Fluids, Electrolytes, and Nutrition for the Neonate：液体，电解质，和营养的新生儿.ppt

OFF-HOURS TPN FOR PREMIES BW 1750G: Goal: Provide protein and calcium within first 24h of life (when can’t order regular TPN yet) Rationale: ELBW infants lose 1% of protein stores daily, must provide protein to balance loss Run at 50 mL/kg/day Components: Dextrose 10% Protein (60 g/L): 3g/kg/day Calcium (4 mEq/L) Minimal electrolytes Heparin TYPES OF ENTERAL NUTRITION: Breast milk is the best milk! Lactation counselors can help NBSCU moms Donor breast milk an option for some premies Variety of formulas available: Term (20 cal): Good Start, Enfamil, Similac Late Pre-term/Transitional (22cal): Enfacare, Neosure Pre-term (24 cal): Similac Special Care Supplements to increase calories, etc.: HMF (protein, Ca), Neosure powder, MCT oil TYPES OF ENTERAL NUTRITION: Specialty formulas available: Lactose Intolerance/Galactosemia: Soy varieties Feeding Intolerance: GentleEase, Similac sensitive Semi-Elemental: Alimentum, Nutramigen, Pregestimil Elemental: Neocate, Elecare Renal disease: Similac PM 60/40 Chylothorax: Enfaport INITIATION OF ENTERAL FEEDING: Preterm 1250g: Goal to start preterm feedings within first 12 hours of life Start with non-nutritive feeds q4h: Low volume (usually 10-15 mL/kg/day) Acclimate the GI tract to feeds Stimulate gut hormone secretion Promote GI tract maturation Preterm 1250-1750g: Start within first 12 hours of life with ~20 mL/kg/day (ie. 4-5 mL/kg/feed q2-3h) Preterm 1750g or Fullterm: If stable, start feeds within first 6 hours of life q3-4h May consider ad lib feeds ADVANCEMENT OF ENTERAL FEEDING: Goal: Advance slowly to reach full enteral feeds within ~2 weeks of life Advance daily as tolerated per feeding protocol (~10-20 mL/kg/day for premies) Monitor for symptoms of intolerance: Abdominal distension Vomiting Bilious aspirates/residuals ADVANCEMENT OF ENTERAL FEEDING: Feeding Day (Volume – mL/kg/d) 0.550g 0.551-0.650g 0.651-0.750g 0.751-0.850g 0.851-0.950g 0.951-1.050g 1.051-1.150g 1.151-1.250g 1 (~12) 1.0 mL