1ЭМШУИС, 2Neonatal Center, Paracelsus University Children’s Hospital, Salzburg, Austria, 3Баянхонгор аймгийн НЭ, 4ЭХЭМҮТ
Objective. The goal of this project was to assess the principles and specific methods of fluid, electrolyte, and nutrition management among Austrian and Mongolian newborn.
Materials and Methods. The study was performed in the Neonatal Center at Paracelsus University Children’s Hospital of Salzburg, Austria, and in the Neonatal Intensive care units of the State Maternal and Child Health Research Center, Mongolia during March to December, 2009. Total 69 term and preterm infants were included into the study if they received parenteral nutrition alone or parenteral nutrition and milk feeding. Total studied days was 674. The regimen of fluid and electrolyte therapy consisted of milk feeding and drug solutions; parenteral nutrition solution which included aminoacids, glucose, electrolytes, trace minerals and vitamins, plus a fat emulsion. Daily energy, protein, fat and carbohydrate intake was calculated, taking into account all parenteral and enteral nutrition received. Infants were studied up to 14 days of fluid and electrolyte therapy. Clinical and laboratory monitoring was performed. All laboratory tests were performed by the local hospital. Some data were collected directly from the relevant hospital records. Data were analyzed using the SPSS-10 for windows statistical package
Results. The mean gestational age was 31.9 completed weeks with a minimum of 24 and a maximum of 42 weeks. The mean birth weight was 1689,5 g with minimum weight at 525 g and maximum at 4000 g. Caesarean section was 54.3% whereas vaginal delivery was 45.7%.
For the austrian group a fluid regimen starting at 87.6 ml/kg/d and a one-week stepwise increment to 160 ml/kg/d. The mean values were for protein 3.2±0.7 g/kg/d; for carbohydrate 10.3±0.4 g/kg/d; and for fat 3.0±0.2 g/kg/d (p<0.001). Energy intake on first day of life was 41.4 kcal/kg/d; on second day 55.4 kcal/kg/d and in one week 93.2 kcal/kg/d. For the mongolian group fluid intake for first day of life was 73.9 ml/kg/d and 159 ml/kg/d for the 7th day. The mean values for protein (2.2 g/kg/d), for carbohydrate (7.4 g/kg/d), and for fat (2.2 g/kg/d) were low than for austrian group. Energy intake on first day of life was 33.0 kcal/kg/d; on second day 35.0 kcal/kg/d and in one week 81.0 kcal/kg/d.
The daily maintenance of Na+ was 2.3 mmol/kg/d (Mongolian group 1.4); K 2.1 mmol/kg/d (Mongolian group 0.8); Ca 1, mmol/kg/d 3 (Mongolian group 0.2); Mg 0,8 mmol/kg/d (Mongolian group 0), and P 1.8 mmol/kg/d (Mongolian group 0). An average osmolalitet of the infusion was 761 mosm/l; max 1208 mosm/l; min 484 mosm/l (Mongolian group 579, max 1072, min 229).
Compared with austrian group without signs of dehydration, 29% of babies among mongolian group has signs of dehydration. Laboratory episodes of low hematocrit was high (60.8%) among austrian group whereas percentages of hypoglycaemia, hypocalcaemia and hypernatremia were high among mongolian group.
Planning and calculating adequate nutritional support for sick infants is tedious, time-consuming work. Besides requiring considerable expert knowledge and practical experience, this task is prone to inherent, possibly fatal, calculation errors. To automate this process, we modified the infusion calculation version of the Neonatal Center at Paracelsus University Children’s Hospital of Salzburg.
Conclusion. In summary, one has to have a strategy to maintain the complex balance between intake and losses. An approach of careful monitoring, step-wise increases in fluid to maintain fluid balance, and electrolytes will avoid complications associated with excessive or inadequate provision of fluid and electrolytes.
