Nutrition Support Special Considerations For Nenaotes

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  • Diuretics case mineral and electrolyte losses.Corticosteroids used to shorten the ventilator support can cause negative nitrogen balance, delayed growth, glucose intolerance, bone demineralization and neurodevelopment impairment.
  • Nutrition Support Special Considerations For Nenaotes

    1. 1. Nutrition Support <br />Special Considerations in Neonates<br />Sajjad Ahmad RPh. BCNSP<br />TPN Pharmacist, In-Charge IV Admixture Services<br />KFSH&RC Jeddah K.S.A<br />(May 2009)<br />
    2. 2. 2<br />
    3. 3. Defining Neonates In Terms Of Weight<br />3<br />
    4. 4. Nutrition Support In NICU<br />4<br />Nutrition Support is applied inappropriately in NICU1<br />1. A.S.P.E.N Nutrition Support Practice manual 2nd edition 2005 p301<br />
    5. 5. Phases of NS in critically Ill Infants<br />5<br />
    6. 6. Special Considerations in Premature & Sick Infants<br />6<br />
    7. 7. Nutritional Issues In NICU<br />7<br />
    8. 8. ParenteralNutrition<br />8<br />
    9. 9. Peripheral Route of Nutrition<br />9<br />
    10. 10. Peripheral Solutions – Osmolarity Calculations<br />10<br />
    11. 11. Routes of Administration - Central<br />11<br />
    12. 12. Central Access Options<br />HICKMAN CATHETER<br />PORT<br />GROSHONG<br />PICC LINE<br />12<br />
    13. 13. Central Solutions<br />13<br />
    14. 14. Fluids<br />14<br />
    15. 15. Fluids<br />15<br /><ul><li>Radiant warmers
    16. 16. Phototherapy
    17. 17. RDS
    18. 18. Fever
    19. 19. Diuretics
    20. 20. GI losses
    21. 21. Glycosuria
    22. 22. Heat shields
    23. 23. Blankets
    24. 24. Double-walled incubators
    25. 25. High humidity
    26. 26. Fluid overload
    27. 27. Heart failure</li></ul>Increased Requirements<br />Decreased Requirements<br />
    28. 28. Fluids<br />16<br />
    29. 29. Parenteral Nutrition<br />17<br />A.S.P.E.N. Board of Directors and the Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. J Parenter Enteral Nutr. 2002;26(1suppl): 1SA–138SA.<br />
    30. 30. 18<br />Parenteral Nutrition<br />
    31. 31. OUTCOMES OF NUTRITION THERAPY<br />19<br />
    32. 32. Energy Requirements components<br />20<br />
    33. 33. TPN Initiation…do not start at goal <br />21<br />
    34. 34. Pathogenesis of Re-feeding Syndrome<br />22<br />
    35. 35. Pathogenesis of Re-feeding Syndrome<br />23<br />
    36. 36. Hypophosphatemia<br />24<br />
    37. 37. Cardiac dysfunction<br />25<br />
    38. 38. Neuromuscular Dysfunction<br />26<br />
    39. 39. Respiratory Insufficiency<br />27<br />
    40. 40. Hematologic Effects of Hypophosphatemia<br />28<br />
    41. 41. Hypokalemia<br />29<br />
    42. 42. Hypomagnesemia<br />30<br />
    43. 43. Recommendations to Avoid Re-feeding<br />31<br />
    44. 44. Parenteral Nutrition<br />32<br />
    45. 45. 33<br />
    46. 46. Parenteral nutrition<br />Protein Requirements<br />34<br />
    47. 47. Parenteral nutrition<br />35<br />
    48. 48. Parenteral Nutrition<br />36<br />
    49. 49. Parenteral Nutrition<br />Dextrose (3.4Kcalories per Gm)<br />37<br />
    50. 50. Parenteral Nutrition<br />38<br />
    51. 51. 39<br />Parenteral Nutrition<br />
    52. 52. 40<br />Parenteral Nutrition<br />
    53. 53. Parenteral Nutrition<br />41<br />
