Nutrition for Neonates with Congenital Heart Disease Clinical Pathway — CICU
Nutrition for Neonates with Congenital Heart Disease Clinical Pathway — CICU
Initiate Parenteral Nutrition
Pre-op
- Initiate within 24 hours of admission unless contraindicated due to the following reasons:
- Scheduled for cardiac surgery within 24 hours of admission
- Cardiac Arrest or ECMO
- If IV access unavailable for PN, prioritize discussion for how to best obtain appropriate access
- Oral intake exceeding minimum requirements
Post-op
- Bypass cases: Post-op day 1, AM rounds unless contraindicated due to the following reasons:
- Cardiac Arrest or ECMO
- Oral intake exceeding minimum requirements
Parenteral Nutrition Order
| Total Volume and Rate | 60 mL/kg/day (adjust as needed to maintain desired TFL) |
|---|---|
| Dextrose | 10% - 12.5% |
| Amino Acids | 2 g/kg |
| Additives | Heparin 0.5-1 unit/mL MVI, neonatal trace |
| Lipids | 2 g/kg/d |
Daily Intravenous Requirements for Electrolytes
Initiate at low end of range, increase based on individual needs
- Ranges are suggested guidelines only
- Specific clinical situations may have different daily requirements
| NaPhos | 1-2 mmol/kg Peripheral access: Limit ≤ 1 mmol/kg |
|---|---|
| NaCl | 1-4 mEq/kg |
| KCl | 1-4 mEq/kg |
| CaGluc | 1-3 mEq/kg Peripheral access: Limit ≤ 1 mEq/kg |
| MgSulf | 0.3-0.5 mEq/kg |
Laboratory Monitoring
Check TPN panel, BMP, Mg, Phos, Hepatic Function, Triglycerides and Pre-albumin within 48 hours of PN initiation, followed by weekly until PN is discontinued.