Nutrition for Neonates Undergoing Surgery for CHD — Advance Parenteral Nutrition — Clinical Pathway: Inpatient

Nutrition for Neonates with Congenital Heart Disease Clinical Pathway — CICU

Advance Parenteral Nutrition

Follow the tables below to guide the daily advancement of preoperative and postoperative parenteral nutrition. Consult RD for modifications.

General Goals for Parental Nutrition Macronutrients to Provide 100 kcal/kg/day:

Goal Components of PN Additional Guidelines
Volume of PN 85 mL/kg/day
  • Adjust to maintain desired total fluid limit (TFL).
  • Account for changes in medications, carriers, etc.
Dextrose 25%
  • If peripheral access only, limit dextrose to ≤ 12.5% (< 1000 mOsm/L).
  • If central access is available, advance dextrose by 2.5 to 5% daily to goal.
Amino Acids 3 g/kg
  • Advance amino acids to goal of 3 to 3.5 g/kg.
  • If creatinine is ≥ 1 mg/dL, limit amino acids to 2 g/kg/day.
Lipids 3 g/kg
  • If triglyceride level is ≥ 200 mg/dL, confirm level has not been drawn from lipid infusing line then hold or reduce dose by 50%. Recheck level in 24 hours.

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
Intravenous Requirements (Daily) for Electrolytes
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.

Advancing (or titrating) PN while advancing enteral nutrition

  • When enteral feeds are initiated, any enteral volume administered may exceed the intravenous TFL of 100 mL/kg/day up to 130 ml/kg/day prior to weaning PN.
  • Continue intravenous lipids until enteral caloric intake ≥ 100 kcal/kg/day.
  • Once goal enteral nutrition achieved, discontinue TFL order.
  • Discuss/evaluate TFL order daily.