecol, 195(4), 914.

JABALPUR INSTITUTE OF NURSING SCIENCE AND RESEARCH

 JABALPUR

SUBJECT:- GYNECOLOGY & OBSTETRIC

TOPIC PRESENTATION ON:- CALCULATION OF

FLUID REQUIRMENT

SUBMITTED To: SUBMITTED BY:

MRS.VINITHA SURESH SONAM PATEL

PROFESSOR HOD OF OBG M.SC FINAL YEAR

AND GYNECOLOGY NURSING JINSAR,JABALPUR

JINSAR,JABALPUR