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Nutritional deficiency in premature babies:

Premature babies are unable to complete the full gestation period inside secured and essential environment of mother’s womb, so they are prone to nutritional deficiencies. Nutritional needs of premature infants are totally dependent on the parenteral nutrition, especially for very low birth weight infants (<1500gm). In these infants, enteral feeding is delayed because of severity of medical problems associated with prematurity (like underdeveloped major organs, infections, feeding intolerance etc.)(3)

The Importance of Total Parenteral Nutrition (TPN) in Sick & Premature Newborn:

TPN is used when infants are unable to receive food or liquids by mouth for delivering it to their stomach. It is always recommended to give food through gastrointestinal (GI) tract, but premature babies cannot absorb nutrients through GI tract, thus for them, TPN plays an important role.

TPN is a method of feeding that bypasses the GI Tract through intravenous administration of fluids which will provide all essential nutrients to the baby. TPN delivers a mixture of fluids, electrolytes, sugar, amino acids (proteins), vitamins, minerals, and lipids into an infant’s vein.(4). TPN is given through a vein by placing an IV line into baby’s hand, foot, scalp or navel and nutrition is supplied through a smaller vein that is less centrally located in baby’s body (peripheral route).

TPN can be lifesaving for very premature and sick babies as it can provide optimal nutrition than regular intravenous feeding methods, which could only provide sugar and salts.

TPN Calculation:

Total parenteral nutrition must be customised for each infant. However, standard concentrations available for protein, fats, and carbohydrate limit the degree of customisation. Thus, various concentrations are mixed in desired amounts to make the final feeding solution for most infants.

Total fluids requirements vary as per the gestational age and weight of the baby :(7)

Common Components of Parenteral Nutrition:

Various concentration of dextrose base solution is available:

(Example: 10% dextrose base solution contain 3.46 kcal\100ml)

The table below illustrates the common components discussed above:

Steps in TPN Calculation:

CNR= 100-200 cal\g (ideal) (8)

TPN is the mixture of parenteral fluid components and lipids. To determine total fluid requirements, firstly we need to calculate and deduct the volume of lipid and any additional fluids (e.g.: fluid from the umbilical arterial catheter, peripheral arterial line, or continuous infusion medicine) and then individually calculate the volumes of glucose, proteins, electrolytes and other components as per the requirement.

TPN calculation in iNICU

iNICU helps to customise the intake amounts of the nutrients required by the infants as per the available standards and weight of the baby. iNICU also keep the entire record of the feeds consumed by the infants for future reference. Below is the TPN screen in iNICU:

Total parenteral nutrition calculator is one of the major features provided by iNICU which is used to calculate daily nutritional needs for the neonates.

Credits:

Dr. Yashika, Dr. Suneyna, Ravneet

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