Appendix 4 - nutritional content of example PN prescription volumes for PRETERM INFANTS
NHS Lothian neonatal guidelines (in development)
Table 4.0: Nutritional Content Vs requirements for PRETERM INFANTS using the STANDARD (12.5%) bag given at standardised fluid volumes for >=750g – 1500g Birth weight
|
|
NICE 2020 Starting dose Nutrition Req (Unless stated) |
Day 1
|
Day 2
|
Day 3
|
Day 4 |
NICE 2020 Full Nutrition Req (unless stated) |
|
Aqueous vol (ml/kg) |
|
63 |
88 |
107
|
125
|
|
|
SMOF lipid solution vol ml/kg |
12 |
12 |
18 |
20 |
||
|
Total vol ml/kg |
75 |
100 |
125 |
145 |
||
|
Protein g/kg/day |
1.35 – 1.8 |
1.8 (7.5kcal/kg) |
2.4 (~10kcal/kg) |
3.0 (12kcal/kg) |
3.6 (14 kcal/kg) |
2.7 – 3.6 |
|
Amino Acid g/kg/day |
1.5 – 2.0 |
2.0 |
2.6 |
3.3 |
4.0 |
3.0 – 4.0 |
|
Sodium mmol/kg/day |
0 – 2.0 (ESPGHAN 2018) |
2.0 |
2.6 |
3.3 |
4.0 |
2.0 – 5.0 (ESPGHAN 2018) |
|
Potassium mmol/kg/day |
0 – 3.0 (ESPGHAN 2018) |
0.82 |
1.07 |
1.36 |
1.62 |
2.0 – 3.0 (ESPGHAN 2018) |
|
Phosphate mmol/kg/day |
1.0 (NICE 2020) 1.0 – 2.0 (ESPGHAN 2018)
|
1.0 |
1.33 |
1.68 |
2.0 |
2.0 (NICE 2020) 1.6 – 3.5 (ESPGHAN 2018) |
|
Calcium mmol/kg/day |
0.8 – 1.0 (NICE 2020) 0.8 – 2.0 (ESPGHAN 2018) |
1.0 |
1.33 |
1.68 |
2.0 |
1.5 – 2.0 (NICE 2020) 1.6 – 3.5 (ESPGHAN 2018) |
|
Magnesium mmol/kg/day |
0.1 – 0.2 (ESPGHAN 2018) |
0.1 |
0.14 |
0.18 |
0.21 |
0.2 – 0.3 (ESPGHAN 2018) |
|
Glucose 12.5% g/kg/day |
6.0 – 9.0 |
7.9 (32kcal/kg) |
10.25 (41kcal/kg) |
13.0 (52kcal/kg) |
15.5 (62kcal/kg) |
9 – 16 |
|
Fat g/kg/day |
1.0 – 2.0 |
2.0 (~20kcal/kg) |
2.0 (~20kcal/kg) |
3.0 (30kcal/kg) |
3.5 (35kcal/kg) |
3 – 4
|
|
NON-PROTEIN energy Kcal/kg/day |
- |
52 |
61 |
82 |
97 |
- |
|
Non protein energy per g Amino acid |
20 – 30 |
26 |
27 |
26 |
24 |
20 – 30 |
|
Proportion of fat energy from non-protein energy % |
25 – 40 |
38 |
33 |
37 |
36 |
25 – 40 |
|
Proportion of carbohydrate energy from non- protein energy % |
60 – 75 |
62 |
67 |
63 |
64 |
60 – 75 |
|
Total Energy Kcal/kg/day |
40 – 60 |
60 |
71 |
94 |
111 |
75 – 120 |
Table 5.0: Nutritional Content Vs requirements for PRETERM INFANTS: using the STANDARD (12.5%) bag given at standardised fluid volumes for >1500g Birth weight
|
|
NICE 2020 Starting dose Nutrition Req (Unless stated) |
Day 1
|
Day 2
|
Day 3
|
Day 4
|
Day 4/5 |
NICE 2020 Full Nutrition Req (unless stated) |
|
Aqueous vol (ml/kg) |
|
48 |
68 |
82 |
100 |
125
|
|
|
SMOF lipid solution vol ml/kg |
12 |
12 |
18 |
20 |
20 |
||
|
Total vol ml/kg |
60 |
80 |
100 |
120 |
145 |
||
|
Protein g/kg/day |
1.35 – 1.8 |
1.4 (~6 kcal/kg) |
2.0 (8 kcal/kg) |
2.4 (~10 kcal/kg) |
2.9 (~12kcal/kg) |
3.6 (14 kcal/kg) |
2.7 – 3.6 |
|
Amino Acid g/kg/day |
1.5 – 2.0 |
1.6 |
2.4 |
2.7 |
3.25 |
4.0 |
3.0 – 4.0 |
|
