Parenteral and enteral nutrition

Question 1

Fluid totals

Answer 1

term: 60-80 mL/kg/d
preterm 30-37 weeks: 80 mL/kg/d
VLBW: 100-120 mL/kg/d, 80-100 in isolette
decrease intake in asphyxiated infants and infants in renal failure

Question 2

parenteral lipids

Answer 2

Start at 0.5-1.5 g/kg/d, advance by 0.5-1 g/d to goal of 3-4 g/d
20% lipids is 20g/100mL
Carnitine supplementation may enhance lipid utilization
Monitor TGAs in babies <1.5kg, sepsis with CR decompensation, PPHN, or very high hyperbili

Question 3

Glucose infusion rate

Answer 3

mg/kg/min of glucose infusion
Start with 4-6 mg/kg/min, advance by 1-2 mg/kg/min to goal of 12 mg/kg/min (advance conservatively in babes <1kg.
Do not go below GIR of 3.5-4 mg/kg/min (neuro injury), and GIR>18-20 may lead to lipogenesis and fatty deposits in liver
For hyperglycemia, decrease GIR by 20%

Question 4

parenteral protein

Answer 4

Start with 1.5-3 g/kg/day and increase 0.5-1.5 mg/kg/d to 3-4 mg/kg/d (4 in preemies)
About 22 nonprotein kcal/kg are needed for every 1g protein/kg to promote protein utilization

Question 5

Parenteral sodium

Answer 5

135-145 mEq/L
Adjust by 1-2 mEq/kg/d
Don’t need supplemental sodium in first days of life

Question 6

Parenteral potassium

Answer 6

1-2+ mEq/kg/d
Adjust by 1 mE/kg/d or 0.5 with renal compromise
Don’t need supplemental potassium in first days of life
Consider adding potassium phosphorus on 2nd DOL starting at 1 mE/kg/d

Question 7

Parenteral calcium

Answer 7

1-4 mEq/kg/d, 20-90 mg/kg/d
(1 mEq Ca= 20 mg elemental Ca)
Serum Ca will not normalize unless Mg and phosphorus are ok
Ca cannot exceed 1mEq/100mL for solubility

Question 8

Parenteral magnesium

Answer 8

(1mEq Mg= 12 mg elemental Mg)

Question 9

Parenteral phosphorus

Answer 9

35-70 mg/kg/d (1-2 mmol/kg/d)

Question 10

Vitamin D

Answer 10

400 IU daily

Question 11

Parenteral copper

Answer 11

Trace mineral
Excreted via bile, so do not give in direct bili>2
Give once/week while D bili remains high

Question 12

Parenteral manganese

Answer 12

Trace mineral
Excreted via bile, so do not give in direct bili>2
Give once/week while D bili remains high

Question 13

Parenteral chromium

Answer 13

Trace mineral

Excreted by kidneys, so do not give in renal compromise

Question 14

Parenteral zinc

Answer 14

May be indicated in patients with GI losses (is ileostomy). Max dose 500 mcg/kg/day

Question 15

Parenteral carnitine

Answer 15

Add within first week at 10-20 mg/kg/d

Biosynth is not fully developed in neonate. Essential for metabolism of long-chain fatty acids.

Question 16

parenteral Selenium

Answer 16

trace mineral
Add to PN in first week
Antioxidant against lipid peroxides
Renal excretion; dose-adjust in renal compromise

Question 17

Parenteral cysteine

Answer 17

lowers acidity of PN, increasing the solubility of calcium and phosphorus

Question 18

1g dextrose= x kcal?

Answer 18

1g dextrose=3.46 kcal

Question 19

1 gram protein= x kcal?

Answer 19

1g protein= 4 kcal

Question 20

kcal/mL in 20% lipid

Answer 20

2 kcal/mL in 20% lipids

Question 21

mEq/mL n NS

Answer 21

0.154 mEq/mL

Question 22

Sodium bicarbonate 4.2% soln, is x mg/mL and xmE/10mL

Answer 22

42 mg/mL and 5 mEq/10mL

Question 23

calorie needs

Answer 23

infants on full TPN require 100-120 kcal/kg/d (ish, depending on disease process)
Infants on full enteral feeds need 120-130 kcal/kg/d