FLUID GUIDELINES (These are suggested starter fluids and are not set in stone!)
Wt/DOL01234PhotoTx Starter Dextrose in fluid
> 2 kg60-808010012014020D10
1 – 2 kg10012014014016020D10
< 1 kg12012014016016020D5 (lytes Q8 for 48 hr)
TOTAL FLUIDS (cc/kg/day)
Total Fluids cc/kg/day= Enteral (feeds) + Intravenous (TPN or D10 or UA lines) + Intralipids
Cc/kg/day = [(Vol per feed in cc)(# feed/day) + (rate of IV cc/hr)(24hr/day) + (IL rate cc/hr)(24hr/day)] / wt kg
Example: 3.2 kg has IV at 15.3 cc/hr and is feeding 10cc/hr q3 (24 hours/q3 = 8 total feeds in the day).
TF = Feeds + IV
TF = [(10cc*8feed/day) + (15.3cc/hr*24hr/day)]/3.2 kg
TF = 139.75 cc/kg/day
TPN PRESENTATION
D (glucose) mg/100ml Na meq/kg/day |Ca/P mg/kg/day| AA g/kg/day
------
K meq/kg/day | Cl/Acetate “| lipid g/kg/day
Ranges
D 5- 250-5 |20-40/0-40| 1 – 3.5
------(cl/ac ratio = 100)
0-3 |0-100/100-0| 0 – 3
example: (Adjust TPN based on lytes)
DayFluidNaKCa/PCl/ACMgAALipid
0600020-30/00/1000.253.00-1
1800-10-140/0-3020/800.253.51-2
21002-31-240/3050/500.253.52-3
31202-31-240/3050/500.253.53
41402-31-240/3050/500.253.53
51602-31-240/3050/500.253.53
INTRALIPIDS (IL gms/kg/day)
20% IL = 20gm/100cc
(Desired IL gm/kg/day)(Wt in KG) 20 gms
------= ------
X (rate in cc/day)(24 hr/day) 100 cc
Hourly IV rate cc/hr = (ILgm/kg/day)(Wt kg)(0.2cc/g/hr)
(0.2 = (100cc/20g)(1 day/24hr)
example: 20%IL for 2kg so that we have 1.5gm/kgday
IL rate = (1.5 gm/kg/day)(2 kg)(0.2cc/g/hr) = 0.6 cc/hr
***(StopIL when feeds are ½ TF) = (Vol per feed in cc)(#feed per day)/wt kg > ½ Total fluids (cc/kg/day)
HOW TO ORDER TPNAdd heparin in central line TPN (0.5)
May be 0.25/0.125 in LBW/VLBW
- Decide on total fluid volume (cc/kg/day)
- NPO rate (wt kg * total fluid (cc/kg/day) / 24 hrs = ml/hr
- IL rate cc/hr = (IL gm/kg/day * wt kg * 0.2 cc/g/hr)
- PO feeds rate cc/hr = [(Vol per feed in cc)(# feed/day)]/24hr/day
- TPN actual rate (cc/hr) = NPO rate – [PO + IL + IV fluids (if running)]
Example: 2 kg with desired total fluid of 160cc/kg/day. IL of 3 gm/kg/day. Feeding PE24 10cc q3
IL RATE = 3 gms/kg/day * 2 kg * 0.2 cc/g/hr = 1.2 cc/hr
TPN RATE = (160 cc/kg/day * 2 kg)/24 – (10cc* 8 per day)/24hr/day + 1.2 cc/hr) = 8.8 cc/hr
CALORIES
Dextrose = 3.4 kcal/gmminimum (60 kcal/kg/day)
Protein = 4.0 kcal/gmWant (70 – 90 kcal/kg/day)
20% IL = 2.0 kcal/ccTo grow (120 kcal/kg/day)
Total CHO kcal/day = (%Dextrose g)/100cc ) * (rate TPN (cc/hr) * 24 hrs/day* 3.4 kcal/gm
Total Protein kcal/day = (gms/kg/day)(wt kg)(4.0kcal/gm)
TPN Fat kcal/day = (Rate (cc/hr) * 24 hrs/day * 2kcal/cc
Formula: SCF = 24 kcal/30cc = 0.8 kcal/cc (<1.8g)
Enf24 = 24kcal/30cc = 0.8 kcal/cc
Neo = 22 kcal/30cc = 0.73 kcal/cc (>1.8g)
Sim = 20 kcal/30cc = 0.67 kcal/cc (Term)
Prog = 20 kcal/30cc = 0.67 kcal/cc (broken down)
Total Kcal/day/kg = (Total CHO + Total Protein + Total Fat + Formula)/kg
Example: 2kg receive 12.5 TPN with 3 gms/kg AA at 12cc/hr with IL 3 gms/kg. Feeding Sim20 10cc q3
IL rate = 1.2 cc/hr (3gm/kg/day * 2kg * 0.2 cc/g/hr)
CHO = 12g/100cc * 12 cc/hr* 24 hr/day* 3.4 kcal/gm = 122.4 kcal/day
Protein = 3 gm/kg * 2 kg * 4.0 kcal/gm = 24 kcal/day
FAT: 1.2 cc/hr * 24 hr/day * 2kcal/cc = 57.6 kcal/day
Formula: (10cc * 8 feeds per day)(0.67 kcal/cc) = 53.6 kcal/day
Total Kcal/day = (122.4 + 24 + 57.6 + 53.6)/2.0kg = 128 kcal/kg/day
GLUCOSE INFUSION RATE
(% dextrose g)/100cc *1000mg/1g * rate cc/hr * 1hr/60 min * 1/wt kg = glucose mg/kg/min
[% dextrose g * rate cc/hr * 0.167]/wt kg = glucose mg/kg/min
example: 1 kg has D10 TPN at 6.7 cc/hr(6-8mg/kg/min) goal: 13-15 mg/kg/min
10 g * 6.7 cc/hr * 0.167 = 11.2 mg/kg/min VLBW advance 2-3 / Premi advance 3 / Term advan 4
GROWTH PATTERNS
Birth6 months1 yr2 yr
Length50 cm75 cm87.5 cm
Weight2.5-4.0kg x2x32.5kg/y
Head Circ32-37 cm
0-3months (2cm/m)
4-6 months (1cm/m)
7-12 months (0.5 cm/m)
HEAD USEYE EXAM
BW < 1250g or sick infant < 1500g 28 wks or 1500g
#1 DOL 1-5 (IVH occur most common in DOL 1-3)Premies > 1500 g if unstable
#2 DOL 10-14 (if only no IVH or grade I/II IVH)#1 4-6 wks or at 31-33 GA
#3 prior to d/c or 3-4 weeks after 2nd (which ever comes last)
All (+) findings need more frequent HUS
Germinal Matrix peak at 23 go away at 35
33-35 week on high O2 discuss HUS option
MRI for all infants under 27 weeks prior to d/c
ETTUVC/UAC PLACEMENT
SizeWtGAtape (cm) Placement
2.5<1<286-7UAC = (3 x BW) + 9 + 1 T6-T9
3.01-228-347-9UVC = (1/2 X UAC) Above Diaph
3.52-334-368-9
4.0>3389-10