TPN IN NEONATE

[ph-adil 10]

Purpose of total parenteral nutrition is to prevent the adverse effect of malnutrition in neonate who are unable to obtain adequate nutrients by oral or enteral route (necrotising enterocolitis or nec, respiratory distress syndrom/bpd, extreme prematurity, sepsis and malabsorption.

In our hospital we prepare the tpn according to each patient needs(calories,protein ,lipid,carbohydrate,multi-vitmns and electrolyts).

As clinical pharmacist my part is to insure accuracy,stability and compatibilty as well as making sure all nutritions required are met.

According to that before the physician start the tpn order he/she call me to discuse the patient nutrition requirement.

Here are some points, which may help you to get the consept of tpn.

1-total volume= 80 to 200 ml/kg/day

2-total caloreis = 60-120 kcal (gaining weight) 1 g of dextrose =3.4 kcal, 1 g protien= 4 kcal ,10% lipid(1 ml=1 kcal)20% (1ml= 2 kcal)

3-carbohydrate = 3-12 mg/kg/mins and maximum 12.5% dextrose for peripheral line.

4-amino acid =0.5 -4 g/kg/day

5- lipids = 0.5-3 g/kg/day

6-osmorality<900 osmol/l peripheral and 1600 osmol/l centeral.

Hope this will be usefull.

It is my pleasure to share my skill and knowldge with you in case of any inquires.

[Stefan Johansson 690]

Thanks for sharing!

[angelanika 10]

Thank you

Do you have any experience in the use of Omegaven? And if so for how long you will use it?

[ph-adil 10]

Thank you

Do you have any experience in the use of Omegaven? And if so for how long you will use it?

I've no experience with that. We never used in nicu.we only use the 10% or 20% lipoven/ lipofundin.

But they are using that for adult in our hospital in case patient has liver disorder.

In nice we use the lipid when we need high calories and patient is on peripheral line as it had not that effect of osmolarity.

[dabour86 10]

in our hospital we donot have clinical pharmacy

parents took time to travel for about 4hours to have tpn from another hospital

l would ask about the instability of the solution during travelling?

Otherwise there is already made tpn like aminoven 10% as aminoacids and smof lipid10%

i would like to ask if you have any experince with it?

[ph-adil 10]

in our hospital we donot have clinical pharmacy

parents took time to travel for about 4hours to have tpn from another hospital

l would ask about the instability of the solution during travelling?

Otherwise there is already made tpn like aminoven 10% as aminoacids and smof lipid10%

i would like to ask if you have any experince with it?

As far as i know it is stable as long as the tpn is protected from light ,prepared under aseptic condition and stored probarly, (2-8 c').

It should be inspected if there is any turbidity or precipitation.

To be in the safe side it should be used withen 24 hours from prepration time.

Regarding the amino and lipid we dont call them tpn unless the mixed together along with dextrose and additives if any like mineral,electrolytes.multivitamis using specialize calculation and mixing order.

[angelanika 10]

Our unit is a regional center for neonatal surgery so we care for newborns and infants with SBS on long term TPN who undergo sepsis and can develop liver impairment. We use SMOF lipid solution but there are reports on the use of Omegaven with promising results.

http://archpedi.jamanetwork.com/article.aspx?articleid=1151637

If you have any experience/recommendations on this I would appreciate your input.

[ph-adil 10]

Our unit is a regional center for neonatal surgery so we care for newborns and infants with SBS on long term TPN who undergo sepsis and can develop liver impairment. We use SMOF lipid solution but there are reports on the use of Omegaven with promising results.

http://archpedi.jamanetwork.com/article.aspx?articleid=1151637

If you have any experience/recommendations on this I would appreciate your input.

In such case, We only recommend the maximum intake of lipid to be 0,5g /kg/day. And to monitor the Tgd level as well as the liver enzymes.

I have read a lot of articles including the one you posted but still no one of them shows that omegaven is the lipid of chose in sepsis neonate.

[angelanika 10]

Thanks for your response. I have recently attended a joint liver – gastro meeting in the UK and they will use omegaven in the event of sepsis in children – neonates with intestinal failure liver disease. Because of issues regarding EFA requirements this is used for limited time and the role i understood is anti inflammatory + hepatoprotective. We use Soy-MCT-Olive oil- Fish oil mixed lipid emulsion in premature infants and those with SB on total TPN. We have however experienced a few cases and deaths of infants with intestinal failure and preexisting liver disease who developed ALF following complicated sepsis. In my country there is no license agreement for the use of omegaven in this age group and it will be hard to get permission. On the other hand however we have neither a liver unit nor liver specialist support for these children so from a clinical perspective anything that might protect or delay further liver damage in selected cases has to be considered. Many thanks once again

[demodia 10]

Hi there,

I would like to ask you about the calculation of TPN. Do you subtract from total aminoacids and lipids the content of aminoacids and lipids in enteral nutrition?

[nabrina 10]

Can we use Carnitine along with Intralip for better metabolism. There are recommendations in the Fanaroff/Klaus Book

[bimalc 138]

There are two issues. Can you? Yes. This is quite normal in inborn errors of metabolism for example. Are there improved outcomes? I am not aware of data for the general nicu population however I have seen that carnitine levels rapidly become low if baby is npo. For many babies who are not so sick and will start enteral feeds soon it probably does not matter, but I wonder if there is benefit in prolonged npo especially if baby is critically ill or with cardiac dysfunction