Besides arguing for more aggressive and earlier use of intravenous protein, Dr. Adamkin noted that newer lipid emulsions (eg. SMOFlipid) are likely to be helpful due to the concentrations of docosahexaenoic acid (DHA) and arachidonic acid (ARA). DHA and AA are the two main long chain polyunsaturated fatty acids (LCPUFAs) and are integral to the structural membranes of cells in the central nervous system and retina.
- SGA infants have low lioprotein lipase –>higher triglycerides
- Slow lipid infusion associated with better tolerance
- Insulin may be needed if not able to provide a glucose infusion rate of at least 4 mg/kg/min; otherwise, he recommends avoiding insulin.
- Dr. Adamkin recommended adding carnitine after 4 weeks of TPN
- During transition to enteral feeding, in order to continue with 3.5-4 g/kg/day of amino acids, many infants will need a stock solution of IVFs with supplemental amino acids to supplement enteral feeds
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