Enteral nutrition

Enteral Nutrition is the preferred route if safe Gut atrophy occurs w/in 3 days of stopping feeds Enteral feeds maintain gut physiology, cell mass, and integrity of intracellular junctions

Trophic feeds (~5-10cc/kg) may result in less bacterial translocation

If pt is at high risk of aspiration, trans-pyloric (TP) tube feedings should be used

Infants (3 -10 kg)

  • Breast milk or standard formula
  • Use comparable formula (ie soy, cow, low fat)
  • Standard concentration 20 kcal/oz
  • May be prepared to 24, 27, or 30 kcal/oz for pts w/ high nutrient needs or volume restriction

Children 1-10 yr (10-40 kg)

  • Use pediatric formulas (Pediasure, Nutren Jr)
  • Standard concentration is 30 kcal/oz or 1kcal/cc

Adolescents

  • For > 40 kg, consider adult formulas
  • Standard concentration is 1.2 kcal/cc

Electrolyte requirement

  Neonates Child/Adolescent
Sodium 2 - 6 Eq/kg/day 3 - 5 Eq/kg/day
Potassium 2 - 3 Eq/kg/day 1 - 2 Eq/kg/day
Chloride 2 - 3 Eq/kg/day 2 - 3 Eq/kg/day

Growth goals

Age Weight (g/day) Length (cm/mo)
0 - 3 mo 20 - 40 2.6 - 3.6
3 - 6 mo 15 - 20 1.77 - 2.4
6 - 12 mo 10 - 15 1.4 - 2.1
1 - 3 yr 5 - 8 0.8 - 0.9
7 - 10 yr 5 - 15 0.4 - 0.6

Parental nutrition

  • Use NVN (neonatal) in neonates <3 kg or < 2 mos
  • Use PVN (pediatric) for pts > 2mos to 35-40 kg
  • Use AVN (adult) for pts > 40 kg

Amino acids – Begin at intended goal concentration, adjustfor metabolic condition or organ function

Dextrose – Begin w/ D12.5W and advance based on glucose levels by 5% increments

Lipids – Initiate on first day of parenteral nutrition, typicall yinfuse over 20 hr. Keep < 30-40% of total calories.

Calories / ml of parenteral nutrition

Dextrose %

Amino Acid %

 

1.8

2.0

2.8

3.0

3.5

4.0

4.5

5.0

D10

.41

.42

.45

.46

.48

.50

.52

.54

D12.5

.50

.51

.54

.55

.57

.59

.61

.63

D15

.58

.59

.62

.63

.65

.67

.69

.71

D17.5

.67

.68

.71

.72

.74

.76

.78

.80

D20

.75

.76

.79

.80

.82

.84

.86

.88

D22.5

.84

.85

.88

.89

.91

.93

.95

.97

D25

.92

.93

.96

.97

.99

1.01

1.03

1.05

Kcal/ml from non standard solutions =
{(3.4 X % Dextrose) + 4 X %AA)} / 100 = kcal /ml

Lipid goals for age

10% lipid

1g  fat/10ml

1.1kcal/cc

20% lipid

2g fat/10ml

2.0kcal/cc

Age

Dose

0-1yr

2-2.5g/kg/day

1-3yr

2g/kg/day

4-10yr

1.0-1.5g/kg/day

>10yr

0.5-1.0g/kg/day