Intravenous nutrition in premature neonates

The article was professionally consulted by Specialist Doctor II Cao Thi Thanh - Department of Pediatrics - Neonatology - Vinmec Hai Phong International General Hospital.

Premature babies receive parenteral nutrition to bring nutrients into the body, instead of parenteral nutrition in case they cannot eat by mouth.
In premature babies, the need for nutrients is high (cal, protein, G, L, Vit, minerals). Feeding preterm infants has many difficulties: The stomach is horizontal or has reflux oesophagus - Poor sucking reflex - Lack of digestive enzymes in the intestines - Intestinal mucosa, underdeveloped intestinal immune system (IgA) Therefore, it is easy to be injured, inflammation is easily damaged.- The liver's collagen reserves are poor, so it is easy to increase or decrease blood sugar. At the same time, babies born prematurely or have respiratory failure, endocardial disease, so it is difficult to feed by mouth, slow weight gain

Neonatal intravenous nutrition is indicated in the following cases:
Children have other diseases when they cannot tolerate at least 60 Kcal/kg/day by mouth for 3 days (if their weight is ≤ 1800g) ) or 5 days (if weight > 1800g). Extremely premature birth (<1000g), severe respiratory failure, preoperative and postoperative care of congenital gastrointestinal malformations (cleft palate, umbilical cord hernia, congenital esophageal atrophy...), inflammation necrotic bowel,...

2.1. Energy requirements On average 120-130 KCal/kg/day, in the first 1-2 days after calving the demand may be lower. In fact, if there are not enough components of the infant's intravenous nutrition, it is not possible to meet the number of calories according to the above requirements. Minimum starting level: 50 kcal/kg/day gradually increased to reach 100-120 kcal/kg/day (term infants), 110-140 kcal/kg/day (preterm infants).
In case of newborn with chronic disease: 150 kcal/kg/day.
Suitable ratio: G:L:P = 5:5:1
1 g glucose → 4 kcal, 1g lipid → 9 kcal, 1g amino acid → 4 kcal
2.2. Fluid and electrolyte requirements The amount of fluid infusion depends on the weight and age of the newborn (calculated in kg of body weight in 1 day). The above amount varies depending on the child's medical condition, but should not exceed 200ml/kg/24 hours. Increase 10-30% of total fluid when the child vomits a lot, has severe diarrhea or is exposed to light. Reduce 10-30% of fluid volume if the baby at birth has edema, heart failure, pneumonia...; Maximum dose 120ml/kg/day. Slow drip infusion time 3-6 drops/min. The amount of fluid should be divided into 2 parts to distribute the infusion throughout the day and night to avoid hypoglycemia. 2.3. Protein needs

Start at 1 day of age Appropriate infusion concentration: 1g% for term infants, 0.5g% for preterm infants, not to exceed 2.5g% Initiation: 0.5-1g/ kg/day Gradually increase 0.5-1 g/kg/day to dose: 2.5-3 g/kg/day, above this dose may cause metabolic acidosis, increase BUN, Ammonia/blood For patients with impaired , AA limit maximum at 1.5g/kg/day until BUN returns to normal. Avoid using AA for energy, calories of non-protein origin must be enough for AA to synthesize protein: 2.4. Vitamin and mineral requirements Indicated when parenteral nutrition is > 2 weeks. Iron: 2-4mg/kg/day after 6 weeks. Vitamin A: reduces the risk of chronic lung disease, extremely low birth weight - given after 72 hours of age. Dose: 5000 IU/time, 3 times/week intramuscularly for 4 weeks, or 1000 Ul/times every other day (if tolerated) X 4 weeks. Dr. Thanh has worked for 25 years in the treatment of neonatal diseases, of which 23 years worked at the neonatal department of Hai Phong Obstetrics and Gynecology Hospital (with experience in neonatal resuscitation in the operating room/delivery room). + late-term care of premature babies (34 weeks - 37 weeks), 02 years working at Hai Phong Children's Hospital Requesting Clinic.Dr. Thanh is currently working in Pediatrics - Neonatology Department of Vinmec International General Hospital Hai Phong