a. Fluid.

Newborns require more fluid relative to their size than adults require.

Additional fluids are required with fever, diarrhea, and vomiting.

(1) Dehydration. Until the ability to retain body water through kidney function improves in the early months of life, the infant is at risk for dehydration. Signs of dehydration are:

(a) Depressed fontanels.

(b) Rapid, weak pulse.

(c) Elevated low-grade temperature.

(d) Dark, concentrated urine.

(e) Dry, hard stools.

(f) Dry skin with little turgor.

(g) Elevated specific gravity (1.020).

(2) Water. Prepared infant formulas provide sufficient water under normal environmental conditions. Water intoxication may result from excessive feeding of water to infants. It may occur when water is fed as a replacement for milk. Signs of water intoxication are:

(a) Hyponatremia.

(b) Weakness.

(c) Restlessness.

(d) Vomiting, diarrhea.

(e) Polyuria or oliguria.

(f) Convulsions.

(3) Nursing care.

(a) Maintain accurate input and output (I&O).

(b) Observe frequently for signs of dehydration or water intoxication.

b. Vitamin, Mineral, and Caloric Requirements.

(1) The newborn’s rapid growth makes him especially vulnerable to dietary inadequacies and iron deficiency anemia. Adequate vitamin intake is especially important to support normal growth and metabolism. When the mother is well-nourished throughout her pregnancy, the full-term neonate can be expected to have adequate vitamin stores at birth. Calcium and iron are the two basic minerals that are of particular importance in maintaining adequate nutrition.

(a) Calcium is essential for the rapid bone mineralization that takes place during the first year of life, muscle contraction, blood coagulation, nerve irritability, tooth development, and heart muscle action.

(b) Iron is an essential element needed for synthesis of hemoglobin and cell metabolism.

(2) Due to the limited nutritional stores, newborns require vitamin and mineral supplements. An infant may become hypoglycemic and require feeding sooner than normal. His blood glucose is checked at one hour of age and if it is decreased, the baby is first fed sips of water to ensure sucking swallowing coordination and is then fed formula to increase calories and decrease utilization of glucose.