Neonatal TPN

 

 

DOL 0

Advance by

Goal

per kg/d

Factors to Consider

Amino Acid (g/kg/d)

2

1

3.5-4 (<1500g)

2.5-3 (term)

BUN/Cr

Dextrose (% conc.)

(GIR in mg/kg/min)

10%

(4-6 mg/kg/min)

0.5-1%

(1-2 GIR)

12-13%

(5-15 mg/kg/min)

PIV’s: must keep £12.5% dextrose 

Lipid (g/kg/d)

1

0.5-1

3

TG, refractory hyperbili, cholestasis

Sodium (mEq/kg/d)

0-1

prn

2-5 mEq

May need up to 8-9 mEq/kg (if diuretics)

Potassium (mEq/kg/d)

0

prn

2-3 mEq

Limit K+ until u/o >1cc/kg/h

Acetate

(mEq/kg/d)

0

prn

0-3 mEq

May need if acidotic

Phosphate

(mmol/kg/d)

0

prn

1.5-2 mmol

Maximize for osteopenia prevention

Calcium Gluconate

(mg/kg/d)

200+

prn

>650  preterm

450    term

Maximize for osteopenia prevention

Magnesium

(mg/kg/d)

0-30

prn

6-30 mg

Caution if mom received Mg during pregnancy

Zinc

(mcg/kg/d)

150-300

prn

400 preterm

250 term

Non-oliguric ARF: 600

SBS: 800

Chromium

(mcg/kg/d)

0-0.14

prn

0.1-0.2

Hold if Creatinine >1

Manganese

(mcg/kg/d)

0-2

prn

1-2

Hold if d. bili >2

Copper

(mcg/kg/d)

0-20

prn

20

Hold if d. bili >2 AND

w/ Cu toxicity

(or limit to 10 mcg/kg/d )

Selenium

(mcg/kg/d)

0-3

prn

1.5-3 preterm

2-3 term

Limit to <1 Se if Creatinine >1

Iron

(mg/kg/d)

0

0

Consider IV Iron if pt on TPN >8 weeks

(0.1-0.2 mg/kg/d)

Add only if pt has not received more than 180 mL of transfused blood

Total kcals/kg/day

35-50

20-30

90-110

>115 kcal/kg may contribute to cholestasis/­ LFT’s

 

Starter TPN should be ordered immediately after birth for infants <1500g