Audit for IV fluid requirement in preterm babies in Sunderland Royal Hospital (SRH)

BackgroundPreterm infants are particularly vulnerable to the effects of fluid mismanagement due to shifts between intracellular, extracellular and vascular compartments; inappropriate fluid administration may lead to electrolyte imbalances, with the potential for serious morbidity.AimTo determine whether preterm babies are receiving the volume of IV fluid prescribed by a doctor, as indicated in the neonatal guidelines.Methods
• A retrospective study of hospital notes was carried out using a pro forma to collect data.
• The study sample (n = 35) consisted of all preterm babies <32 weeks admitted to ITU between July and December 2013.
• Mean fluid intake, including and excluding lipids, was calculated and compared to volume prescribed. It was categorised as correct (±1.0 ml/kg/24 h prescribed volume), too much or too little.Results
• 27/37 notes were available for analysis; 23 were suitable for the audit.
• On average 22% (n = 5) babies received the correct volume of fluid, 22% (n = 5) received too much, 56% (n = 13) received too little (mean deficit: 3.89 ml/kg/24 h).
• 21 babies received lipids; with lipid inclusion 4% (n = 1) received the correct volume, 86% (n = 18) received too much (mean excess 5.51 ml/kg/24 h), 10% (n = 2) received too little.
• There was no correlation between fluid accuracy and age of baby.ConclusionMost babies receive total daily fluids within 6 ml of the volume prescribed yet few receive the correct volume to the nearest ml/kg/24 h. The inclusion of lipids in daily totals shifted the trend from under to over administration of fluid; clarification is required on whether this is significant enough to require lipid inclusion in daily totals.