Hi..greetings to all. At what amount of enteral feeding (ml/kg/day) you start to adjust your protein/lipid TPN?

Hello! We do not change the TPN composition while increasing enteral feeds. But, at a level of ~75% enteral feeding, we usually switch from TPN to 10% glucose (+electrolytes).

(we do not prepare TPN inhouse, but use commercially available ready-made TPN)

We must calculate daily protein, lipids & calories per kg and adjust accordingly to limit protein & lipid intake to 3.5g/kg/d in view of recent literature questioning the worse impact of higher intakes. This usually correspond well to enteral intake of 25%/50%/75% and reduce TPN at similar rates probably & practically. We generally stop TPN once >100 ml/kg/d enteral intake is reached.

We calculate the total protein and lipids at orally route and get a balance according to the specific requirements of each baby with parenteral nutrition. At we advance in enteral feedings we reduce the amount in PN.

HELLO GROUP, I TALK ABOUT WHAT WE DO,
 FORTIFIED HUMAN MILK PROVIDES APPROXIMATELY 0.5 A 0.8 G OF PROTEIN EVERY 20ML,
 WE TRY TO LOWER THE PROTEINS OF THE NPT SO THAT THE TOTAL CONTRIBUTION 
OF PROTEINS BETWEEN ORAL VIA AND NPT DOES NOT ADD MORE THAN 4MG, THE SAME
 WITH THE FLOW OF GLUCOSE AND LIPIDS, WE SUSPEND NPT WHEN THEY REACH 100ML/KG 
THROUGH THE ORAL ROUTE. AND WE COMPLETE THE CONTRIBUTION WITH 
A PHP OF GLUCOSATE.

On 1/10/2024 at 12:37 PM, Kedar Sawleshwarkar said:

We must calculate daily protein, lipids & calories per kg and adjust accordingly to limit protein & lipid intake to 3.5g/kg/d in view of recent literature questioning the worse impact of higher intakes. This usually correspond well to enteral intake of 25%/50%/75% and reduce TPN at similar rates probably & practically. We generally stop TPN once >100 ml/kg/d enteral intake is reached.

Hi Kedar, would you mind highlighting the literature you refer to. I am curious as we tend to continue TPN until we reach 120ml/kg of enteral feed.

Many thanks

Al

We had similar approach but off late I read an article citing poor neuro developmental outcomes if high protein >3.5 g/kg/d is administered. So, we are calculating total intake of protein & calories through TPN & enteral and adjusting to total protein intake to max 3.5 g/kg/d.