Chris van den Akker

Interesting case, but I'd definately check serum phosphate concentrations first. Since baby is SGA, a refeeding like syndrome may have resulted in low phosphate levels, which in turn may cause hyperglycemia. One needs a lot of phosphate for successful glycolysis (e.g. Dreyfus 2016 Clin Nutr). Thus, if phosphate is low, supplement extra phosphate and hyperglyc will likely resolve with no need of insulin. Only if phosphate is >1.60 mmol/L, I'd start insulin

Difficult question/answer. In general I'd reduce infusion rates of serum urea exceeds above 10 (or perhaps max 12.5) mmol/L. Please take notion on correct conversion, cause this may sometime introduce errors. But before simply adjusting infusion rates, also assess others causes. Did you provide sufficient concomitant energy (minimal 35 kcal/g animo acids) and electrolytes (esp sufficient phosphate and potassium), and what is fluid status and kidney function?

For a multi-centre multi-country RCT on formula feeding for healthy term-born neonates (at risk for obesity), we are looking for researchers in Europe who have access to both PeaPod AND BodPod (Air Displacement Plethysmography (ADP)) in their institution. If you do have a PeaPod AND BodPod available, please contact us for potential participation in our trial! Thanks! Best wishes, Jacqueline Muts and Chris van den Akker (also on behalf of Hans van Goudoever) j.muts@amsterdamumc.nl and/or c.h.vandenakker@amsterdamumc.nl

May I ask whether anyone has experience with a prolonged hanging time of a parenteral nutrition (PN) bag (incl lipids) of up to 48h? We are probably changing our PN regimen into an all-in-one bag. Since the bag contains >400 mL, it would suffice for most premature infants for 2 days. One strategy could thus be to prolong hang time from 24h to 48h to cut PN costs by half. A recent Australian study (attached) also suggests this would be a feasible approach: https://www.ncbi.nlm.nih.gov/pubmed/23320598 Since our pharmacy will do all additions to the bag in an aseptic environment, including connection and filling the line, I think it could be an attractive solution. Also there is an air-filled dripping chamber in the line, so there exists no continuous fluid-filled connection from the patient to the PN-bag. On the other hand, the line would be in place for 48h as well, so this could form a potential risk. We must be sure it is a safe approach though… What are your thoughts and experiences on this matter? Thank you so much, best wishes, Chris van den Akker, neonatologist Amsterdam UMC, the Netherlands

The NeoMate app is very helpful! There is an infusion calculator, where you can easily 'calculate' how much medication needs to go in the syringe, with how much glucose/saline, and at which rate the pump then needs to run. https://london-nts.nhs.uk/professionals/neomate-mobile-app/