Who is the Holliday-Segar method not suitable for?

• A. Neonates < 14 days old
• B. Adults with renal failure
• C. Infants over 6 months
• D. Children with fever

Answer: (A)

The method is not suitable for the youngest neonates because their kidneys are not yet mature and their fluid balance is driven by different physiology in the first days to weeks of life. In neonates, there are rapid shifts in body water, high insensible losses, and immature renal handling of electrolytes and fluids. Using the Holliday-Segar maintenance formula, which assumes stable renal function and typical energy-expenditure-driven needs, can misestimate true needs in this age group, risking both under- and overhydration. For infants beyond the neonatal period, this method is appropriate, and in adults with renal failure, adjustments or different approaches are required due to impaired excretion.