Pediatrics II: Parental Nutrition

Question 1

Indications for use of TPN

Answer 1

• Significant Bowel dysfunction resulting in inability to achieve adequate enteral nutrition for >4-5 days (children & adolescents) or 2-3 days (infants)
• Hypermetabolism( eg. trauma, burns)
• Moderate-to-severe pancreatitis requireing bowel rest > 7 days
• Boweldys function

Question 1

Reasons for bowel dysfunction

Answer 1

• Paralytic ileus
• Major gut resection leading to diarrhea, malabsorption (>70%)
• Small bowel obstruction
• Radiation enteritis
• GI fistula; except when enteral access can be placed distal to the fistula
• Hemodynamic instability where high risk for mesenteric ischemia (eg Necrotizing enterocolitis in premature infants)
• Severe dysmotility leading to non-functioning GI tract

Question 2

Contraindications for PN

Answer 2

• When the gut works: PN is contraindicated!!
• Prognosis does not warrant aggressive nutrition support (eg palliation; note TPN can be part of palliation in children; not typically in adults)
• Vascular access is severely compromised

Question 3

Energy requirements for PN

Answer 3

Energy Requirements in PN to meet growth requirements (may be higher with hypermetabolism)
* 80-100 kcal/kg; infants < 1 year
* 60-90 kcal/kg for 1-12 years
* 30-60 kcal/kg (adolescents > 12 years)

Influenced by age, disease type & severity, gender, body composition

Question 4

Guidelines for Administration of Parenteral Dextrose

Answer 4

Ignore preterm

Question 5

Guidelines for Administration of Parenteral Amino Acids

Answer 5

• may need more than maximum for LBM accumulation
• 1-2 years post puberty needs are similar to adults

Question 6

Guidelines for administration of Parenteral Lipids

Answer 6

volumes administered are lower than adults since weight is lower

Question 7

What is chylothorax?

Answer 7

Leakage of chyle (lymphatic fluid) into the pleural space through thoracic duct

Question 8

How is chylothorax managed?

Answer 8

Managed using Portagen
* chyle production, chyle flowing through lymphatic system
* MCT formula-absorbed directly into portal system, do not enter lymphatic system
* Require supplemental folic acid, vitamins A,D,C (Trivisol)

Question 9

Infant PN case

Answer 9

Peds nutrition II

Question 10

Child PN case

Answer 10

Peds nutrition II

Question 11

Steps for PN

Answer 11

1. in Pediatric Nutrition Assessment: Evaluate weight and height in terms of actual vs ideal body weight
2. Determine IBW and %IBW
3. evaluate which weight to use
4. follow other PN instructions…