Fluid and Electrolyte Requirements of Newborn Infants with Intestinal Obstruction.

The findings in a consecutive series of 120 children of all ages treated with parenteral fluid therapy in support of major abdominal surgery have been reported (Young, McIntosh, Swain and Levin, 1959). The series included 23 newborn infants with intestinal obstruction. The plan of fluid therapy used was designed to replace initial deficits of water and electrolytes, to provide water, electrolytes and calories for maintenance, and to replace further abnormal losses after operation. This plan is now supported by the findings from balance studies on three older children with ileal obstruction in that series and by similar observations reported previously (Lowe, Rourke, MacLachlan and Butler, 1950; Holliday, Wallace and Stapleton, 1958). However, the newborn infants' requirements of fluid and electrolytes remain controversial, and some surgeons (Gross, 1953; Santulli, 1954; Rickham, 1957; Wilkinson, 1960) have advised less water and electrolytes than are recommended in the plan, preferring to keep such infants 'on the dry side'. On the other hand, Swenson (1958) and Grob (1960) include infants 1-2 days old in emphasizing that dehydration should be corrected before operation, and Colle and Paulsen (1959) consider that the assessment of volumes required for maintenance should be based upon the average normal oral intake from day to day during the first week of life, which is also recommended in this plan (Fig. 1). These authors were unable to demonstrate a fall in urine flow even in the early phase after surgery in newborns, Calcagno, Rubin and Singh (1955) in infants a few weeks old, and Young et al. (1959) in older children, although adults usually pass very little urine on the first day after operation (Le Quesne and Lewis, 1953; Le Quesne, 1957; Black, 1957). Water