How to Calculate Components in Neonatal TPN
Instructions
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1
Calculate the amount of protein the TPN formula should include by using 2 to 3 grams of amino acids per kilogram per day to begin with and advancing to no more than 3 grams per kilogram per day, according to UCSF Benioff Children's Hospital's 2006 Intensive Care Nursery House Staff Manual. For example, a baby that weighs 3 kg should receive a maximum of 9 g of amino acids per day.
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2
Calculate the amount of carbohydrate that should be included in the TPN formula by using 4 to 6 milligrams of dextrose monohydrate per kilogram per minute and gradually increasing to no more than 12 milligrams per kilogram per minute. For example, a 3 kg infant should receive a maximum of 36 mg per minute.
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3
Calculate the amount of fat needed in the TPN formula using the rate of 0.25 to 0.5 grams per kilogram per day to prevent a deficiency in essential fatty acids. For example, a 3 kg baby should receive at least 0.75 g of lipids per day.
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4
Determine if calorie needs are being met. The minimal amount needed to prevent catabolism is 40 kilocalories per kilogram per day. To sustain continued growth, a goal of 100 kilocalories per kilogram per day should be met. Use the following conversion factors to convert grams of each macronutrient to kilocalories: 1 g amino acids = 4 kcal, 1 g dextrose = 3.4 kcal and 1 g lipids = 10 kcal. (For dextrose, be careful to convert milligrams to grams and minutes to days before using the conversion factor.)
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5
Determine the calorie percentage of each macronutrient and make sure that lipids do not exceed 60 percent of the total caloric intake.
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6
Choose the appropriate dextrose/amino acids solution and lipid emulsion that meet the calculated requirements.
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7
Account for electrolytes, vitamins and minerals according to the suggested ranges on the TPN order form.
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8
Monitor laboratory values and make adjustments as needed to keep the TPN in an appropriate balance that will support the infant's growth and recovery.
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