Pediatric Nutrition in Practice

Parenteral Nutritional Support 159

3

The recommendations on parenteral sub-
strate supply to stable patients are summarized
in table  1. In individual patients, other dosages
may be required, depending on the patients’ con-
dition.

W a t e r

Fluid needs vary markedly and must be adapted
to the individual patient’s condition. For exam-
ple, some renal or cardiac disorders require lower
water intakes, whereas higher intakes are needed
with enhanced fluid losses (e.g. due to fever, hy-
perventilation or diarrhoea, or from wounds or
fistulae). Monitoring of the fluid status is neces-
sary, considering the patient’s clinical status,
body weight and possibly water intake and excre-
tion, blood electrolytes, acid base status, haema-
tocrit, urine-specific gravity and urine electro-
lytes. The postnatal fluid supply should be gradu-
ally increased ( table 2 ).

Energy

Energy needs vary with physical activity, growth
and the possible need to correct malnutrition.
The energy supply can be adjusted based on for-
mulae for energy expenditure (see Chapter 1.3.2)
and during weight changes. Low energy supplies
induce failure to thrive, but excessive energy in-
take (‘hyperalimentation’) must also be avoided
because it may induce metabolic imbalances, liv-
er damage and a serious refeeding syndrome
particularly in severely malnourished patients
[4].

Amino Acids

Parenteral amino acid requirements are lower
than enteral needs because PN bypasses intestinal
amino acid uptake and utilization. Amino acid Ta b l e 1.

Recommended dosages for parenteral substrate supply to stable patients by age

Age group

Water, ml/kg

Energy,kcal/kg

Amino acidsg/kg

Glucose,g/kg

Lipids,g triglyceri-des/kg

Sodium,mmol/kg

Potassium,mmol/kg

Calcium, mmol/kg

Phosphorus,mmol/kg

Magnesium,mmol/kg

Preterm

140 – 160

110 – 120

1.5 – 4

18

up to 3 – 4

3 – 5 (–7)

2 – 5

Neonate (1st month)

140 – 160

90 – 100

1.5 – 3

18

up to 3 – 4

2 – 3

1.5 – 3

0 – 1 years

120 – 150 (max. 180)

90 – 100

1 – 2.5

16 – 18

up to 3 – 4

2 – 3

1 – 3

0 – 6 months: 0.87 – 12 months: 0.5

0.5

0.2

1 – 2 years

80 – 120 (max. 150)

75 – 90

1 – 2

1 – 3

up to 2 – 3

1 – 3

1 – 3

0.2

0.2

0.1

3 – 6 years

80 – 100

75 – 90

1 – 2

1 – 3

up to 2 – 3

1 – 3

1 – 3

0.2

0.2

0.1

7 – 12 years

60 – 80

60 – 75

1 – 2

1 – 3

up to 2 – 3

1 – 3

1 – 3

0.2

0.2

0.1

13 – 18 years

50 – 70

30 – 60

1 – 2

1 – 3

up to 2 – 3

1 – 3

1 – 3

0.2

0.2

0.1

Depending on the condition of the individual patient, different dosages may be required. Adapted from Koletzko et al. [3]. K

+ supplementation should usually start after onset

of diuresis. Chloride supply usually equals the sum of sodium and potassium supply.

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 158–162
DOI: 10.1159/000375190