    54. 54. essential fatty acid deficiency (EFAD)<br />Deficiency of linoleic and linolenic acids<br />Manifestations (hair loss, delay wound healing, dry scaly skin)<br />EFAD can develop within 72 hours if exogenous fat is not given. <br />EFAD can be prevented with as little as 0.5–1 g/kg/d of IV lipid<br />42<br />
    55. 55. 43<br />Parenteral Nutrition<br />
    56. 56. Parenteral Nutrition<br />44<br />
    57. 57. Parenteral Nutrition<br />45<br />
    58. 58. Calcium Phosphate Solubility<br />Precipitation factor =mEq of Ca++ + mM of PO4 x 100<br />Vol (ml) of TPN before addition of Ca & Phosphate<br />If AA Concentartion &gt; 1.5% the precipitation factor must be &lt; 3<br />If AA concentration &gt;1 % and &lt; 1.5%, the precipitation factor should be &lt; 2<br />For PN solutions &lt; 1% AA concentration, either calcium or phosphorous should be added<br />Parenteral Nutrition<br />46<br />
    59. 59. Parenteral Nutrition<br />47<br />
    60. 60. 48<br />Parenteral Nutrition<br />3. Effects of Early Erythropoietin Therapy on the Transfusion Requirements of Preterm Infants Below 1250 Grams Birth Weight A Multicenter, Randomized, Controlled Trial. Pediatrics. 2001;108:934–942.<br />
    61. 61. Effects of micronutrient deficiency<br />49<br />
    62. 62. Effects of micronutrient deficiency<br />50<br />
    63. 63. Effects of micronutrient deficiency<br />51<br />
    64. 64. 52<br />Parenteral Nutrition<br />
    65. 65. Monitoring<br />53<br />Parenteral Nutrition<br />
    66. 66. Monitoring<br />54<br />Parenteral Nutrition<br />
    67. 67. Parneteral Nutrition<br />55<br />
    68. 68. Parenteral Nutrition<br />56<br />
    69. 69. Parenteral Nutrition<br />57<br />
    70. 70. Parenteral Nutrition<br />58<br />
    71. 71. Parenteral Nutrition<br />59<br />
    72. 72. Parenteral Nutrition<br />60<br />
    73. 73. Cyclic TPN<br />61<br />
    74. 74. 62<br />
    75. 75. Parenteral Nutrtion<br />63<br />
    76. 76. Cause of Occlusion<br />Thrombus<br />Crystals<br />Urokinase<br />HCl 0.1N<br />Success<br />Failure<br />Failure<br />Success<br />HCl<br />Urokinase<br />Success<br />Success<br />Failure<br />Failure<br />Ethanol 70%<br />Ethanol 70%<br />64<br />Management Of Catheter Occlusion<br />
    77. 77. Do’s and Don’tsParenteral Nutrition Solutions<br />65<br />
    78. 78. 66<br />Do’s and Don’tsParenteral Nutrition Solutions<br />
    79. 79. Filtration of Parenteral Nutrition Admixtures<br />67<br />
    80. 80. Transitioning to Enteral Feeds<br />68<br />
    81. 81. Enteral Nutrition<br />Special Considerations in Neonates<br />69<br />
    82. 82. Enteral Nutrition<br />70<br />
    83. 83. Enteral Nutrition<br />71<br />
    84. 84. Necrotizing Enterocolitis and Enteral Feeding<br />72<br />
    85. 85. Necrotizing Enterocolitis and Enteral Feeding<br />73<br />
    86. 86. Enteral Formulations<br />74<br />
    87. 87. Enteral Formulations<br />75<br />
    88. 88. 76<br />Enteral Formulations<br />
    89. 89. Enteral Formulations<br />77<br />
    90. 90. Enteral Feeding Methods<br />78<br />
    91. 91. Enteral Feeding Methods<br />79<br />
    92. 92. Enteral Formulations<br />80<br />
    93. 93. Enteral Formulations<br />81<br />
    94. 94. Enteral Formulas<br />82<br />
    95. 95. Enteral Formulas<br />83<br />
    96. 96. Enteral Formulas<br />84<br />
    97. 97. Enteral Formulas<br />85<br />
    98. 98. Enteral Formulas<br />86<br />
    99. 99. Enteral Formulas<br />87<br />
    100. 100. Enteral Formulas<br />88<br />
    101. 101. Thank you...<br />

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