What Route Can Babies Get Breast Milk Nicu

NICU:  Fluids, Electrolytes, Nutrition

(run across also Neonatology: Enteral and Parenteral Nutrition)

Initial Fluids
TPN Components
Calorie Calculations
Enteral Feeds

Initial Fluids

The initial fluid, electrolyte and glucose requirements can exist estimated by weight and gestational age:

Gestational Age	Weight	Fluids	Glucose	Electrolytes
weeks	grams	cc/kg/solar day	mg/kg/min	Na	K	Ca
Term	>2000	60-80	6-8	2-four	one-2	0.5-ane
Preemie	800-m	80-100	5-six	three-4	1-two	0.5-1
Micropremie	< 800	120-140+	5-6	3-4	1-2	0.5-1

Infants with gelatinous pare may require very large volumes.  Peel epithelialization occurs at 48-72 hours later which volume requirements may sharply turn down.  Think that fluid overloaded infants are at risk of PDA.

Initial Fluid Orders:

TPN Components (besides see Parenteral Nutrition Recommendations)

Once electrolytes are stable (i.e., changes in fluid limerick are necessary only in one case daily), full parenteral nutrition (TPN) may be started.  Components of TPN are as follows:

Dextrose (glucose)

:  Outset with the dextrose concentration from the previous IVF.  You may increment dextrose by 2.5% daily every bit long as meaning hyperglycemia is not present.  Higher serum glucose levels may be adequate (140s-150s) as long as no more than trace glucouria is present.  Maximum dextrose concentration in PIC is 12.5%; maximum in fundamental line (UVC or Broviac) is that which gives 12-15 mg/kg/min of dextrose (unremarkably D₂₀ to D₂₅).

mg/kg/min glucose =	%glucose * fluid rate in cc/60 minutes * 0.167
	weight (kg)

Amino Acids:  Ordered on TPN form as grams/kg/24-hour interval.  Get-go with 0.5 g/kg/day and advance daily by 0.5 thou/kg/day to a maximum of two.v - 3 g/kg/day.  Monitor BUN (try to continue the BUN below 18) and bicarbonate (try to maintain higher up xx).

Acetate:  Converted by the liver to bicarbonate.  The dose is based on the bicarbonate value from daily electrolytes.  As the amino acid dose increases, more acetate is required.  Since bicarbonate is converted to carbon dioxide, ventilation must exist adequate.  Usual dose is 0.five - 1 mEq/kg/day, merely this is highly variable from patient to patient.

Electrolytes: (refer to table of basic maintenance electrolytes).  In add-on to Na, K and Ca, PO₄ (0.5 to 1 mmol/kg/day) and Mg (0.2 to 0.5 mEq/kg/day).

Lipids:  First with 0.five g/kg/day and advance to iii g/kg/day.  Practise not advance if triglyceride levels are > 180.  If 180-200, either decrease the dose or hold IL for that twenty-four hours.  If greater than 200, concord intralipids for that twenty-four hours and bank check the triglycerides the following morning.  Intralipids are ordered as cc's to exist given over xx to 24 hours equally a continuous infusion.  Using 20% intralipids, multiply the g/kg/solar day by 5 to make up one's mind the volume required per day.
Write the order as: 20% intralipids, run XX cc over 24 hours (= Twenty grams/kg/day)

Caloric Calculations

The full calories and total fluid intake per kilogram should be reported each day using the data sheet from the previous day.  Provision of adequate calories is of import to ensure growth and timely recovery from complications of prematurity.  The usual goal is 120-150 kcal/kg/day (although TPN starts lower, and approaches this goal by advancing dextrose and intralipids).  The caloric yield is cleaved down into calories from TPN (dextrose, protein, intralipids) and enteral feeds (milk/formula and supplements).

Dextrose:  Call back that percentage dextrose is grams of dextrose per 100 cc, and the energy content is 4 kcal/gram.  To summate the energy yield from IV dextrose, multiply the per centum dextrose past the volume (per kg/twenty-four hours) by 0.034

For a 3 kg patient who received 300 cc of D₁₂,

100 cc * 12 % * 0.034 = 40.eight kg/kg/twenty-four hours from glucose.


