Heather, an infant born at 26 weeks of gestation, was admitted to the neonatal intensive care unit. Her birth weight was 850 g (appropriate for gestational age). Heather had respiratory distress syndrome and had to receive a tube for mechanical ventilation. During the first few hours of her life, she was given surfactant, and her ventilator settings were lowered. She was also placed in a humidified incubator and given 100 ml/kg/day of starter parenteral nutrition (dextrose 10% in water with amino acids) intravenously. On the second day after her birth, she had gained 20 g, and her serum sodium concentration and urine volume output were low. She was diagnosed with excessive fluid intake. Her blood pressure was low and the drug dopamine was provided to increase her urine output. On the fourth day after birth, her body weight had decreased 50 g—6% of her birth weight—and her serum electrolyte levels were normal. The protein concentration of her parenteral fluids was increased, as was the volume of intravenous fat being provided. By the fifth day, Heather was clinically stable. She began receiving feedings of milk from her mother—1.0 ml every 3 hours (10 ml/kg of her birth weight)—via bolus oral gastric tube. The feedings were tolerated well. She then began receiving daily a larger volume of her mother’s breastmilk and less parenteral fluids. On day eleven, full enteral feedings were established, and after extubation Heather was successfully breathing on her own.
Nutrition Diagnostic Statement, Day 2
Excessive fluid intake related to intravenous fluids administered as evidenced by gain of 20 g and low serum sodium level.
Nutrition Diagnostic Statement, Day 11
Inadequate intake of protein and minerals related to increased needs due to prematurity as evidenced by unfortified human milk not meeting established nutritional needs of premature infants.
Nutrition Care Questions
1. On the second day after birth, should Heather’s intravenous fluid volume have been (1) increased because she needed more calories, (2) decreased because she was overhydrated, or (3) changed to enteral feedings because she was clinically stable?
2. How should the intravenous fat that was given to Heather have been administered?
3. The breastmilk from Heather’s mother may have inadequate amounts of which nutrients? What do you recommend to resolve this?