Anemia of Prematurity - Portal Neonatal

intake from protein is included in calculations of total energy intake, not all the proteinderived
calories are available for energy expenditure.
• The ideal energy ratio is to provide 65% of the energy as carbohydrates and 35% as lipids.
Providing more than 165-180 cal/kg/d is of no benefit.
• As an example, the total energy needs of a growing enterally fed premature infant without
any acute illness are listed as follows:
o Resting expenditure: 50 cal/kg/d
o Minimal activity: 4-5 cal/kg/d
o Occasional cold stress: 10 cal/kg/d
o Fecal loss (10-15% of intake): 15 cal/kg/d
o Growth (4.5 cal/g of growth): 45 cal/kg/d
o Total required to produce a 10 g/d weight gain: 125 cal/kg/d
TOTAL PARENTERAL NUTRITION MANAGEMENT Section 7 of 11
Goals for nutrition management
The primary goal is to provide energy and nutrients in sufficient quantities to allow normal growth
and development. Although the goal is to have growth rates that follow either the intrauterine growth
curve for premature infants or the postnatal growth curve for term infants, this is rarely achieved
during the acute phase of an infant's illness.
Calculations
When calculating FEN requirements, most practitioners use an infant's birth weight until the infant
has regained the birth weight. Thereafter, daily weight is used in calculations. Total parenteral
nutrition (TPN) can be started on the first or second day of life in infants who are not likely to
achieve total enteral nutrition within the first week of life. Especially in infants who are ill, protein is
required to decrease or prevent catabolism, and starting TPN on the first day is important. The goal
for TPN is to provide 90-100 kcal/kg/d with 2.5-3 g/kg/d protein.
• Fluid requirement: Calculate the infant's daily fluid (water) requirement. Then, determine the
delivery method, either parenteral (IV) or enteral (OG/PO).
• Energy requirement: Calculate the amount of energy required.
o Determine the specific amounts and sources of carbohydrates and lipids.
o Determine the amount of protein to deliver based on the total number of calories to
be provided. Keep in mind that an infant needs an adequate number of nonprotein
calories (150-200 kcal/g nitrogen) to have a positive balance of nitrogen. Most
practitioners start at 1.5 g/kg/d of protein on the first or second day and increase
daily by 0.5-1.0 g/kg/d, as tolerated. Various amino acid preparations are
commercially available for use in the neonate (eg, TrophAmine).
• Determine the amounts of vitamins and trace elements to deliver.
Carbohydrate
IV dextrose provides most of the energy in TPN. The caloric content of aqueous dextrose is 3.4
kcal/g glucose, which is equal to 34 kcal/100 mL of D10W. As a result of the high osmolarity of
concentrated dextrose solutions, the maximum dextrose concentration that can be delivered safely
through a peripheral vein is 12.5%. Even with central venous access, a dextrose concentration
exceeding 25% usually is not required.
A glucose infusion rate expressed in mg glucose/kg/min is the most appropriate way to express
glucose administration, since the rate accounts for both the glucose concentration and rate of
infusion. Very small premature infants weighing less than 1500 g demonstrate impaired glucose
tolerance. For this reason, in infants weighing less than 1 kg, start at an infusion rate of 6
mg/kg/min. In infants weighing 1-1.5 kg, start at 8 mg/kg/min. If the glucose infusion rate is