Nutrition

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Cite this article as:
Anders, M. Nutrition, Don't Forget the Bubbles, 2013. Available at:
http://doi.org/10.31440/DFTB.3905

Facts:

1. Nutritional support for children in PICU is important to prevent deficiency and remain in a positive or neutral neutrogen balance

2. Overfeeding is associated with adverse effects

3. There is no clear evidence supporting PN over TPN

4. If the bowel works, use it !

5. Always slowly introduce lipids !

5. Cautiously introduce enteral feeding where there is low CO!

Energy requirements in healthy children
premature 110 – 120 kcal/kg/d
0 < age < 1 90 – 100 kcal/kg/d
1 < age < 7 75 – 90 kcal/kg/d
7 < age < 12 60 – 75 kcal/kg/d
12 – 18 30 – 60 kcal/kg/d
Feeding the healthy neonate
Day Dextrose Protein Lipids
g / kg /d
1 4 – 8 1 ( – 3) 1
2 4 – 8 1 ( – 3) 2
3 5 – 10 1 ( – 3) 3
4 5 – 12 2 ( – 3) 3
5 6 – 15 2.5 ( – 3) 3
6 7 – 16 2.5 ( – 3) 3
Feeding the healthy child
Age Dextrose Protein Lipids
g / kg /d
< 1 mo 7 – 16 2.7 1 – 3
< 6 mo 7 – 16 1.5 1 – 3
< 1 y 7 – 16 1 – 1.5 1 – 3
< 7 y 5 – 15 0.9 1 – 2
< 12 y 5 – 15 0.9 1 – 2
> 12 y 5 – 10 0.9 1 – 2

 

  • 1 Kcal = 1 calorie = 1000 cal = 4184 joules
  • 1 g dextrose = 3.8 Kcal
  • 1 g protein = 4 Kcal
  • 1 g lipid = 9 Kcal

References:

[1] Intensive Care Med, 2004, 30(9), 1807-13: van der Kuip M: Nutritional support in 111 pediatric intensive care units: a European survey

[2] Cochrane Database Syst Rev. 2009, 15;(2):Joffe et all: Nutritional support for critically ill children

[3] Ger Med Sci, 2009 Nov 18;7, Doc15: Fusch et all: Neonatology/Paediatrics – Guidelines on Parenteral Nutrition, Chapter 13

[4] J Parenter Enteral Nutr. 2009 May-Jun;33(3):260-76: A.S.P.E.N. Clinical Guidelines: Mehta et al: nutrition support of the critically ill child

[5] J Parenter Enteral Nutr. 2010 May-Jun;34(3):247-53: Jaksic et al: A.S.P.E.N. Clinical guidelines: nutrition support of neonates supported with extracorporeal membrane oxygenation JPEN


Table: nutrition in EBM/formula:

Formula / Additive

kCal

/ml

Prot (g)

/ 100ml

Fat (g)

/ 100ml

CHO (g)

/ 100ml

INFANT FEEDS 0 – 12 MONTHS or < 8kg
Human Milk/ EBM 0.69 1.0 4.3 7.2
Human Milk + 2 blue scoops Karicare 0.83 1.3 4.9 8.8
Karicare Gold Plus 1 ¼ strength 0.83 1.7 4.4 9.1
Infatrini FS 1.0 2.6 5.4 10.3
Pepti-junior Gold FS (partially hydrolysed) 0.67 1.8 3.6 6.9
Pepti-junior Gold 1 ¼ strength 0.84 2.25 4.5 8.6
Neocate LCP FS (extensively hydrolysed) 0.70 1.9 3.4 7.9
Neocate LCP 1 ¼ strength 0.87 2.4 4.2 9.9
Monogen FS (MCT based feed – chylothorax) 0.75 2.0 2.1 12.0
Monogen 1¼ Strength 0.93 2.5 2.6 15
Kindergen FS (renal) 1.0 1.5 5.3 11.8
Kindergen 1¼ Strength 1.25 1.9 6.6 14.8
Neocate advance FS (>12months) 1.0 2.9 5.1 10.5
PAEDIATRIC FORMULAE 1-6 YEARS
* Nutrini Multi-fibre
(0.8g fibre per 100ml)
1.0 2.8 4.4 12.3
Nutrini 1.0 2.8 4.4 12.3
Nutrini Energy 1.5 4.1 6.7 18.5
ADULT FORMULAE >12 YEARS or 45kg
* Nutrison multi-fibre (1.5g per 100ml) 1.0 4.0 3.9 12.3
Nutrison Standard 1.0 4.0 3.9 12.3
Nutrison Energy 1.5 6.0 5.8 18.5
Nutrison Energy multi-fibre (1.5g per 100ml) 1.5 6.0 5.8 18.5
ADDITIVES (per 100ml) – per gram or ml
Duocal 1x Blue Scoop (1.2g) 5.9 0 0.27 0.87
Polyjoule 1x Blue Scoop (1.2g) 4.6 0 0 1.1
Protifar 1x Blue Scoop (0.85g) 3.1 0.75 0.014 0.013
Per ml MCT oil 8.4 0.95
Karicare Gold 1x Blue Scoop 6.9 0.15 0.37

0.72

 


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Marc Anders is a paediatric intensivist.

Author: Marc Anders Marc Anders is a paediatric intensivist.

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