Pediatric Nutrition in Practice

160 Koletzko^

utilization requires an energy supply of ∼ 30–40
kcal/g of amino acid to prevent excessive amino
acid oxidation. In very-low-birth-weight infants
(VLBWI) requiring PN, amino acid supply should
start on the first day of life with a dose of ≥ 2 g/kg
per day [5]. Infants and young children should
receive paediatric amino acid solutions with ad-
equate amounts of cysteine, taurine and tyrosine
(conditionally essential amino acids; see Chapter
1.3.3).

Glucose

Glucose is the only carbohydrate recommended
for PN and should provide 60–75% of non-pro-
tein calorie intake. During the first days on PN,
the glucose supply should be gradually increased.
In preterm infants, the glucose intake should be-
gin with 4–8 mg/kg per minute (5.8–11.5 g/kg per
day) and increase gradually. In critically ill chil-
dren, the glucose intake should be ≤ 5 mg/kg per
minute (7.2 g/kg per day). Glucose infusion for
term neonates and children ≤ 2 years should not
exceed 18 g/kg per day (13 mg/kg per minute).
Glucose intake should be adapted to the adminis-
tration of drugs that impair glucose metabolism
(e.g. steroids, somatostatin analogues and tacroli-
mus). Very high glucose intakes and marked hy-
perglycaemia should be avoided because they

may induce increased lipogenesis and tissue fat

deposition, liver steatosis, enhanced CO 2 produc-

tion, impaired protein metabolism and possibly

increased infection-related morbidity and mor-

tality [3]. In critically ill and unstable patients, the

glucose dosage should be lower and increased ac-

cording to the patient’s condition and blood glu-

cose levels.

Lipids

Lipid emulsions supply essential fatty acids and

energy at iso-osmolarity. Lipids should generally

provide 25–40% of non-protein PN calories.

Parenteral lipid intake is usually limited to 3–4

g/kg per day (0.13–0.17 g/kg per hour) in infants

and 2–3 g/kg per day (0.08–0.13 g/kg per hour)

in children. In VLBWI requiring PN, the supply

of lipid emulsions should start on the first day

with a dose of at least 2 g/kg per day [5]. A step-

wise increase of lipid infusion rates by 0.5–1 g/

kg per day has not been shown to improve toler-

ance, but it allows monitoring for hypertriglyc-

eridaemia. Regular plasma triglyceride measure-

ments are recommended, particularly in criti-

cally ill or infected patients during PN. A dosage

reduction should be considered at triglyceride

concentrations during infusion >250 mg/dl in

infants or >400 mg/dl in children, but there

Ta b l e 2. Recommended standard parenteral fluid supply (in ml)

Time after birth

1 day 2 days 3 days 4 days 5 days 6 days

Term neonate 60 – 120 80 – 120 100 – 130 120 – 150 140 – 160 140 – 180

Preterm neonate

>1,500 g 60 – 80 80 – 100 100 – 120 120 – 150 140 – 160 140 – 160

<1,500 g 80 – 90 100 – 110 120 – 130 130 – 150 140 – 160 160 – 180

In neonates, parenteral fluid supply should be gradually increased over the first days of life. Ad-

apted from Koletzko et al. [3].

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