Pediatrics II: Parental Nutrition Flashcards
Indications for use of TPN
- Significant Bowel dysfunction resulting in inability to achieve adequate enteral nutrition for >4-5 days (children & adolescents) or 2-3 days (infants)
- Hypermetabolism( eg. trauma, burns)
- Moderate-to-severe pancreatitis requireing bowel rest > 7 days
- Boweldys function
Reasons for bowel dysfunction
- Paralytic ileus
- Major gut resection leading to diarrhea, malabsorption (>70%)
- Small bowel obstruction
- Radiation enteritis
- GI fistula; except when enteral access can be placed distal to the fistula
- Hemodynamic instability where high risk for mesenteric ischemia (eg Necrotizing enterocolitis in premature infants)
- Severe dysmotility leading to non-functioning GI tract
Contraindications for PN
- When the gut works: PN is contraindicated!!
- Prognosis does not warrant aggressive nutrition support (eg palliation; note TPN can be part of palliation in children; not typically in adults)
- Vascular access is severely compromised
Energy requirements for PN
Energy Requirements in PN to meet growth requirements (may be higher with hypermetabolism)
* 80-100 kcal/kg; infants < 1 year
* 60-90 kcal/kg for 1-12 years
* 30-60 kcal/kg (adolescents > 12 years)
Influenced by age, disease type & severity, gender, body composition
Guidelines for Administration of Parenteral Dextrose
Ignore preterm
Guidelines for Administration of Parenteral Amino Acids
- may need more than maximum for LBM accumulation
- 1-2 years post puberty needs are similar to adults
Guidelines for administration of Parenteral Lipids
volumes administered are lower than adults since weight is lower
What is chylothorax?
Leakage of chyle (lymphatic fluid) into the pleural space through thoracic duct
How is chylothorax managed?
Managed using Portagen
* chyle production, chyle flowing through lymphatic system
* MCT formula-absorbed directly into portal system, do not enter lymphatic system
* Require supplemental folic acid, vitamins A,D,C (Trivisol)
Infant PN case
Peds nutrition II
Child PN case
Peds nutrition II
Steps for PN
- in Pediatric Nutrition Assessment: Evaluate weight and height in terms of actual vs ideal body weight
- Determine IBW and %IBW
- evaluate which weight to use
- follow other PN instructions…