Sodium mmol/kg/day |
0 – 2.0 (ESPGHAN 2018)
|
1.54 |
2.2 |
2.6 |
3.2 |
4.0 |
2.0 – 5.0 (ESPGHAN 2018) |
|
Potassium mmol/kg/day |
0 – 3.0 (ESPGHAN 2018) |
0.63 |
0.9 |
1.1 |
1.3 |
1.62 |
2.0 – 3.0 (ESPGHAN 2018) |
|
Phosphate mmol/kg/day |
1.0 (NICE 2020) 1.0 – 2.0 (ESPGHAN 2018) |
0.78 |
1.1 |
1.33 |
1.62 |
2.0 |
2.0 (NICE 2020) 1.6 – 3.5 (ESPGHAN 2018) |
|
Calcium mmol/kg/day |
0.8 – 1.0 (NICE 2020) 0.8 – 2.0 (ESPGHAN 2018) |
0.78 |
1.1 |
1.33 |
1.62 |
2.0 |
1.5 – 2.0 (NICE 2020) 1.6 – 3.5 (ESPGHAN 2018) |
|
Magnesium mmol/kg/day |
0.1 – 0.2 (ESPGHAN 2018) |
0.08 |
0.12 |
0.14 |
0.17 |
0.21 |
0.2 – 0.3 (ESPGHAN 2018) |
|
Glucose 12.5% g/kg/day |
6.0 – 9.0 |
6.0 (24kcal/kg) |
8.5 (34 kcal/kg) |
10.25 (41kcal/kg) |
12.5 (50kcal/kg) |
15.5 (62kcal/kg) |
9 - 16 |
|
Fat g/kg/day |
1.0 – 2.0 |
2.0 (20kcal/kg) |
2.0 (20 kcal/kg) |
3.0 (30 kcal/kg) |
3.5 (35 kcal/kg) |
3.5 (35kcal/kg) |
3 – 4
|
|
NON-PROTEIN energy Kcal/kg/day |
- |
44 |
54 |
71 |
85 |
97 |
- |
|
Non protein energy per g Amino acid |
20 – 30 |
27.5 |
22.5 |
26 |
26 |
24 |
20 - 30 |
|
Proportion of fat energy from non-protein energy % |
25 – 40 |
45 |
37 |
42 |
41 |
36 |
25 - 40 |
|
Proportion of carbohydrate energy from non- protein energy % |
60 – 75 |
55 |
63 |
58 |
59 |
64 |
60 - 75 |
Table 6.0: Central bag – 16% Glucose - given at maximum volume of 125ml/kg (including lipid) for PRETERM INFANTS Vs preterm nutritional requirements
|
|
Aiming for 120ml/kg |
NICE 2020 Full Nutrition Requirements (unless stated) |
|
Aqueous vol (ml/kg) |
100 |
|
|
SMOF lipid solution vol ml/kg |
20 |
|
|
Total vol ml/kg |
120 |
|
|
Protein g/kg/day |
3.1 (12.4kcal/kg)
|
2.7 – 3.6 |
|
Amino Acid g/kg/day |
3.47 |
3.0 – 4.0 |
|
Sodium mmol/kg/day |
4.0 |
2.0 – 5.0 (ESPGHAN 18) |
|
Potassium mmol/kg/day |
0 |
2.0 – 3.0 (ESPGHAN 18) |
|
Phosphate mmol/kg/day |
0.8 |
2.0 (NICE 2020) 1.6 – 3.5 (ESPGHAN 18) |
|
Calcium mmol/kg/day |
0.8 |
1.5 – 2.0 (NICE 2020) 1.6 – 3.5 (ESPGHAN 18) |
|
Magnesium mmol/kg/day |
0.2 |
0.2 – 0.3 (ESPGHAN 18) |
|
Glucose 16% g/kg/day |
16 (64kcal/kg) |
9 – 16 |
|
Fat g/kg/day |
3.5 (35 kcal/kg)
|
3 – 4
|
|
NON-PROTEIN energy Kcal/kg/day |
99 kcal/kg |
- |
|
Non protein energy per g Amino acid |
28.5 |
20 – 30 |
|
Proportion of fat energy from non-protein energy % |
35 |
25 – 40 |
|
Proportion of carbohydrate energy from non- protein energy % |
65 |
60 – 75 |
|
Total Energy Kcal/kg/day |
111.4 |
75 – 120 |
Table 7.0: Sodium Free bag - 10% glucose nutritional content Vs preterm infant requirements
- This is an example of nutritional content with standard fluid increments
- This bag is likely to be used mostly for the first 48 hours after birth for < 28/40 infants - it is not formulated to be used for much longer than this.
