These values are intended as guidelines and should be adjusted according to the infant's clinical status. Adjustments should be made based on monitoring the infant's hydration status, including serial measurements of the infant's weight and serum or plasma sodium levels.
Other adjustments include the following:
- For very low birth weight (VLBW) infants (BW <1500 g), the above values assume that the infant is being cared for in a humidified incubator with appropriate thermal control, and if respiratory support is provided, humidified gas is used.
- For VLBW infants cared for in an open warmer or receiving respiratory support with non-humidified gases, the required amount of daily fluid is higher. In this clinical setting, fluid administration is started at the upper end of the normal range and increased in increments of 20 mL/kg per day based on frequent monitoring of hydration status performed at least every eight hours until a stable regimen is established.
- For term infants, fluid adjustments are not needed for those cared for in an open warmer or bassinette if they are adequately wrapped, as they have less fluid skin loss than preterm infants due to more mature, thicker skin.
- For term infants receiving therapeutic hypothermia, many practitioners will restrict fluids to 40 to 60 mL/kg/d if there is evidence of acute kidney injury.
- For infants receiving conventional phototherapy using fluorescent blue lights, requirements are approximately 10 percent higher (10 to 15 mL/kg per day).
- For infants that receive therapy using LED lights that use high-intensity blue gallium nitride, there is no need for additional adjustment because there is no increased insensible skin losses.
