Why is insensible water loss more pronounced in extremely premature infants?

Insensible water loss is more pronounced in extremely premature infants primarily due to their high body surface area to body weight ratio. In neonates, particularly those who are extremely premature, the skin is thin and immature, which contributes to an increased rate of transepidermal water loss. The greater surface area relative to body weight allows for a larger area through which water can be lost, exacerbating dehydration risks.

Furthermore, the physiological immaturity of these infants, including underdeveloped skin and the absence of a fully effective barrier, enhances this insensible water loss. This characteristic makes it vital for healthcare providers to closely monitor hydration status and implement appropriate interventions for fluid management.

In contrast, aspects such as fluid intake and respiratory rates are not directly connected to the inherent characteristics making insensible water loss more significant in these infants, and the presence of a mature skin barrier is not applicable in this context since extremely premature infants lack such protection. Thus, the unique anatomical and physiological properties of these infants lead to the heightened risk of insensible water loss, reinforcing the importance of understanding their needs in the NICU setting.