Nutrition/TPN

Parenteral Nutrition Calculator (CTICU - DOWNLOAD TO USE)

Enteral Nutrition Calculator (BETA - DOWNLOAD TO USE)

GIR Equations:

• (D% x Rate) / (6 x Wt in kg)

• (D% x TDF in mL/kg/day) / 144

Start on DOL# 1 and increase by 1 g/kg/day to goal

Preterm goal: 4.5 g/kg/day (ELBW may not tolerate it initially) 

Term goal: 3.5 g/kg/day 

Renal failure/azotemia: 2-2.5 g/kg/day (not less than 1.5 g/kg/day) 

Hypoalbuminemia: additional protein may be required if serum albumin < 3.0 g/dL, and/or BUN < 5 mg/dL 

If severe metabolic acidosis, hold L-cysteine for few days 

Max GIR 12-15 mg/kg/min as needed for adequate caloric intake

May need to adjust for the infant with sepsis, on steroids or ELBW

Peripheral TPN: maximum dextrose concentration of 12.5%, min 4.5%

IV with medications: may not dilute with dextrose greater than D10W 

Start on DOL #1 at 1 g/kg/day in ELBW and 2 g/kg/day for older preterm and term infants

Increase by 0.5-1 g/kg/day up to 3 g/kg/day if TG level is normal

Check TG in infants <1500 grams before they are increased to 3 (goal is triglycerides < 200 mg/ dL)

Stop IL when enteral volume intake >120 mL/kg/day

Chylothorax: no need to withhold IV lipids

Cholestasis: decrease IV lipids to 2 g/kg/day if direct bili > 2 mg/ dL and increasing.

Sepsis: check triglyceride levels and adjust lipids as needed to keep TG <200 mg/dL 

If lipids withheld for any reason, do so < 5 days (prevent essential fatty acid deficiencies)

Start Na 1-2 mEq/kg/day on DOL #2-3

• Infants are born with excess sodium and will usually have a salt diuresis ~DOL 3

Start K 1-2 mEq/kg/day on DOL #2-3 if adequate UOP

Start Mg 0.5-1 mEq/kg/day on DOL #3 

Start calcium on DOL #1

Start phosphorus on DOL #2 at Ca: Phos ratio of 1.3:1

Progress to goal for both calcium and phosphorus in 2-3 days 

• <32 weeks GA or <2 kg: Ca 75 mg/kg and Phos 57 mg/kg

• >32 weeks GA or >2 kg:      Ca 60 mg/kg and Phos 46 mg/kg

Start at the appropriate formulation for gestational age on DOL # 1

Preterm formulation: continue until 3.5 kg

Term formulation: term infants and preterms when >3.5 kg

Cholestasis formulation for severe disease: direct bilirubin > 5 mg/dL with upward trend

• Check serum copper once/month (while on TPN) if the infant is >44 weeks C.A.

• If serum copper > 1.45 microgram/mL -> change to cholestasis trace elements

• If < 1.45 microgram/mL -> continue age-appropriate trace elements