Nutrition

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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

 


 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 AndroidA list of contributors can be seen here.

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