Parenteral Nutrition PN for the preterm infant with short bowel syndrome'

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Parenteral Nutrition (PN) for the preterm infant
with short bowel syndrome.

• Deirdra Hartigan
• Lead Pharmacist for Paediatric and Neonatal
  Nutrition
• 6th October 2009

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Neonatal PN Requirements

• ELBW 70-85kcal/kg to maintain stores
• ELBW 105-115kcal/kg to grow
• VLBW 60-70kcal/kg to maintain stores
• VLBW 90-100kcal/kg to grow

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Intralipid

• Developed in the 1960s
• Mainly Omega 6 fatty acids
• 60 polyunsaturated fatty acids (PUFA)
• 23 monounsaturated fatty acids (MUFA)
• Reliable source of essential fatty acids

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Clinoleic

• Olive oil based lipid
• soybean olive oil
• long chain fatty acids
• 20 PUFA
• 65 MUFA
• ? intake PUFA

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Omegaven

• Fish oil based lipid
• Rich in Omega 3
• Improves bile flow
• Inhibiting steatosis
• Immunomodulatory effects

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LTH LIPID protocol

• Conjugated bilirubin gt50mcmol/L reduce fat to
  2g/kg and change to Clinoleic
• Conjugated bilirubin gt100mcmol/L change to mix
  of Clinoleic and Omegaven
• Conjugated bilirubin gt150mcmol/L Add in
  ceruletide to treatment.

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Line Locks

• Gentamicin line locks (2mg/ml)
• Vancomycin line locks (5mg/ml)
• Amphoteracin B line locks (2.5mg/ml)
• Taurolock
• All LTH line locks 2ml

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Reference sources

• ESPGHAN website
• BPNG website
• Fresenius Kabi quarterly abstract bulletin
• Pediatric Surgery International-SpringerLink
  (www.springerlink.com)
• Pediatrics (pediatrics-mailer_at_alerts.stanford.edu)
  
• American Journal of Clinical Nutrition
• (ajcn-mailer_at_alerts.stanford.edu)