From the Guidelines
Recommended Fluid Intake for Newborns Undergoing Phototherapy
The recommended fluid intake for newborns undergoing phototherapy is 100-140 mL/kg/day, with an additional 10-20% increase in volume due to phototherapy 1.
Key Considerations
- Fluid requirements are highly dependent on treatment conditions and environmental factors, and certain clinical conditions may afford modifications of daily fluid intakes 1.
- Breast-fed term infants need as little as 0.35-0.7 mmol/kg body weight per day of Na during the first 4 months of life to achieve adequate growth 1.
- Preterm infants require a higher growth rate, which explains a higher Na requirement, and may need 1.5-2.6 mmol/kg/d of Na and 2-3 mmol/kg/d of K 1.
- Maintaining adequate hydration and good urine output is important to improve the efficacy of phototherapy, but routine intravenous fluid or other supplementation is not necessary unless there is evidence of dehydration 1.
Electrolyte Management
- Electrolyte supplements such as sodium chloride and potassium chloride may be administered as needed to maintain proper electrolyte balance 1.
- The amount of K usually recommended is similar to the amount provided in human milk, about 2-3 mmol/kg per day 1.
Monitoring and Adjustments
- Monitoring urine specific gravity and output is crucial to guide fluid management, with a target output of 1-2 mL/kg/hour.
- Adjustments to fluid intake should be made based on individual needs and urine output, taking into account the increased volume required due to phototherapy 1.
From the Research
Fluid Intake for Newborns Undergoing Phototherapy
There is limited direct evidence on the recommended fluid intake for newborns undergoing phototherapy. However, studies on fluid intake for low-birth-weight infants and preterm infants provide some insights:
- A study from 1992 2 suggests that fluid restriction can reduce mortality and morbidity in low-birth-weight infants. The study used a fluid administration schema of 50-120 ml/kg/day during the first week and 150 ml/kg/day until aged four weeks.
- Another study from 1981 3 found that weight gain was seen when water intake was 80-100 ml/kg/day and energy intake was 200-300 kJ/kg/day in healthy newborn infants.
- A 2020 review 4 compared early full enteral feeding with delayed or progressive introduction of enteral feeds in preterm or low birth weight infants. The review found that early full enteral feeding (60 mL/kg to 80 mL/kg on day one after birth) may increase nutrient intake and growth rates, but the evidence was of very low certainty.
Key Findings
- Fluid intake of 50-120 ml/kg/day during the first week and 150 ml/kg/day until aged four weeks may be beneficial for low-birth-weight infants 2.
- Water intake of 80-100 ml/kg/day and energy intake of 200-300 kJ/kg/day may support weight gain in healthy newborn infants 3.
- Early full enteral feeding may have benefits for preterm or low birth weight infants, but the evidence is limited and of very low certainty 4.