Advances in providing care for infants of very low birth weight have improved their survival status. Because the fundamental problem for these infants is physical immaturity, the balance of fluids and electrolytes is a complex phenomenon to assess and manage. In managing the major problems of fluid and electrolyte balance for these infants, the controversy of fluid restriction versus fluid replenishment has persisted to the present. Thus, the challenge of managing fluid and electrolyte therapy remains to be conquered in the next decade, providing chances for nurses' to expand their role in neonatal intensive care units. They will become more involved and will take on supervisory roles in managing the fluid and electrolyte balance of these infants.