Nutrition Interventions for Children with Special Health Care Needs

Appendix O
Technical Aspects of Home parenteral
nutrition
Kathryn L. Hunt, RD, CD
Appendix O
The American Society of Enteral and Parenteral Nutrition (ASPEN) defines parenteral
nutrition (PN) as nutrients provided intravenously. The most commonly used
solutions are a combination of dextrose (carbohydrate), amino acids (protein), and
fat (lipids). Parenteral nutrition can refer to all three components or the components
dextrose and amino acids only. This section describes methods used to determine the
components of a parenteral nutrition solution.
Fluid
The initial step in determining the PN solution is the estimation of the patient’s fluid
needs. General guidelines for fluid management of PN in older infants and children
are outlined in Table O-1 (1).
Infants on PN often have increased energy needs due to the natural demands of
growth combined with the stress of illness. PN solutions providing “maintenance”
levels of fluid may not meet such energy needs and may be too hypertonic. For
example, infants with illness or under stress often need between 135-150 mL/kg/
day of total fluid to adequately meet their energy needs for growth. Therefore,
fluid volumes may be administered in excess of maintenance calculations and then
macronutrients may be increased until the solution reaches the desired energy goal.
Table O-1: Estimating Fluid Requirements: Older infant/child
Child’s weight (kg) Fluid Requirements Per Day
0-10 kg 100 ml/kg/day (infants may need up to 135-150 mL/kg/d)
10-20 kg 1000 ml + (50 ml/kg for every kg between 10-20 kg)
>20 kg 1500 ml + (20 ml/kg for every kg > 20)
>40 kg 1500 ml per M2 body surface area
Nutrition Interventions for Children With Special Health Care Needs 369