Which of these assessments indicate dehydration in a preterm neonate?

Appeared in: Daman & Diu Staff Nurse - 2018

Explanation

A urine output below 1 mL/kg/hr, known as oliguria, is a critical indicator of dehydration in neonates.
This reduced output signifies decreased blood flow to the kidneys, a compensatory mechanism to conserve body fluid when intravascular volume is depleted.
Normal urine output for a neonate is 1–3 mL/kg/hr, so any value below this range, especially an absolute value under 1 ml/hr in a preterm infant, requires immediate attention.
As dehydration worsens, the body reduces urine production to conserve water, making oliguria a key sign of significant fluid deficit.

Option A: Bulging fontanels are a sign of increased intracranial pressure or fluid overload (overhydration), which is the opposite of dehydration.
Option B: Good skin turgor, where the skin promptly returns to its normal position after being pinched, is an indicator of adequate hydration.
Option C: Excessive weight gain suggests fluid retention and overhydration. Dehydration is characterized by weight loss from fluid deficit.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Assessment of dehydration in preterm neonates as background academic context rather than a clinical decision trigger.
Daily weight measurement is the single most sensitive and accurate method for monitoring a neonate's fluid status.
Preterm neonates are at a higher risk for dehydration due to a larger body surface area to weight ratio, thinner skin leading to higher insensible water losses, and immature kidney function.
What if? If a preterm neonate has a urine output of 2 mL/kg/hr but also has a sunken fontanel and dry mucous membranes, the nurse should still suspect early dehydration. The urine output might not have dropped yet, but other clinical signs are present, warranting closer monitoring and potential intervention.

How to Approach the Question

First, identify the core concept of the question: recognizing the signs of dehydration in a preterm neonate.
Second, recall the pathophysiology of dehydration, which involves a deficit in total body fluid.
Third, evaluate each option to determine if it reflects a state of fluid loss or fluid excess.
Bulging fontanels and excessive weight are signs of fluid excess (overhydration), so eliminate these options.
Good skin turgor is a sign of normal hydration, so it can also be eliminated.
Decreased urine output (oliguria) indicates that the kidneys are conserving water in response to a low fluid volume, which is a hallmark of dehydration. This makes it the correct answer.

Concept Tested & Keywords

QHJlkk6Cph7-oOIV-1q64z

E6 Ghai Essential Pediatrics(pp 26-904 of 913) pp. 311-313, 129-131

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 574-576

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