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
All Marc’s PICU cardiology FOAM can be found on PICU Doctor and can be downloaded as a handy app for free on iPhone or Android. A list of contributors can be seen here.
Nutrition
Tags: karicare, nutrition
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!
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 JPENTable: nutrition in EBM/formula:
kCal
/ml
Prot (g)
/ 100ml
Fat (g)
/ 100ml
CHO (g)
/ 100ml
(0.8g fibre per 100ml)
0.72
All Marc’s PICU cardiology FOAM can be found on PICU Doctor and can be downloaded as a handy app for free on iPhone or Android. A list of contributors can be seen here.
About Marc Anders
Marc Anders is a paediatric intensivist.