The document discusses guidelines for total parenteral nutrition (TPN) administration for neonates. It provides examples of TPN regimens for various clinical cases, including a low birth weight infant with respiratory distress, gradual advancement of enteral feeds, necrotizing enterocolitis, and hypoglycemia. The document also covers calculating calorie and amino acid needs, dosing for medications like aminophylline and nystatin prophylaxis criteria.

1. TPN PERINA
Dan dosis obat PERINA

3. GIR = Dx X rate
--------------
6 x BB
Cairan:
- PG1 (1) 30 ml (Na 0)  hari 0-1 BB<2000  untuk neonatus usia 1 hari
- PG2 (1) 30 ml (Na)  hari ke2 dst  untuk neonatus usia >1 hari
- Dextrose 10% + Ca (2)  hari 0-1 BB>2000
- Lipid (1) 5 ml

4. Contoh Kasus
Bayi lahir 1500 gram, sesak berat, HMD gr III, CPAP 8/40%.
NPO
TC 60 ml/kg/hari  3,8 ml/jam
• PG1 (1,8)  55 ml/kg/hari  3,4 ml/jam
GIR 4, Dextrositas 11%
• L (1)  5 ml/kg/hari  0,4 ml/jam
TC TPN 60 ml/kg/hari
BB 1500 kg
PG1 (1,8) GIR 4, dextrosity 11%  3,4 ml/jam
Lipid (1)  0,4 ml/jam

5. Contoh naik minum cepat
Bayi lahir 1500 gram, sesak ringan, HMD gr I, CPAP 6/21%.
• TC 60 ml/kg/hari
Enteral: 4x1 ml, 4x2 ml, 4x4 ml (24 ml  20 ml/kg/hari)
Parenteral: 40 ml/kg/hari  2,5 ml/jam
PG1 (1,3)  40 ml/kg/hari  2,5 ml/jam, dextrosity 10%, GIR 2,7
• TC 60 ml/kg/hari
Enteral: 4x6 ml, 4x8 ml, 4x10 ml (96 ml  64 ml/kg/hari)

6. Contoh naik minum bertahap
Bayi lahir 1500 gram, sesak berat, HMD gr III, CPAP 6/21%.
• TC 60 ml/kg/hari (hari 0)
Enteral: 10 ml/kg/hari (8 x 2 ml)
Parenteral: 60 ml/kg/hari  3,8 ml/jam
PG1 (1,8)  55 ml/kg/hari  3,4 ml/jam
GIR 4, Dextrositas 11%
L (1)  5 ml/kg/hari  0,4 ml/jam
• TC 70 ml/kg/hari (hari 1)
Enteral: 30 ml/kg/hari (8 x 6 ml) GIR 1,8
Parenteral: 40 ml/kg/hari
PG2 (1,3)  40 ml/kg/hari  2,5 ml/jam
GIR 3,2, dextrosity 12%
• TC 80 ml/kg/hari (hari 2)
Enteral: 50 ml/kg/hari (8 x 10 ml) GIR 3
Parenteral: 30 ml/kg/hari
PG2 (1)  30 ml/kg/hari  1,8 ml/jam
GIR 2,5, dextrosity 12%

7. Contoh kasus NEC
BB 1800 kg, NEC gr III, NPO, usia 2 minggu
• TC 150 ml/kg/hari: obat 10 ml/kg/hari
• TC TPN 140 ml/kg/hari  10,5 ml/jam
• PG2 (3) 90 ml/kg/hari  6,7 ml/jam
GIR 7,2 dextrosity 12%
• Lipid (2) 10 ml/kg/hari  0,8 ml/jam
• Dextrose 10% + Ca (2) 40 ml/kg/hari  3 ml/jam
GIR 2,8
GIR total 10
TC TPN 140 ml/kg/hari
BB 1800
(TPN untuk 48 jam)
PG2 (3) GIR 7,2 dextrosity 12%  6,7 ml/jam
Lipid (2)  0,8 ml/jam
Dextrose 10% + Ca (2) GIR 2,8  3 ml/jam (boleh digabung ke PG)
Tulis di notes resep:
TC TPN 140 ml/kg/hari
BB 1800
PG2 (3)  6,7 ml/jam
Dextrose + Ca (2)  3 ml/jam (boleh digabung ke PG)
GIR 10, dextrosity 11%
Lipid (2)  0,8 ml/jam
GIR total 10

8. Atau…..
• TC TPN 140 ml/kg/hari  10,5 ml/jam
• PG2 (4) 120 ml/kg/hari  9 ml/jam
GIR 10 dextrosity 12%
• Lipid (4) 20 ml/kg/hari  1,5 ml/jam
TC TPN 140 ml/kg/hari
BB 1800
PG2 (4) GIR 10 dextrosity 12%  9 ml/jam
Lipid (4)  1,5 ml/jam

9. Contoh kasus hipoglikemia
GIR 20, BB 1800 kg
TC TPN 140 ml/kg/hari
• PG2 (3,5)  105 ml/kg/hari  9 ml/jam
GIR 14,5, dextrositas 17,5%
• Lipid (3)  15 ml/kg/hari
• Dextrose 40%  20 ml/kg/hari  1,5 ml/jam
GIR 5,5
18.00 GDS 100  GIR 19
Dextrose 40%  1,2 ml/jam
GIR 4,5

10. NOTES:
Dextrosity max di PG 23%
Perifer: dextrosity max 12%
PICC/umbilical/long blue: dextrosity >>>
Bisa membuat TPN 48 jam

11. Menghitung kalori
• Protein 1 gr  4 kkal /kg/hari
• Lipid 1 gr  9 kkal/kg/hari
• GIR … x 5.7 /hari

12. Dosis aminofilin
• LD: 10 mg/kg
• MD: 2,5 mg/kg tiap 12 jam

13. Aplikasi TPN made by Anya

21. Nystatin
Nystatin profilaksis:
• Diberikan pada bayi yang memiliki risiko
tinggi infeksi jamur invasif.
• Kriteria:
• 1. Bayi lahir dengan usia gestasi ≤ 32 minggu
atau berat lahir < 1500 gram;
• 2. atau bayi yang lebih besar dengan faktor
risiko penggunaan antibiotik, memiliki akses
vena sentral
• (PICC/CVC atau long blue/UVC kateter
umbilikal), menggunakan nutrisi parenteral
atau mendapat terapi steroid inhalasi.