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"I hear the nurses and doctors talking about TPN. What is that?"

TPN stands for Total Parenteral Nutrition, and refers to the solution infused into your baby’s veins that provides nourishment when s/he is not feeding into his/her tummy. TPN is life-saving in the short term, and can provide all of the protein, carbohydrate, and fat, along with vitamins and minerals, needed to grow and develop. Technically, two solutions comprise TPN: 1) a yellow-colored liquid that has the protein, sugar, vitamins and minerals needed; 2) and a milky white liquid that is the fat. To be precise, the yellow liquid is actually called “Hyperalimentation” and the milky white stuff is called “IntraLipid.” Because the two solutions together provide the full spectrum of nutrition, the combination is called TPN.

Your care team specifies everyday what recipe is used to mix the TPN – and what goes into the solution is what your baby has to grow. If not enough of the substrates are provided, then your baby will either use up precious body stores, or will not develop optimally. If too much of something is provided, it may overstress your baby’s delicate metabolism or organ function, sometimes as to be life-threatening. Hospitals have elaborate mechanisms in place to prevent compounding and administration errors, but sometimes mistakes happen despite everyone’s best efforts.

The best measure of your baby’s normal development is a growth rate that matches fetal growth rates at your baby’s gestational age. Your baby should be weighed frequently, usually every day, and weight gain plotted on a standardized growth chart. While this measures overall body weight, it does not measure body composition, and there is new discussion among neonatologists that our babies may not be developing lean body tissue – muscle and bone – even though they are gaining weight. Some people call this “skinny-fat.”

Every day, from birth, your baby should be receiving at least 4gm/kg/day of protein, 17 gm/kg/day of carbohydrate, and 3gm/kg/day of fat. Total calories, from all sources, should be at least 120kcal/kg/day for older babies, and >135kcal/kg/day for tiny premies or those with increased needs such as lung or heart disease. Weight and head circumference should be charted weekly on the most recent standardized chart, using fetal growth curves as a reference.

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