Glucose requirements in neonates

[lcsar]

Does anyone know where I can find the glucose requirements (per day) for neonates? I found the fluid and electrolyte requirements, but I can't find glucose requirements. I haven't done my peds clerkship yet but I am doing a surgical selective in peds surgery and my attending asked me to figure it out. I've been looking everywhere and I can't find it. Obviously there are caloric needs, but she was giving the scenario of supplying enough glucose to supply the needs of the brain, rather than caloric needs per day. I know that D10-1/4NS is frequently given, and in kids it could be D5, but I can't find out the exact needs per kg. Can anyone point me in the right direction? Maybe I'm searching with the wrong buzzwords?
Thanks!

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[edmadison]

Does anyone know where I can find the glucose requirements (per day) for neonates? I found the fluid and electrolyte requirements, but I can't find glucose requirements. I haven't done my peds clerkship yet but I am doing a surgical selective in peds surgery and my attending asked me to figure it out. I've been looking everywhere and I can't find it. Obviously there are caloric needs, but she was giving the scenario of supplying enough glucose to supply the needs of the brain, rather than caloric needs per day. I know that D10-1/4NS is frequently given, and in kids it could be D5, but I can't find out the exact needs per kg. Can anyone point me in the right direction? Maybe I'm searching with the wrong buzzwords?
Thanks!

With our NICU babies, the amount of glucose is "as much as we can get them". I've had kids on D17 or higher. Typically, we start preemies on D10 sterile water with a rate between 60cc/kg/day and 100cc/kg/day. The older the child in gestational age, the lower the starting fluid rate (younger preemies have greater insensible losses). Starting at about 24-48 hours following birth, we will start to add electrolytes, protein and trace minerals to the IV = TPN; we will also start lipids as well. We will gradually increase the "D-ness" (dextrose concentration) of the fluids over time. We watch the Glucose Infusion Rate (GIR) and try not to increase this by more than 2 (usually less) every day. We follow d-sticks and weights very closely.

Fluid and nutrition management is a critical skill in the NICU. The micro preemies may only be getting 100 cc of fluid daily. If they are sick and receiving a lot of medication, it restricts the amount of nutrition you can give them. This is a terrible parasox: the sicker the baby is, the more IV medication they get and the less nutrition they get. Nutrition is what is going to save these kids, if something else doesn't kill them first. They're only about 3/5 cooked and need their building blocks. We also try to get this kids feeding as soon as they are stable. Typically, they are tube fed until 34-35 weeks.

If you're asking about non-preemies, the Harriet Lane Handbook has the answers you are looking for. In terms of calories for neonates, we usually shoot for about 160/kg/day total, more if we can get it, regardless of gestation age.

Ed