Guideline neonatal parenteral nutrition

Neonatal parenteral nutrition

Starter TPN 100 ml (Prefilled syringe 50ml /syringe)

(ประกอบดว้ ย 10%Dextrose(glucose 20 ml), AA 4.2 g (42 ml), Ca 0.5 mmol (2 ml), sterile water 36 ml)

Indication GA<32 wk or BW<1500 gm

20%SMOF

Indication

1.ELBW

2.เคสทพี่ จิ ารณาแล้วว่าต้องให้ TPN 2 wk ขึน้ ไป

3.มปี ัญหา PNALD/liver disease

Initiate Advance Goal

Preterm/(Term) per day Preterm/(Term)

Fluid (ml/kg/day) 60-80 10-20 140-160/(100-140)

Energy(Kcal/kg/day) 45-55/(45-50) 90-120/(75-85)

Protein (g/kg/day) อยา่ งนอ้ ย1.5 1 3.5/(3)

Fat (g/kg/day) 0.5-1 0.5-1 4

Glucose (mg/kg/min) 4-8/(2.5-5) 1-2 8-10/5-(10) Max: 12

Na (mEq/kg/day) 0-2 2-5/(2-3)

K (mEq/kg/day) 0-3 1-3

Ca (mmol/kg/d) 0.8-2 0.8-2 [Ca:P molar ratio = 0.8-1:1]

P (mmol/kg/day) 1-2 1-2 [Ca:P molar ratio = 0.8-1:1]

Keep serum P 5-8 mg/dl

Mg (mEq/kg/day) 0.2-0.4 0.2-0.4 keep serum Mg ≥ 1.7mg/dl

Zn(mcq/kg/day) 450-500mcg/kg/day Preterm ใส่ Zn อีก 2 ml/kg/ Term ไมต่ อ้ งใส่

ESPGHAN/ESPEN/ESPR 2018
https://www.ucsfbenioffchildrens.org/pdf/manuals/47_TPN.pdf

+Vitalipid-N-infant 4 ml/kg (max 10 ml/day)

+Trace element (Peditrace 1 ml/kg)
Monitoring

Infants Frequency Lab test

ELBW 1st 3days Q 12 hr DTX, Na, K, Cl, HCO3
ELBW 1st 3days OD Ca, P, Mg, TG( fat>2 g/kg/day)

All (stable) จนั ทร,์ พฤหสั DTX, Na, K, Cl, HCO3, Ca, P, Mg, Alb
TPN > 2 wk Q 1-2 wk
LFT, ALP

- เพมิ่ BUN, Cr at DOL 3-4 (หลงั ได้ protein ≥ 3g/kg/day)