Nutritional management of newborn infants: Practical guidelines

Table 2 Evidence-based PN in preterm newborns

	Evidence-based PN
Fluids	D 1: 60-80 mL/kg per day. Infants < 28 wk gestation are nursed in a maximally humidified environment (90% humidity) for at least 7 d. Postnatal weight loss of 5% per day to a maximum of 15% is acceptable, which is achieved by progressively increasing the fluid intake to 120-150 mL/kg per day at 1 wk of age
Energy	An intake of 50 kcal/kg per day is sufficient to match ongoing expenditure, but it does not meet additional requirements of growth. The goal energy intake is 120 kcal/kg per day, which is higher in infants with chronic lung diseases
Protein	Optimal parenteral amino acid intake is 3.5 g/kg per day. Parenteral amino acids can begin from day 1 at a dose of 1.75 g/kg per day
Carbohydrate	From day 1, 6-10 g/kg per day can be infused and adjusted to maintain blood glucose level of 2.6-10 mmol/L. Insulin is only used in infants whose blood glucose level is higher than 15 mmol/L and associated with glycosuria and osmotic diuresis, even after glucose intake has been decreased to 6 g/kg per day. Carbohydrate is given as a continuous infusion commencing at a rate of 0.05 U/kg per hour, and increased as required for persistent hyperglycemia
Fat	Intravenous fat, 1 g/kg per day, can be started from day 1, or when intravenous amino acids are started. The dose of intravenous fat is increased to 2 g/kg and 3 g/kg per day over the next 2 d. Twenty percent intravenous fat is delivered as a continuous infusion via a syringe pump, separated from the infusate containing amino acids and glucose. The syringe and infusion line should be shielded from ambient light
Minerals	Minerals should include sodium (3-5 mmol/kg per day), chloride (3-5 mmol/kg per day), potassium (1-2 mmol/kg per day), calcium (1.5-2.2 mmol/kg per day), phosphorus (1.5-2.2 mmol/kg per day), and magnesium (0.3-0.4 mmol/kg per day)
Trace elements	Trace elements should include zinc (6-8 μmol/kg per day), copper (0.3-0.6 μmol/kg per day), selenium (13-25 nmol/kg per day), manganese (18-180 nmol/kg per day), iodine (8 nmol/kg per day), chromium (4-8 nmol/kg per day), and molybdenum (2-10 nmol/kg per day)
Vitamins	Vitamins must be added to the fat emulsion to minimize loss of vitamins due to adherence to tubes and photodegradation