|
|
NICE 2020 Starting dose Nutrition requirements (Unless stated) |
Day 1 |
Day 2 |
Day 3 (if needed)
|
NICE 2020 Full Nutrition Requirements (unless stated) |
|
Aqueous vol (ml/kg) |
|
78 |
108
|
132 |
|
|
SMOF lipid solution vol ml/kg |
12 |
12 |
18 |
||
|
Total vol ml/kg |
90 |
120 |
150 |
||
|
Protein g/kg/day |
1.35 – 1.8 |
1.78 (7.1 kcal/kg) |
2.45 (9.8kcal/kg) |
3.0 (12kcal/kg) |
2.7 – 3.6 |
|
Amino Acid g/kg/day |
1.5 – 2.0 |
2.0 |
2.7 |
3.26 |
3.0 – 4.0 |
|
Sodium mmol/kg/day |
0 – 2.0 (ESPGHAN 2018)
|
0 |
0 |
0 |
2.0 – 5.0 (ESPGHAN 18) |
|
Potassium mmol/kg/day |
0 – 3.0 (ESPGHAN 18)
|
1.26 |
1.75 |
2.14 |
2.0 – 3.0 (ESPGHAN 18) |
|
Phosphate mmol/kg/day |
1.0 (NICE 2020) 1.0 – 2.0 (ESPGHAN 18) |
0.47 |
0.65 |
0.79 |
2.0 (NICE 2020) 1.6 – 3.5 (ESPGHAN 18) |
|
Calcium mmol/kg/day |
0.8 – 1.0 (NICE 2020) 0.8 – 2.0 (ESPGHAN 18) |
0.47 |
0.65 |
0.79 |
1.5 – 2.0 (NICE 2020) 1.6 – 3.5 (ESPGHAN 18) |
|
Magnesium mmol/kg/day |
0.1 – 0.2 (ESPGHAN 18) |
0.13 |
0.18 |
0.22 |
0.2 – 0.3 (ESPGHAN 18) |
|
Glucose 10% g/kg/day |
6.0 – 9.0 |
7.8 (31.2kcal/kg)
|
10.8 (44kcal/kg) |
13.2 (52.8kcal/kg) |
9 – 16 |
|
Fat g/kg/day |
1.0 – 2.0 |
2.0 (20kcal/kg) |
2.0 (20kcal/kg) |
3.0 (30kcal/kg) |
3 – 4
|
|
NON-PROTEIN energy Kcal/kg/day |
- |
51.2 |
64 |
82.8 |
- |
|
Non protein energy per g Amino acid |
20 – 30 |
25.6 |
23.7 |
25.4 |
20 – 30 |
|
Proportion of fat energy from non-protein energy % |
25 – 40 |
39 |
31 |
36 |
25 – 40 |
|
Proportion of carbohydrate energy from non- protein energy % |
60 – 75 |
61 |
69 |
64 |
60 – 75 |
|
Total Energy Kcal/kg/day |
40 – 60 |
58.3 |
73.8 |
94.8 |
75 – 120 |