MINERALS and VITAMINS in NEONATAL TPN- Part 3 - Tala Talks NICU

Na, K, Mg- when do we add them and how much do babies need? Why do we bolus with NS? What is the ratio of Calcium and Phosphorous needed? When do we add Acetate or Chloride? What about the vitamins? What about Zinc and Copper?Do we always add heparin? Learn the answer to all these questions in the final part of our TPN series.
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Dr. Tala is a board-certified neonatologis and has worked in busy level III and IV units for the past 15 years. She has won multiple teaching awards throughout her time as a neonatologist.

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References:
Parenteral Nutrition Additive Shortages: The Short-Term,
Long-Term and Potential Epigenetic Implications in
Premature and Hospitalized Infants
Corrine Hanson, 1,*  Melissa Thoene, 2  Julie Wagner, 3  Dean Collier, 4  Kassandra Lecci, 2  and  Ann Anderson-Berry 5
Nutrients. 2012 Dec; 4(12): 1977–1988. 
Published online 2012 Dec 7. doi: 10.3390/nu4121977
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***TIMESTAMPS***
01:18 Sodium
08:54 Potassium
10:53 Calcium and Phosphorous
15:50 Magnesium
17:33 Anions
20:18 Trace Elements (Zinc, Copper, Selenium, Manganese, Chromium)
24:19 Multivitamins (Vitamins A, E, C, and cysteine)
27:57 Heparin
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*Disclaimer*: This video is intended for educational purposes only and while
we strive to give the most accurate information, errors may occur. Subsequently,
this video should not be a replacement for medical advice.

[TalaTalksNICU]

ERROR in video!! Thanks so much to the brilliant Mel Wall for pointing this out! Not sure how it got through us. At 7 mins 38 seconds: we were calculating how much Na is given to a 500g infant if the UAC runs at 1ml/hr of 1/2NS. We calculated it as if the infant was getting NS- so in actual fact, should be 77meq Na in 1L. Final answer is 3.69meq/kg/day. SORRY EVERYONE!!!

[hafsaomer]

Thank you so much for creating this educational material. This is my first week as a neonatology clinical fellow. I finished the fluid series in one shot. I would highly recommend your channel to all residents and beyond, and I wish I knew this wonderful channel earlier. Thank you for the effort you are putting to make the branch of neonatology easy. HMC, Doha, Qatar.

[VernalAffluence]

Kindly make a video lecture on neonatal cholestasis in detail.

[dave]

Watched the whole series, excellent info and presentation! Love how you also show your references. Would you be able to do a video on writing a TPN for an example patient and go over your thought process? Would be interested to see how you apply these concepts in your every day practice

[KendallBergmann]

Thank-you! Could you do a talk on TORCH infections?

[osamaalagamawy]

ما شاء اللة. بارك اللة فيكى.
أعتقد حضرتك تستحقى جائزة نوبل فى التعليم حضرتك موهبة ربانية.

[beatrixross]

Don't mean to be a finicky, but perhaps someone might understand it better if I point this out. Tala, you had me puzzled with the volume concentration calculation most of the afternoon, I just couldn't get it figured out 😮. Until I realised that the 4.16 (1000ml/24ml) is a factor/ratio and don't have a unit (in the video it states 4.16meq). So the 4.16 is the ratio 1000ml needs to reduce to 24ml and that the concentration of the Na should decrease with the same ratio.

Thank you so much for the tremendous effort and prep you put into your videos! - Beatrix from Welkom, Free State, South Africa ❤

[sabajunaid]

Thank you very much Dr Tala.
These videos are incredible.
You made TPN so much clearer for. I am working in UK in neonates your lectures are very useful.

[adrianafinot]

PPHN crisis / Cardiac Arrest please ! And meds love your videos super helpful ❤️🙏🏽

[naitramsingh]

Amazing video as always, thanks to you and your team for always making complicated topics simpler, thanks and do tc

[melwall]

Love all your videos, especially for NNP boards studying. I do have a question regarding this particular TPN calc video: your example with the 500g infant getting 1ml/hr if 1/2NS through the UAC. Do you not have to use 77 meq of sodium in 1L for your calc vs the usual 154meq since your said this is 1/2NS and not 0.9NS? Would love a video with some more calculations with examples because they definitely ask these questions on boards and very few study materials actually provide any good examples! Thank you! Messaging you from USA

[m.e.]

Thank you for your helpful videos. Would you please make a series about BPD? 🙏🏼☺️

[felipeguinancio]

Another great video Dr Tala! Thank you so much! I know its a complex theme but If possible would enjoy to know your experience about IMDs at the Nicu. When do we start to think about it? Thank you so much again. Keep up The good work.

[dave]

What if the recommended sodium (2-3mEq/kg/day), but that ends up giving you a hypotonic TPN? Wouldn't you be concerned that this could cause hyponatremia? I don't understand the idea of calculating sodium "additively" with mEq/kg/day, wouldn't it be better to base it off concentration since the concentration of the solution compared with the body fluid is going to be what ultimately causes a shift in sodium? i.e. Assuming stable patient, why wouldn't we make a TPN going through central line closer to 150mEq/liter and isotonic instead of doing these calculations and ending up with a hypotonic solution? This could potentially result in situations where the sodium is "10meq/kg/day", but the solution itself would be isotonic. Hope my question makes sense

[raibinodini]

Please reply.... How to check Baby brain development? (6 to 12 months)