In this chapter, we review the metabolic and energy demands of the preterm and full-term neonates. The immature neonatal hypothalamic–pituitary–adrenal (HPA) axis and renal system at birth affect both fluid and electrolyte homeostasis during the early postnatal period. Preterm infants are deficient in endogenous nutrient stores as fetal accretion of calcium, phosphorus, carbohydrate, fat, and protein predominantly occurs during the third trimester. Consequently, extremely low birth weight (ELBW) infants (<1000 g) and infants with intrauterine growth restriction (IUGR) are at increased risk for both transient and prolonged hypoglycemia during early postnatal life compared with full-term neonates. The introduction of feeding poses serious challenges in both preterm and term neonates. When surgery is required, providers must appreciate the constraints of preexisting metabolic and surgical conditions on fasting, intraoperative, and postoperative fluid management and transfusion thresholds. Finally, temperature homeostasis in the neonate has overarching effects on each of the metabolic, neuroendocrine, and coagulation status and these are addressed in this chapter.
Bertolizio, G., Ingelmo, P., Lerman, J. (2023). Metabolic Care of the Preterm and Term Infants, Including Control of Body Temperature. In J. Lerman (a cura di), Neonatal Anesthesia, Second Edition (pp. 257-290). Springer International Publishing [10.1007/978-3-031-25358-4_8].
Metabolic Care of the Preterm and Term Infants, Including Control of Body Temperature
Ingelmo P.;
2023
Abstract
In this chapter, we review the metabolic and energy demands of the preterm and full-term neonates. The immature neonatal hypothalamic–pituitary–adrenal (HPA) axis and renal system at birth affect both fluid and electrolyte homeostasis during the early postnatal period. Preterm infants are deficient in endogenous nutrient stores as fetal accretion of calcium, phosphorus, carbohydrate, fat, and protein predominantly occurs during the third trimester. Consequently, extremely low birth weight (ELBW) infants (<1000 g) and infants with intrauterine growth restriction (IUGR) are at increased risk for both transient and prolonged hypoglycemia during early postnatal life compared with full-term neonates. The introduction of feeding poses serious challenges in both preterm and term neonates. When surgery is required, providers must appreciate the constraints of preexisting metabolic and surgical conditions on fasting, intraoperative, and postoperative fluid management and transfusion thresholds. Finally, temperature homeostasis in the neonate has overarching effects on each of the metabolic, neuroendocrine, and coagulation status and these are addressed in this chapter.
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