Clinical Nutrition

Tabled 1Table: Recommendations on fluid and electrolytesNeonates during the transition phase (phase I)R 6.1In term neonates, postnatal weight loss generally occurs during the first 2–5 days of life and should not usually exceed 10% of birth weight (LoE 2++, RG 0, conditional recommendation)R 6.2In ELBW and VLBW infants, 7–10% weight loss seems to be adequate taking into account their higher body water content and the adverse complications associated with fluid overload (LoE 2++, RG B, strong recommendation)R 6.3A gradual increase of fluid intake is recommended in preterm and term neonates after birth (LoE 3, RG B, strong recommendation)R 6.4Electrolytes (Na, Cl and K) should be supplied starting during phase I/contraction of ECF compartment/initial loss of body weight (LoE 3, RG 0, strong recommendation)R 6.5Cl intake should be slightly lower than the sum of Na and K intakes (Na + K-Cl = 1–2 mmol/kg/d) to avoid excessive Cl intakes and risk of iatrogenic metabolic acidosis (LoE 3, RG 0, strong recommendation)R 6.6In ELBW and VLBW infants, Na and K may be recommended from the first day of life when giving the recommended high amino acids and energy supply, providing that urine output is ascertained, and taking into account the potential for the development of nonoliguric hyperkaemia (LoE 2+, RG 0, conditional recommendation)R 6.7It should be recognized that the needs of individual patients may deviate markedly from the ranges of generally recommended intakes depending on clinical circumstances such as fluid retention, dehydration or excessive water losses, or others (GPP, strong recommendation)Neonates during intermediate phase (phase II)R 6.8After initial postnatal weight loss, birth weight should usually be regained by 7–10 days of life (GPP, conditional recommendation)Neonates during the phase of stable growth (phase III)R 6.9Fluid and electrolyte homoeostasis should be maintained while the infant is gaining appropriate weight during the phase of stable growth (LoE 3, RG B, strong recommendation)Children and in...

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Fluid and electrolytes