Neonates

Question 1

a neonate is considered the first ___ days of life

Answer 1

28 days

Question 2

premature infants usually need to start off with what type of artificial nutrition

Answer 2

parenteral nutrition

Question 3

what are the indications to begin PN in neonates

Answer 3

very low birth weight <1500 grams
severe respiratory distress syndrome
Volvulus
Meconium ileus
atresia
gastrochisis
severe Hirschprung's
enteric fistula 
diaphragmatic hernia

Question 4

the time of starting PN on neonates depends on

Answer 4

their weight at birth

Question 5

when is PN ideally started in Very Low Brith Weight Neonates

Answer 5

the first few hours of life

Question 6

what type of PN is started in neonates

Answer 6

Vanilla/Starter/Base PN

Question 7

how much grams of protein do neonates need when starting on PN

Answer 7

3-3.5g/kg/day

Question 8

when is PN ideally started in low brith weight premature babies

Answer 8

within 24-48 hours

Question 9

when can PN be stopped in premature babies

Answer 9

when adequate EN is established

Question 10

what is the purpose of starter PN in premature infants

Answer 10

to provide immediate protein

Question 11

what range of dextrose is given in base PN

Answer 11

5-10%

Question 12

what range of amino acids is given in base PN

Answer 12

3-4%

Question 13

why is heparin added to neonatal PN

Answer 13

there is not enough forward pressure in the baby’s lines this will prevent back flow and clotting

Question 14

how much heparin is recommended for neonatal PN

Answer 14

0.25-1 unit/mL

Question 15

what prevents clotting in the neonatal PN line

Answer 15

heparin 0.25-1 unit/mL

Question 16

neonates require ______ fluid in the first 48 hours of life (about 70-90mL/kg/day) *it is better for the lungs

Answer 16

decreased fluid

Question 17

over time, neonates will have _____ fluid needs from insensible losses associated with prematurity and phototherapy

Answer 17

increased

Question 18

a preterm infant requires ____mL/kg/day of water

Answer 18

75-120mL/kg/day

Question 19

a term infant requires ____mL/kg/day of water

Answer 19

60-120 mL/kg/day

Question 20

an infant over 1 month old or 3-10 kg requires _____mL/kg/day of water

Answer 20

100mL/kg/day

Question 21

how are total fluid needs calculated for neonatal TPN

Answer 21

Total fluid from calculation - fluid from drips - ILE volume- volume in feeds = volume left over for PN

Question 22

Example: a 25 week gestational male is admit to the NICU. his brith weight is 515 grams, head circumference 21.5 cm and length is 30 cm. He is at the 4th percentile weight, 17% percentile HC and 14% tile length. On the Fenton curve his z-score is - 1.7. On his first day your hospital gives 70mL/kg/day of fluids, what is his hourly rate?

Answer 22

515 grams / 1000 = kg - .515 kg

.515 x 70mL/day = 36mL of fluid in 24 hours = 36/24= 1.5mL/kg/day

Question 23

why do neonates usually have high ammonia and BUN when given PN

Answer 23

they have higher protein needs due to an immature urea cycle activity This is common)

Question 24

when is adding insulin considered in neonatal PN

Answer 24

when BG consistently >200mg/dL (response is variable)

Question 25

should insulin be added to PN in neonates

Answer 25

no you'll have better control if given separately

Question 26

be careful when providing insulin to neonates as they are

Answer 26

very insulin sensitive

Question 27

premature neonates can be deficient in fatty acids within ___ days

Answer 27

3-7 days

Question 28

fatty acids are essential for neonates because t

Answer 28

they are essential for central nervous system development

Question 29

if ____ lipids are used for ILE they need to be given at a higher rate to meet essential fatty acid requirements

Answer 29

SMOF

Question 30

neonates can safely be at a GIR rate up to

Answer 30

14mg/kg/min

Question 31

Calculate the GIR of a patient getting 12g/kg/day of dextrose

Answer 31

GIR: a mg per kg per min 12 grams * 1000 mg = 12000mg 24 hrs , 1 hr= 60 min x 24 = 1440 min 12000/1440= 8.3 mg/kg/min

