front 1 Validated Screening tools in paediatrics, recommended frequancy | back 1 STAMP: 2-17 yr, 5 steps PYMS: 1-16 yr, 4 steps (widely adopted in UK, BMI) |
front 2 Weaning PN recommendations (Infants) | back 2
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front 3 Weaning PN recommendations (older children) | back 3
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front 4 Weaning PN for long term HPN patients | back 4 Night off PN (may require IV fluids) |
front 5 NEC Conservative Management | back 5 • NBM 5-10 days • Parenteral nutrition • Triple antibiotics |
front 6 What’s the expected small intestinal length for a 30 week gestation infant? | back 6 ~175cm |
front 7 The presence of protein and fat in the duodenum stimulate production of .... | back 7 CCK -> gallbladder contraction |
front 8 Possible Benefits of recycling stoma losses | back 8 • Improved fluid and electrolyte balance • Faster rate of weight gain (improved capacity for absorption) • Cessation of PN in 60% of patients • Liver enzyme and function profiles improved • Reduction in size discrepancy between proximal and distal bowel • Reduction in rates of post operative anastomotic strictures and leakage |
front 9 Managing IFALD | back 9 1. SMOF lipid 2. Cycle lipid component (e.g. give lipid on alternate days – 1 day on, 1 day off) 3. 3g/kg/day parenteral fat (10kcal/1g) = 30kcal/kg |
front 10 Anti-infective factors in human milk | back 10 1. lactoferrin 2. immunoglobulins |
front 11 Non nutritive components of formula | back 11 • Nucleotides • Oligosaccharides |
front 12 Monogen formula fat content | back 12 84% MCT 16% LCT |
front 13 Trophic feeding maximum rate | back 13 12-24 ml/kg/day |
front 14 Feed advancement recommendations (term vs preterm) | back 14 Preterm high risk -> 10-20 ml/kg/day Term standard risk -> 30 ml/kg/day |
front 15 Fresh MEBM vs pasteurised DEBM | back 15 MEBM higher - micronutrients - immunoactivite factors - trophic factors DEBM lower - Microbes |
front 16 DEBM criteria for eligibility | back 16 All babies < 32 weeks and or <1000g |
front 17 When DEBM supply low only babies will receive it ? | back 17 High risk of feed intolerance: <31 weeks on PN Abdominal surgery or recovering from NEC End diastolic flow Growth restriction below 2nd centile |
front 18 BMF recommendations | back 18 1g to 25 ml of BM Start hen EN reach 40-100ml/kg/day Protein hydrolysed 1.3g and 16 kcal No iron added, provideing vitamines and minerals |
front 19 Nutriprem 1 content and indications | back 19 Whole protein + 9% MCT + lactose = Osmo 310 For preterm infants, < 2Kg |
front 20 Nutriprem 2 indications | back 20 Preterm infants <35 weeks, >2kg Up to 6 months corrected age |
front 21 hydrolyzed nutriprem content | back 21 EHP+ 7% MCT + lactose = Osmo 410 |
front 22 TPN ratios recommendations | back 22 Non-protein energy = 60-75% CHO + 25-40% lipids AA intake = at least 1.5 g/kg/day NPE to N : 20-30 kcal / 1g AA Total energy: 30-40 kcal/ 1gAA 25kcal/1 g AA AA to protein / 1.12 |
front 23 PN criteria | back 23 weight < or = 1.5 kg Gestation < or = 30 +6 weeks IUGR between 31-34 weeks or EDF or 31-37 feed not expected NEC IF <37 weeks NBM for 48 hrs |
front 24 When to start PN | back 24 within 6 hrs of birth or admission |
front 25 Supplementary glucose % and advancement of PN in neonates 25 weeks and over | back 25 more than or = 5 days 10% glucose max rate 30 ml/kg/day |
front 26 Supplementary glucose % and advancement of PN in neonates 24 +6 weeks and under | back 26 over > or = 7 days 5% glucose |
front 27 Lipid rate reduced if TG level is | back 27 > or = 2.8 mmol/l |
front 28 SCAMP | back 28 -Two-compartment standardised PN -Maintenance PN bag= Glucose, protein, electrolytes, trace elements Rate: 60 -> 75 -> 90 ml/kg/day maximum -Lipid PN syringe= Fat, water and fat soluble vitamins 6,1 -> 12,2 -> 17ml, 3g/kg/day maximum +Supplementary infusion of glucose 10% or 5% +Supplementary infusion of electrolytes - Primene amino acid course allowing longer shelf life |
front 29 NEON | back 29 - Two-compartment standardised PN - start up and maintenance bag Depending on postnatal day of life run at a different rate - Can use side arms of glucose 5% and 10% x- Does not use additional electrolytes Lower starting protein and glucose delivery than SCAMP - Primene amino acid source- allows longer shelf life |
front 30 Only licensed three compartment neonatal PN Amino acid, glucose and lipid separately | back 30 NUMETA |
front 31 Glucose Infusion Guidelines Preterm | back 31 Start at 6-9 g/kg/day (4.1–6.3 mg/kg/min) After 4 days 9–16 g/kg/day Maximum intake 16 g/kg/day (11 mg/kg/min) |
front 32 Can you think of a candidate that would be better on a standardised PN bag than bespoke PN | back 32 - A baby meeting nutritional recommendations and growing well on - A baby that is extremely fluid restricted - At a weekend or out of hours |