Kedar Sawleshwarkar

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.

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.

Repa A, Mayerhofer M, Cardona F, Worel N, Deindl P, Pollak A, Berger A, Haiden N. Safety of blood transfusions using 27 gauge neonatal PICC lines: an in vitro study on hemolysis. Klin Padiatr. 2013 Dec;225(7):379-82. doi: 10.1055/s-0033-1355329. Epub 2013 Oct 24. PMID: 24158888.

We do add 0.5 -1 ml 3% NS in feeds especially to ELBW babies who are hyponatremic on full enteral feeds and continue till 37 weeks.

That’s really tough to answer it velocity of growth and lean body mass should be the priority probably.