Nutrition Support Special Considerations For Nenaotes
- 1. Nutrition Support Special Considerations in NeonatesSajjad Ahmad RPh. BCNSPTPN Pharmacist, In-Charge IV Admixture ServicesKFSH&RC Jeddah K.S.A(May 2009)
- 2. 2
- 3. Defining Neonates In Terms Of Weight3
- 4. Nutrition Support In NICU4Nutrition Support is applied inappropriately in NICU11. A.S.P.E.N Nutrition Support Practice manual 2nd edition 2005 p301
- 5. Phases of NS in critically Ill Infants5
- 6. Special Considerations in Premature & Sick Infants6
- 7. Nutritional Issues In NICU7
- 9. Peripheral Route of Nutrition9
- 10. Peripheral Solutions ¨C Osmolarity Calculations10
- 11. Routes of Administration - Central11
- 12. Central Access OptionsHICKMAN CATHETERPORTGROSHONGPICC LINE12
- 14. Fluids14
- 16. Phototherapy
- 17. RDS
- 18. Fever
- 19. Diuretics
- 20. GI losses
- 21. Glycosuria
- 22. Heat shields
- 23. Blankets
- 25. High humidity
- 26. Fluid overload
- 27. Heart failureIncreased RequirementsDecreased Requirements
- 28. Fluids16
- 29. Parenteral Nutrition17A.S.P.E.N. Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. J Parenter Enteral Nutr. 2002;26(1suppl): 1SA¨C138SA.
- 31. OUTCOMES OF NUTRITION THERAPY19
- 33. TPN Initiation¡do not start at goal 21
- 34. Pathogenesis of Re-feeding Syndrome22
- 35. Pathogenesis of Re-feeding Syndrome23
- 40. Hematologic Effects of Hypophosphatemia28
- 41. Hypokalemia29
- 42. Hypomagnesemia30
- 43. Recommendations to Avoid Re-feeding31
- 45. 33
- 49. Parenteral NutritionDextrose (3.4Kcalories per Gm)37
- 54. essential fatty acid deficiency (EFAD)Deficiency of linoleic and linolenic acidsManifestations (hair loss, delay wound healing, dry scaly skin)EFAD can develop within 72 hours if exogenous fat is not given. EFAD can be prevented with as little as 0.5¨C1 g/kg/d of IV lipid42
- 58. Calcium Phosphate SolubilityPrecipitation factor =mEq of Ca++ + mM of PO4 x 100Vol (ml) of TPN before addition of Ca & PhosphateIf AA Concentartion > 1.5% the precipitation factor must be < 3If AA concentration >1 % and < 1.5%, the precipitation factor should be < 2For PN solutions < 1% AA concentration, either calcium or phosphorous should be addedParenteral Nutrition46
- 60. 48Parenteral Nutrition3. Effects of Early Erythropoietin Therapy on the Transfusion Requirements of Preterm Infants Below 1250 Grams Birth Weight A Multicenter, Randomized, Controlled Trial. Pediatrics. 2001;108:934¨C942.
- 61. Effects of micronutrient deficiency49
- 62. Effects of micronutrient deficiency50
- 63. Effects of micronutrient deficiency51
- 73. Cyclic TPN61
- 74. 62
- 76. Cause of OcclusionThrombusCrystalsUrokinaseHCl 0.1NSuccessFailureFailureSuccessHClUrokinaseSuccessSuccessFailureFailureEthanol 70%Ethanol 70%64Management Of Catheter Occlusion
- 77. Do¡¯s and Don¡¯tsParenteral Nutrition Solutions65
- 78. 66Do¡¯s and Don¡¯tsParenteral Nutrition Solutions
- 79. Filtration of Parenteral Nutrition Admixtures67
- 80. Transitioning to Enteral Feeds68
- 81. Enteral NutritionSpecial Considerations in Neonates69
- 84. Necrotizing Enterocolitis and Enteral Feeding72
- 85. Necrotizing Enterocolitis and Enteral Feeding73
- 100. Enteral Formulas88
- 101. Thank you...
Editor's Notes
- #7: Diuretics case mineral and electrolyte losses.Corticosteroids used to shorten the ventilator support can cause negative nitrogen balance, delayed growth, glucose intolerance, bone demineralization and neurodevelopment impairment.