Guidelines for Optimal Ca/P Intake for Infants at Risk for Osteopenia 

(Version 1.0  6/2/2006 - 5/22/2007)

Parenteral:

1.  Use infant reference ranges for Ca/P:  iCa <3.2 - >6.5mg/dl   P <4.5 - >10.5mg/dl. 

2.  Until a total of 1mEq/kg of either Na or K is added to TPN, order no more than 10mEq/L of 

     Ca. 

3.  Add Ca and Phosphorus to TPN as soon as possible.

4.  Add Ca and P in 2:1 ratio - 30mEq/L of Ca and 15mmol/L of P is optimal. 

                                              

TPN

          Peripheral

mEq/kg Na/K

mEq/L Ca

mmol/L P

 1

 10

 5

>1

 15

 7.5

 

TPN

          Central

mEq/kg Na/K

mEq/L Ca

mmol/L P

         1

       10

      5

        1.5

       20

     10

       > 2

       30

     15

 

Enteral:

1.  Use SSC for initial feedings if breast milk is in short supply.  

2.  Fortify breast milk with SNC at 40 ml/kg/day.

3.  Use HMF rather than SNC at 100 ml/kg/day if breast milk supply is adequate.

 

Breast Milk

Supplement or Fortifier

Comments

Initial Feedings

Supplement with SSC

If breast milk is in short supply or unavailable

At 40-50ml/kg/day

Fortify with SNC

 

At 100ml/kg/day

Fortify with HMF

If breast milk supply is adequate

 

Lasix/Fluid Restriction:

1.  Limit use of Lasix.

2.  Change Lasix to QOD schedule as soon as possible.

3.  Consider adding HCTZ to spare Ca loss.

4.  If feeding premature formula use SSC. 

5.  If feeding EBM/HMF, alternate with SSC feedings.

6. If feeding EBM/SNC, change to EBM/HMF if possible and alternate with SSC feedings.

 

ELBW/VLBW babies who are both fluid restricted (130-140 mL/kg/day) and receiving Lasix, will get more Ca/P if they are fed SSC for half their feedings and EBM/HMF for the other half.  This provides more Ca/P than EBM/SNC supplemented with SSC feedings.

        Archived Versions: None