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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