Nutrition is something that every neonatologist must calculate for each child during the morning rounds. It is estimated that no one can calculate more and consider more carefully than us except nutritionists. It is estimated that the doctor will directly prescribe several bags of 250-500ml liquid for adult infusion, but we calculate it according to each ml, because the nutrients supplied by the baby should be calculated according to the daily needs. This is especially true in Elb, which needs to "live within our means".
Generally speaking, the components that need to be calculated every day are: water (unit ml/kg), amino acids, fat and glucose (unit g/kg/d); There are also daily calories, osmotic pressure and sugar concentration of intravenous nutrition (to determine whether it can be used in different veins). At the same time, the weight gain should be calculated regularly (usually once a week, in g/kg/d).
Electrolyte, vitamins (fat-soluble and water-soluble), trace elements, calcium and phosphorus are all rough, so just give a fixed amount every day. In some cases, careful calculation is needed. For example, when there is low potassium, calculate the total amount of potassium needed every day (2-3 mmol/kg, the molecular weight of kcl is 74.5, if the baby is 1kg, it needs 150-225mg every day), and the concentration of potassium in the preparation solution is also limited, generally not exceeding 0.3% (65438+).
These calculations tested the math scores of our middle school. People who study medicine are not bad at math, and medical schools are all better universities. So this calculation is not complicated, but it is time-consuming. It is estimated that the time to calculate TPN every day in the intensive care unit is about 1 hour (assuming 10 patients). So some busybodies design simple programs to improve the speed of calculating intravenous nutrition.
I don't like using programs, because I do well in math in middle school.
Foreigners are more extravagant. They have diatician specially equipped with TPN, and the doctor only needs to give a total amount. In fact, there are nutritionists in domestic hospitals, but it seems that they have never seen nutritionists help neonatologists calculate TPN. I don't know what they are doing every day, so we must be nutritionists.
In fact, foreigners have another way. They prepared a standard solution called Primene, which contains most nutrients, including sugar, amino acids and electrolytes (like Ringer's solution, but Ringer's solution is mainly sodium-containing electrolyte, without amino acids and other nutrients). Vitamins and fats should be added extra. When a doctor orders a doctor's order, just calculate how many milliliters it is, and if it is necessary to increase the content of a certain nutrient, add extra.
It's strange that we don't have this thing in China. It is said that it is not difficult to produce this kind of thing, and no special patent is needed. Why is no manufacturer willing to do it? There are about10.5 million premature babies in China every year. If everyone uses 5 bags on average, it is 7.5 million bags. If it is an exclusive monopoly, each bag of 20 yuan is the output value of10.50 billion yuan. I wonder if it is worth developing. If you use 500ml of Ringer's solution to go to 2.5 yuan (cheaper than many mineral waters), it is estimated that there is no chance.
It's a little far. I want money crazily, which is more important, the stress of life or the dignity of life?
Because nutrition involves so many ingredients, no one dares to say that he is good at all aspects of nutrition. Premature infant nutrition is also the fastest growing field. I remember returning to China six years ago, many doctors used to give 0.5g/kg amino acid on the first day, and then increase it by 0.5g every day. It is estimated that no one will do this now, because newborns need at least 1.5g/kg every day. Below this supply, they are lost every day (negative nitrogen balance).
Long-term vein will have some complications, such as infection, which opens a channel for bacteria to enter compared with intravenous infusion; May lead to cholestasis (affecting liver function, nutrients need to be decomposed and metabolized through the liver); It may lead to some nutritional deficiencies (such as bone disease in premature infants caused by calcium deficiency) and so on.
No matter how the intravenous nutrition is matched, it is not as good as the baby's absorption of nutrition through intestinal feeding. Because it is impossible to calculate and configure dozens or hundreds of nutrients. Moreover, the administration of ELBWI intravenous nutrition requires central venous catheterization, and the longer the intubation time, the higher the risk of infection. Therefore, premature infants should start breastfeeding as soon as possible and achieve total gastrointestinal nutrition as soon as possible. However, in order to realize total gastrointestinal nutrition as soon as possible, a virtuous circle is needed: adjust the functions of various organs of Elb Uygur quickly and carefully after birth, use noninvasive ventilation as much as possible, shorten the use time of antibiotics as much as possible, start milk as soon as possible, and adopt breast feeding. The sooner total gastrointestinal nutrition is achieved, the shorter the time required for central venous catheterization, the less the chance of infection, and the less the risk of affecting the development of various organs of infants.
However, Elb Wei had to undergo great changes when he was born, and the gastrointestinal tract was not ready to digest food. So in my opinion, how long it takes to achieve total gastrointestinal nutrition is a reflection of the comprehensive level of neonatology. Moreover, the amount of milk is increasing rapidly, and neonatologists are often worried about causing digestive tract problems, self-denial and entanglement.
Of course, breast milk is the best, not just the food for premature babies.