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.

Slow Evolution of Lipid Emulsions

Decreasing Incidence of Growth Failure with More Aggressive Nutrition –average daily protein intake in most recent cohort during 1st 5 days is 3 g/kg/day (much higher than in previous years

At U of L, they have developed a quick card to calculate glucose infusion rate based on dextrose and fluid volume (mL/kg/day)

Other points:

• 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

Related blog posts:

• Neonatal Nutrition Lecture -What We Know Right Now …
• Current Mortality from Being Born Premature | gutsandgrowth
• Visual Acuity and LCPUFA | gutsandgrowth
• New lipid emulsions — lacking data to support usage | gutsandgrowth
• Long-chain polyunsaturated fatty acids, breastmilk… | gutsandgrowth