Target Feeding Volume for a 3-Day-Old Neonate
For a 3-day-old term neonate, target feeding volume is 60-80 ml/kg/day, while for preterm neonates it ranges from 100-140 ml/kg/day depending on birth weight. 1
Term Neonates (Day 3 of Life)
On day 3 of life, term neonates should receive 60-80 ml/kg/day of fluid intake. 1 This represents the Phase I adaptation period where fluid requirements gradually increase from the initial 40-60 ml/kg/day on day 1. 1
- Day 3 specifically targets 60-80 ml/kg/day for term infants, which accounts for physiological fluid losses while avoiding overhydration during the critical adaptation period. 1
Preterm Neonates (Day 3 of Life)
The target varies significantly based on birth weight:
- Preterm neonates >1500g: 100-120 ml/kg/day on day 3 1
- Preterm neonates 1000-1500g: 110-130 ml/kg/day on day 3 1
- Preterm neonates <1000g: 120-140 ml/kg/day on day 3 1
Clinical Context and Adjustments
Environmental and treatment factors require volume modifications. 1 Phototherapy increases insensible water losses and necessitates adding approximately 10-20% to baseline fluid requirements. 1 Conversely, infants receiving mechanical ventilation with humidified respiratory gases may require 10-20% volume reduction. 1
- Infants with cardiac defects require fluid restriction to 60-80 ml/kg/day to prevent pulmonary congestion and worsening heart failure, even if this is below typical maintenance requirements. 2
Progression Beyond Day 3
By days 4-5, term neonates advance to 60-100 ml/kg/day (day 4) and 100-140 ml/kg/day (day 5). 1 Preterm infants similarly progress, with those >1500g reaching 120-140 ml/kg/day by day 4 and 140-160 ml/kg/day by day 5. 1
Important Caveats
Extremely low birth weight (ELBW) infants <1000g require careful monitoring at the onset of diuresis, as high urinary sodium losses may necessitate sodium supplementation exceeding 5 mmol/kg/day despite fluid volumes of 120-140 ml/kg/day. 1
Avoid the common pitfall of using adult-based formulas (like Holliday-Segar) for neonates in the first week of life, as these do not account for the unique physiology of Phase I adaptation with its expected physiological weight loss and fluid redistribution. 1