Neonates Flashcards
a neonate is considered the first ___ days of life
28 days
premature infants usually need to start off with what type of artificial nutrition
parenteral nutrition
what are the indications to begin PN in neonates
very low birth weight <1500 grams severe respiratory distress syndrome Volvulus Meconium ileus atresia gastrochisis severe Hirschprung's enteric fistula diaphragmatic hernia
the time of starting PN on neonates depends on
their weight at birth
when is PN ideally started in Very Low Brith Weight Neonates
the first few hours of life
what type of PN is started in neonates
Vanilla/Starter/Base PN
how much grams of protein do neonates need when starting on PN
3-3.5g/kg/day
when is PN ideally started in low brith weight premature babies
within 24-48 hours
when can PN be stopped in premature babies
when adequate EN is established
what is the purpose of starter PN in premature infants
to provide immediate protein
what range of dextrose is given in base PN
5-10%
what range of amino acids is given in base PN
3-4%
why is heparin added to neonatal PN
there is not enough forward pressure in the baby’s lines this will prevent back flow and clotting
how much heparin is recommended for neonatal PN
0.25-1 unit/mL
what prevents clotting in the neonatal PN line
heparin 0.25-1 unit/mL
neonates require ______ fluid in the first 48 hours of life (about 70-90mL/kg/day) *it is better for the lungs
decreased fluid
over time, neonates will have _____ fluid needs from insensible losses associated with prematurity and phototherapy
increased
a preterm infant requires ____mL/kg/day of water
75-120mL/kg/day
a term infant requires ____mL/kg/day of water
60-120 mL/kg/day
an infant over 1 month old or 3-10 kg requires _____mL/kg/day of water
100mL/kg/day
how are total fluid needs calculated for neonatal TPN
Total fluid from calculation - fluid from drips - ILE volume- volume in feeds = volume left over for PN
Example: a 25 week gestational male is admit to the NICU. his brith weight is 515 grams, head circumference 21.5 cm and length is 30 cm. He is at the 4th percentile weight, 17% percentile HC and 14% tile length. On the Fenton curve his z-score is - 1.7. On his first day your hospital gives 70mL/kg/day of fluids, what is his hourly rate?
515 grams / 1000 = kg - .515 kg
.515 x 70mL/day = 36mL of fluid in 24 hours = 36/24= 1.5mL/kg/day
why do neonates usually have high ammonia and BUN when given PN
they have higher protein needs due to an immature urea cycle activity This is common)
when is adding insulin considered in neonatal PN
when BG consistently >200mg/dL (response is variable)
should insulin be added to PN in neonates
no you’ll have better control if given separately
be careful when providing insulin to neonates as they are
very insulin sensitive
premature neonates can be deficient in fatty acids within ___ days
3-7 days
fatty acids are essential for neonates because t
they are essential for central nervous system development
if ____ lipids are used for ILE they need to be given at a higher rate to meet essential fatty acid requirements
SMOF
neonates can safely be at a GIR rate up to
14mg/kg/min
Calculate the GIR of a patient getting 12g/kg/day of dextrose
GIR: a mg per kg per min
12 grams * 1000 mg = 12000mg
24 hrs , 1 hr= 60 min x 24 = 1440 min
12000/1440= 8.3 mg/kg/min
how much sodium is required for preterm neonates in PN
2-5 meq/kg/day
why do neonates require higher amounts of calcium and phos
bone growth
___ and ____ are extremely important to prevent metabolic bone disease (they have lost out on bone mass accrual in their third trimester)
calcium and phos
what is the optimal calcium to phos ratio to promote the greatest retain
2.6 to 1 mEq:mM or 1.7 to 1.0 mg:mg
premature neonates may need a calcium to phosphorous ratio up to _____ especially if they were categorized as intrauterine growth restriction (they tend to reseed a little)
2:1 mEq/mM
if a neonate is <2.5 kg how much PEDI trace is needed
2mL/kg/day
if a neonate is greater than or equal to 2.5 kg how much PEDI trace is needed
5mL/day
_____ is the precursor too glutathione. It acts as an antioxidant, allows for the reduction of methionine, and lowers pH to improve calcium and phos solubility
L-cysteine
L-cystiene is not required unless
giving at least 4g/kg/day protein in PN
how much carnitine is given in neonatal PN
5-10mg/kg/day
_____ is added or given to neonates on PN to help better utilize triglycerides as it is required for transport of long chain fatty acids across the mitochondrial membrane for oxidation
Carnitine
when is supplemental carnitine required for premature neonates on PN
<32-34 weeks gestational age
_____ is added to neonatal PN to maintain catheter patency
heparin
when are labs typically drawn in neonates when started on PN
after the first 24 hours of life
a baby only has ____mL of blood/kg body weight
80 mL
some electrolytes are naturally _____ in neonates especially potassium and phosphorous
higher
what is the average potassium level in a neonate
4-6.2 Meq/L
what is the average BUN in a neonate
4-15 mg/dL
what is the average serum creatinine in a neonate
4-15 mg/dL
what is the average phosphorous level in neonates
4.1-9 mmol/L
what osmolarity is allowed In central PN
> 900mOsm/L
pediatric patients can tolerate a slightly higher ___ in PN due to increased elasticity of their veins
osmolarity about 1,000 mOsm
ILE in neonates is often y-site or piggy backed in order to
prevent phlebitis
what factors affect calcium and phos solubility
amino acids (not enough)
calcium and phos concentration (if exceeds 55)
calcium salt form (gluconate is preferred over chloride)
pH: lower pH is more desirable
temperature; don’t let it get hot
order of mixing : ALWAYS ADD PHOS FIRST in pn and ALWAYS ADD CALCIUM LAST in pn
what calcium salt form is preferred for mixing PN for optimal calcium-phosphorous solubility
calcium gluconate
should pH be low or high to promote optimal calcium-phosphorous solubility
LOWER (can add L cysteine to lower_
what can be added to PN to lower its pH for better ca-Phos solubility
L-cysteine amino acid
when mixing PN _____ should always be added first and _____ should always be added last
PHOS FIRST
CALCIUM LAST
on a calcium phosphorous curve does your calcium phos level want to be above or below the curve
BELOW THE CURVVE will decrease the risk of precipitation
