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Parenteral Nutrition Strategies For Optimal Outcome PDF
Parenteral Nutrition Strategies For Optimal Outcome PDF
Parenteral Nutrition Strategies For Optimal Outcome PDF
Rinawati Rohsiswatmo
Severe IUGR
Oral care
THE FIRST GOLDEN HOUR
Val Castrodale, MSN, RN, NNP-BC; Shannon Rinehart, RNC-NIC, BSN. The Golden Hour, improving the stabilization of the very low birth-
weight infant. The natinal association of neonatal nurses. 2014.F9-14
Aggressive early total parenteral nutrition
in low birth-weight infants
32 ventilator-dependent preterm infants were
prospectively randomized into two groups
The Early Total Parenteral Nutrition The Late Total Parenteral Group
(ETPN) group Nutrition (LTPN):
mg/kg/day g/kg/day
No TPN TPN
400 2.5
300 1.9
200 1.3
100 0.6
0 0
7 14 21
-100 -0.6
N Intake
-200 N Urine -1.3
N Retention
Postnatal age (days)
Schanler, J Pediatr 1994;125:961
Even the lung benefit from increased amino
acid intake in ELBW infants
Long term study of ELBW with mean birth weight 800 g & GA
26 wk;; given early amino acid infusion showed significant
growth in 36 weeks postmenstrual age.
19
Early aggressive protein to reduce deficits
(Dinerstein, 2006)
Delayed TPN, Hyperglycemia & Hyperkalemia
Delayed TPN
Insulin
Glucose K+
FLUID REQUIREMENTS
Age ( day ) 1 2 3 4 5+
22
FLUID REQUIREMENTS....
23
Amino • Start amino acids within 2 hours of birth
with 1.5-3 g/kg/day & increase by 1
Acids g/kg daily to max 4.0 g/kg/day
25
Clinical Practice: Total Parenteral
Nutrition Administration
Advance by 1-3
mg/kg/min daily to a Hyperglycemia is more
maximum of 12 commonly encountered
mg/kg/min. GIR during anesthesia and
>10mg/kg/min may result surgery
in glycosuria and osmotic
diuresis
Lipid/fat
For infants with cholestasis (i.e, direct bilirubin >2.5 mg/dl), discontinue
the trace element solution and give :
- Zinc 400 mcg/kg/d TOTAL (preterm infants) -
300 mcg/kg/d TOTAL (term infants)
- Chromium 0.2 mcg/kg/d
- Selenium 0.2 mcg/kg/d
- Discontinue selenium with patients on renal dialysis
…Minerals and fat and water soluble
vitamins
Aluminum : aluminum is found as a contaminant
in parenteral solutions. Aluminum is associate
with impaired neurologic development and
decreased bone calcium uptake. The
recommended IV aluminum exposure is ‘no
more than 5
¨ Micro nutrient:
¤ Zn given at dose 300mcg/kg since day one
SCHEDULE LAB
DAILY urine glucose, vital signs (temperature,
respiratory rate, heart rate, blood pressure)
3x/WEEK serum electrolytes, HCO3, renal function,
calcium, magnesium, Phosphor
WEEKLY liver function tests incl protein/albumin,
haematocrit, FBC
<700g 700-999g
Hari 0 100 6-8 2.5 0.5 1.0
Hari 1 110 7-8 3.5 1.0 2.0
Hari 2 130 8-9 4 1.5 3.0
Hari 3 140 9-10 4 2.0 3.0
Hari 4 150 10-11 4 2.5 3.0
Hari 5 160 11-12 4 3.0 3.0
TPN REGIMENTS IN CIPTO MANGUNKUSUMO HOSPITAL
(requiring peripheral line – providing less calories)
Birth
Weight
:
1000-‐1500
g
or
GA
28-‐32
weeks
1
g
=
30
ml
Hari 0 60 4-6 0 0
Hari 1 80 6-8 1.5 1.0
Hari 2 100 8-9 2.5 2.0
Hari 3 120 9-10 3.0 3.0
Hari 4 140 10-11 3.0 3.0
Hari 5 150 11-12 3.0 3.0
TPN REGIMENTS IN CIPTO MANGUNKUSUMO HOSPITAL
(requiring peripheral line – providing less calories)
Birth
Weight
:
≥2500g
or
GA
28-‐32
weeks
1
g
=
30
ml
Hari 0 60 4-6 0 0
Hari 1 80 6-8 0 0
Hari 2 100 8-9 1.0 1.0
Hari 3 120 9-10 2.0 2.0
Hari 4 140 10-11 3.0 3.0
Hari 5 150 11-12 3.0 3.0
Usia gestasi Berat lahir <700 Usia gestasi Usia gestasi 28-32 Usia gestasi 33- Cukup bulan (37-
g <28 minggu minggu ATAU <37 minggu ATAU 42 minggu)
ATAU
ATAU
Berat lahir 1000 - Berat lahir 1500-
Berat lahir bayi Berat lahir 1500 g 2500 g
<1000 g
Kebutuhan karbohidrat 6-8 mg/kg/menit 6-8 mg/kg/menit 6-8 mg/kg/menit 4-6 mg/kg/menit 4-6 mg/kg/menit
dalam GIR
Amino acids 6 % 17 ml 17 ml
Potassium 0,4 ml 1 ml
NaCl 3 % 0 2,7 ml
Amount 40 cc 40 cc
49
SUMMARY
¨ Karbohidrat :
GIR (mg/kg/min) =
Kecepatan cairan (cc/jam) x konsentrasi Dextrose (%)
6 x berat (Kg)
Day 1 PG 1 100 3 90 2 10
Day 2 PG 1 110 3 90 3 15
Day 1 PG 1 100 3 90 2 10
Day 2 PG 1 110 3 90 3 15
Day 1 PG 1 80 0 0 0 0
Day 2 PG 1 80 2 60 2 10
Day 4 PG 2 120 3 90 3 15
Day 5 PG 2 150 3 90 3 15
KEBUTUHAN ELEKTROLIT
Riskesdas, 2013
Low Birth Weight (LBW)
¨ Birthweight < 2,500 grams .
¨ Incidence in Indonesia: 10.2%
¨ 6-30 % LBW were categorized as IUGR (Helen
Kay, 2000)
INTRA UTERINE GROWTH IN THE
LAST TRIMESTER
Brain Weight Body calcium
BW BL
375 g
3500 g 28000 mg
50 cm
800 g
30 cm 75 g 5600 mg
IUGR
Small For
Gestasional
Age
Catch Up
Growth
EUGR
¨ EUGR occurs when a premature infant's growth falls
below the 10th percentile in comparison to a normal
fetus of the same gestational age.