Dear Editor, Effective fluid and electrolyte management involves (1) calculating the fluid and electrolyte requirement for maintaining metabolic functions; (2) replacing losses (evaporative, third space, external); and (3) considering pre-existing fluid deficit or excess. The daily fluid requirements can be approximated to 120-150ml/kg/24 hours in prematures, 100ml/kg/24 hours in neonates (term) and 1000ml+50ml/kg/24 hours in infants >10 kg of body weight Detail of fluid requirement in normal neonates based on birth weight is as follows : The estimations of daily fluid requirements should also take into consideration : (1) urinary water losses, (2) gastrointestinal losses, (3) insensible water losses, and (4) surgical losses (drains). Water represents 70-80% of the body weight of the normal neonate and premature baby respectively. Total body water (TBW) varies inversely with fat content, and prematures have less fat deposits. TBW is distributed into extracellular fluid (ECF) and intracellular fluid (ICF) compartment. The ECF compartment is one-third the TBW with sodium as principal cation and chloride and bicarbonate as anions. The ICF compartment is two third the TBW with potassium the principal cation. The newborn's metabolic rate is high and extra energy is needed for maintenance of body temperature and growth. A change in body water occurs upon entrance of the fetus to his new extrauterine existence. There is a gradual decrease in body water and the extracellular fluid compartment with a concomitant increase in the intracellular fluid compartment. This shift is interrupted with premature birth. The newborn's body surface area is relatively much greater than the adults and heat loss is a major factor. Insensible water losses are from the lung (1/3) and skin (2/3). Transepithelial (skin) water is the major component and decreases with increase in post-natal age. Insensible water loss is affected by gestational age, body temperature (radiant warmers) and phototherapy. As the relative humidity of environment increases the transpithelial water loss (TEWL) decreases. The radiant warmer exposure increases the TEWL between 50 and 140%. Similarly, the TEWL increases approximately 60% with exposure to phototherapy while the impermeable plastic covering decreases the TEWL about 50-70%. The respiratory water loss (RWL) for a new born full term infant is approximately 5 ml/kg body weight per 24h at a relative humidity of 50% and TEWL 7ml/kg in a similar environment. Thus, the insensible water loss for a full term infant in the thermoneutral environment at 50% relative humidity is 12ml/kg/24h. Neonatal renal function is generally adequate to meet the needs of the normal full-term infant but may be limited during periods of stress. The ideal urine output in neonate representing the renal water required to allow excretion of the solute load at an isotonic urine osmolality of 280 mOsmol/dl (specific gravity 1.009-1.012) is 2-4 ml/kg/hr. The older child needs about l-2ml/kg/hr and the adult 0.5-1 ml/kg/hr. The electrolyte requirement of the full term neonate is : sodium 2-3 meq/kg/day. potassium l-2meq/kg/day. chloride 3-5 meq/kg/day at a rate of fluid of 100ml/kg/24 hours for the first 10 kg of weight. Special needs of preterm babies fluid therapy are : conservative approach, consider body weight changes, sodium balance and ECF tonicity. They are susceptible to both sodium loss and sodium and volume overloading. High intravenous therapy can lead to PDA, left ventricular failure, respiratory distress syndrome, bronchopulmonary dysplasia, and necrotising enterocolitis. The degree of dehydration can be measured by clinical parameters such as body weight, tissue turgor, palpation of peripheral pulsations, depression of fontanelle, dryness of the mouth and urine output. Blood urea nitrogen, haematocrit, serum sodium, serum potassium, serum chloride levels and urine osmolality are the additional factors to monitor the response of the patient and the IV fluids are adjusted accordingly. Blood volume estimates of help during surgical blood loss are : (1) premature 85-100ml/kg, (2) term 85 ml/kg, and (3) in infant 70-80 ml/kg. Intravenous nutrition is one of the major advances in neonatal surgery and will be required when it is obvious that the period of starvation will go beyond five days. Oral feeding is the best method and breast is best source. A newborn infant requires 100-200 calories/kg/day for normal growth. This is increased during stress, cold, infection, surgery and trauma. Minimum daily requirement is 2-3gm/kg of protein, 10–15 gm/kg of carbohydrate and a small amount of essential fatty acids.