Question 32

how much sodium is required for preterm neonates in PN

Answer 32

2-5 meq/kg/day

Question 33

why do neonates require higher amounts of calcium and phos

Answer 33

bone growth

Question 34

___ and ____ are extremely important to prevent metabolic bone disease (they have lost out on bone mass accrual in their third trimester)

Answer 34

calcium and phos

Question 35

what is the optimal calcium to phos ratio to promote the greatest retain

Answer 35

2.6 to 1 mEq:mM or 1.7 to 1.0 mg:mg

Question 36

premature neonates may need a calcium to phosphorous ratio up to _____ especially if they were categorized as intrauterine growth restriction (they tend to reseed a little)

Answer 36

2:1 mEq/mM

Question 37

if a neonate is <2.5 kg how much PEDI trace is needed

Answer 37

2mL/kg/day

Question 38

if a neonate is greater than or equal to 2.5 kg how much PEDI trace is needed

Answer 38

5mL/day

Question 39

_____ is the precursor too glutathione. It acts as an antioxidant, allows for the reduction of methionine, and lowers pH to improve calcium and phos solubility

Answer 39

L-cysteine

Question 40

L-cystiene is not required unless

Answer 40

giving at least 4g/kg/day protein in PN

Question 41

how much carnitine is given in neonatal PN

Answer 41

5-10mg/kg/day

Question 42

_____ is added or given to neonates on PN to help better utilize triglycerides as it is required for transport of long chain fatty acids across the mitochondrial membrane for oxidation

Answer 42

Carnitine

Question 43

when is supplemental carnitine required for premature neonates on PN

Answer 43

<32-34 weeks gestational age

Question 44

_____ is added to neonatal PN to maintain catheter patency

Answer 44

heparin

Question 45

when are labs typically drawn in neonates when started on PN

Answer 45

after the first 24 hours of life

Question 46

a baby only has ____mL of blood/kg body weight

Answer 46

80 mL

Question 47

some electrolytes are naturally _____ in neonates especially potassium and phosphorous

Answer 47

higher

Question 48

what is the average potassium level in a neonate

Answer 48

4-6.2 Meq/L

Question 49

what is the average BUN in a neonate

Answer 49

4-15 mg/dL

Question 50

what is the average serum creatinine in a neonate

Answer 50

4-15 mg/dL

Question 51

what is the average phosphorous level in neonates

Answer 51

4.1-9 mmol/L

Question 52

what osmolarity is allowed In central PN

Answer 52

> 900mOsm/L

Question 53

pediatric patients can tolerate a slightly higher ___ in PN due to increased elasticity of their veins

Answer 53

osmolarity about 1,000 mOsm

Question 54

ILE in neonates is often y-site or piggy backed in order to

Answer 54

prevent phlebitis

Question 55

what factors affect calcium and phos solubility

Answer 55

amino acids (not enough) calcium and phos concentration (if exceeds 55) calcium salt form (gluconate is preferred over chloride) pH: lower pH is more desirable temperature; don't let it get hot order of mixing : ALWAYS ADD PHOS FIRST in pn and ALWAYS ADD CALCIUM LAST in pn

Question 56

what calcium salt form is preferred for mixing PN for optimal calcium-phosphorous solubility

Answer 56

calcium gluconate

Question 57

should pH be low or high to promote optimal calcium-phosphorous solubility

Answer 57

LOWER (can add L cysteine to lower_

Question 58

what can be added to PN to lower its pH for better ca-Phos solubility

Answer 58

L-cysteine amino acid

Question 59

when mixing PN _____ should always be added first and _____ should always be added last

Answer 59

PHOS FIRST | CALCIUM LAST

Question 60

on a calcium phosphorous curve does your calcium phos level want to be above or below the curve

Answer 60

BELOW THE CURVVE will decrease the risk of precipitation