NICU Rotation: Requirements, Schedule, and Guidelines for Residents and Medical Students, Summaries of Nutrition

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NICU rotation

For residents and medical students

Updated on 2/10/

Rotation requirements

● Carol Jo Vecchie Women’s Center - 4th floor

● The day starts at 7 AM and ends around 5 PM after the 4 PM sign out or at 8

PM if you are on call

● Make sure that you have at least 10 hours off between shifts

● Make sure that you have at least 24 hours off between rotations

What do you need for the rotation....

● Purple book

○ Ask Elisia Hopkins, NICU office manager, about this book

● Rounding sheet

○ Present in NNP drawer in the NICU

Bedside nurse starts with overnight

events and social concerns

Age in days and gestational age (GA)

● Age in days

○ Example: 2 days old, 5 days old …

● Corrected Gestational Age (cGA) or Post Conceptual Age (PCA) or

Postmenstrual Age (PMA)

○ Example: Newborn born at 30 weeks and 5 days. Newborn is 4 days old. Newborn’s cGA is 31 weeks and 2 days ■ PS: Epic may have a different calculation

Apnea, Bradycardia and Desaturation

● Bedside nurse

● Charted in epic

○ Summary → Apnea/Bradycardia tab ○ Flowsheets → PICU/NICU VS → Apnea and Bradycardia

Compare weights

● Change per day ○ Example ■ Newborn gained 30 gm compared to yesterday’s weight ■ Newborn lost 10 gm compared to yesterday’s weight

● Change from birth or per week ○ Example ■ Newborn gained 30 gm compared to birth weight ■ Newborn gained 200 gm over a week ○ You compare the weight to birth weight for the first week of life than per week ○ Always calculate the % of weight loss compared to birth weight ○ = [(birth weight - actual weight) / birth weight] * 100 ○ Example ■ Newborn A has a birth weight of 2.6 Kg but current weight is 2.35 Kg. Calculate % of weight loss since birth. ■ [(2.6-2.35)/2.6]x100 = 9.6%

Use birth weight until newborn attains

birth weight or passes it

Total Enteral Volume

● NPO ● Receiving expressed breast milk and/or donor breast milk and/or formula ● Fortified or not fortified ● Oral and/or feeding tube ● Don’t forget to mention if breastfeeding was attempted

Newborn could be

Total Enteral Volume

● Ad lib (as needed)

○ You get the total enteral volume in 24 hours from Intake/Output tab in Epic and divide this number by weight ■ Example: newborn is 2.5 kg and ate 500 ml in the last 24 hours. The volume is 500 ml / 2.5 kg = 200 ml/kg/day

● Oral and feeding tube

○ You get the total enteral volume in 24 hours from Intake/Output tab in Epic and divide this number by weight ○ You get the total enteral volume in 24 hours from Intake/Output tab that was given orally and divide this number by total enteral volume and multiply it by 100 = percent of oral intake ■ Example: newborn is 1.35 kg and ate 216 ml in the last 24 hours. 100 ml were orally. Total oral intake is: (100/216)*100 = 46% ● PS: always use birth weight until newborn gains it

Enteral feeds - calories

● Breast milk calories is 20 Kcal/oz

■ PS: the actual breast milk calories is unknown

● Fortification could be 22 Kcal/oz, 24 Kcal/oz, 26 Kcal/oz, 28 Kcal/oz, 30

Kcal/oz

○ Sometimes we add prolacta cream to increase the calories more ○ 2.5 Kcal per 1 ml of prolacta cream - approximately 2 Kcal/oz

● Calculation in Kcal/kg/day

○ 20 kcal → 1 oz → 30 ml ○ Multiply the enteral fluid volume (in ml/kg/day) by calories and divide by 30 ml ■ Baby B is 12 day old. He is a former 29 weeker. He is getting 120 ml/kg/day of prolacta 26 Kcal/oz. His calories are: ■ (120*26)/30 = 104 Kcal/kg/day

Parenteral volume

● Intravenous fluid options

○ D5W or D10W ○ D5 ¼ NS or D10 ¼ NS ○ Total Parenteral Nutrition (TPN) ○ Others

● Central line (PICC line, Umbilical lines, Broviac)

○ Add heparin

● Start total parenteral volume between 60 ml/kg/day and 100 ml/kg/day

depending on the initial diagnosis, gestational age and weight

Glucose Infusion Rate (GIR)

● Every infant on continuous infusion that has dextrose should have a GIR

calculated and presented during round

○ [Dextrose % x fluid intake (ml/kg/day)] / 144 = GIR in mg/kg/min ○ (Dextrose % x current IV rate) / 6 / weight = GIR in mg/kg/min ■ Start GIR between 4 and 6 mg/kg/min ■ Advance by 1 to 2 mg/kg/min daily ■ Maximum 12 mg/kg/min ■ Monitor GIR by accucheck

Intralipid

● Every 1 gm of intralipid give 10 Kcal

○ Dietary fat: 9 Kcal/gm - the fat in intralipid has a glycerol molecule attached which adds 1 Kcal/gm

● Intralipid used in TPN is between 0.5 and 3 gm/kg/day

● Calories

○ Number of gm/kg/day x 10 = calories from intralipid ■ Example ● Newborn weighs 0.98 kg. He is on 2.5 gm/kg/day intralipid. Calculate the calories from lipid? ● 2.5 gm/kg/day x 10 = 25 kcal/kg