Clinical Chemistry
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Clinical Chemistry 43: 205-210, 1997;
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(Clinical Chemistry. 1997;43:205-210.)
© 1997 American Association for Clinical Chemistry, Inc.

Articles

Assessing fluid and electrolyte status in the newborn

John M. Lorenza

Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI and Sparrow Regional Children's Center, Sparrow Hospital, Lansing, MI.
a Address correspondence to: Sparrow Hospital, P.O. Box 30480, Lansing, MI 48909-7980. Fax 517-483-3994; e-mail lorenzj{at}pilot.msu.edu

Fluid and electrolyte assessment during the first week of life is complicated by rapid changes in fluid and electrolyte balance during the transition from fetal to neonatal life and by the newborn's small size. A physiologic decrease in extracellular water volume, as well as a transient increase in serum potassium and transient decreases in plasma glucose and total plasma ionized calcium concentrations must be taken into account. In general, the more immature the newborn, the greater the changes that can be expected. The use of plasma creatinine as an indicator of glomerular filtration rate is limited because it is a function of maternal renal function at birth and because of non-steady-state conditions in the immediate postnatal period. Guidelines for monitoring schedules are provided on the basis of these physiologic considerations and the author's experience. Method of blood sampling and time to separation of serum are important considerations in interpreting results. Minimization of sample volume is critical to minimize blood transfusion requirements. Clinicians should be aware of the analytical error associated with these measurements in their own institutions. Reference ranges are provided.




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Copyright © 1997 by the American Association for Clinical Chemistry.