Protein:  Although amino acids can be catabolized equally an free energy substrate, this free energy is not usually included in the daily energy yield because the intention is for them to be used as a edifice block for proteins.  To summate the percent contribution of fat, protein and carbohydrate, withal, it is useful to exist able to calculate calories from protein.  Each gram of protein contributes 4 kilocalories.

Lipids:  Every gram of lipid yields nine kcal:


30 cc IL/3 kg * 0.2 g/cc IL * nine kcal/gram IL = xviii kcal/kg/day

Enteral Feeds (likewise encounter Enteral Nutrition Recommendations)

One time an babe (premature or otherwise) has achieved clinical stability (especially with respect to hemodynamics and gas exchange), it is frequently appropriate to brainstorm enteral feedings.  The RR should be less than 60  for oral feeds and less than 80 for nasogastric (NG) feeds.  Ideally, the patient should be without UAC or UVC.  If asphyxia is confirmed or suspected, filibuster feeding until day of life 7 in the term newborn.  If the infant is > 2 kg and > 34 weeks, oral feeds may be tried.  Otherwise, NG feeds are necessary.

To begin feeds, determine the route and what you wish to feed the infant.  For oral feeds, begin with sterile water (optional if the patient is fed by NG.  The method, limerick and rate will depend on the weight and gestational age of the patient.


>ii kg, > 34 weeks:  Try sterile h2o first, 5 - 10 cc.  If tolerated, requite maternal breast milk (the optimal food for a newborn) or formula (may beginning with half-strength for smaller or tenuous infants).  For greater than 34 weeks gestation, use regular formula. For less than 34 weeks, use preemie formula  Depending on the weight, begin with five-15 cc q 2-3 hours and advance by v-10 cc every (or every other) feeding until the total daily fluid goal is comprised of feedings.  If using half-strength formula, feeds can be advanced to full forcefulness past the second day of feeds.  Remember to subtract IVF or TPN as feeds are increased to maintain a constant fluid intake.

< 2 kg, < 34 weeks:  usually NG feeds are required since these babies ordinarily lack an adequately coordinated suck-swallow reflex.  I way to begin is with continuous feeds of MBM or half forcefulness premie formula.  As rough guidelines: start with 0.5 cc/hr for weight less than 1200 grams, or 0.five - 1 cc/hr for weight greater than 1200 grams.  If residuals are greater than 5-10 cc, consider holding feeds.  When feeds are begun, follow abdominal girth (AG) every vi-12 hours; follow the abdominal exam closely equally well (picket for distension and palpable bowel loops).  If increasing AG, or abnormal abdominal examination, or bloody stools, obtain a flat abdominal and cross-table lateral radiograph immediately.  If tolerated, feeds may exist advanced by 0.five - 1 cc/hour every 4-6 hours until full feeds are reached.  Also, accelerate to full strength formula by day 2-3 of feeds.  Again, wean TPN/IVF as feeds are increased.


Once an infant is tolerating full feeds, the caloric density of the feeds can be increased.  This is expressed as an abbreviation next to the formula which signifies the number of kcal per ounce of formula.  Once ounce = 30 cc.  Thus, 30 cc of chest milk (MBM₂₀) yields 20 kcal. Advance as tolerated: 24 kcal/ounce for i-2 days, and so 27 kcal/ounce for one-two days, up to a maximum of thirty kcal per ounce.  Signs of feeding intolerance include increasing intestinal girth and residuals, and frequent, loose stools.  If this occurs, either hold the feeds or decrease the caloric density to a previously tolerated level.

For a 3 kg patient who has taken 350 cc of MBM fortified to 24 kcal/ounce with human milk fortifier (HMF):

  360 cc/3kg * 24 kcal/30 cc = 96 kcal/kg/day

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Last modified December 1, 1998

monaghanalkinew.blogspot.com

Source: http://netscut.templaro.com/neonatology/neonatal_survival/nicu_FEN.html

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