“Case Study: Enteral Nutrition” by Nancy Braudis for OPENPediatrics
Case Study: Enteral Nutrition by Nancy Braudis.
A three month old baby with a complete atrial
ventricular canal is admitted with symptoms
of congestive heart failure.
Mom reports that he’s breathing fast and not
His oral intake for the past 24 hours is 280
milliliters of 24 calories per ounce formula.
Respirations are 66 per minute.
Oxygen saturation is 88 percent on room air.
His weight is 3.7 kilograms, and that is decreased
from four kilograms on his last clinic visit
three weeks ago.
The baby has nasal flaring and subcostal retractions.
Now it is your turn to practice.
Please calculate the daily caloric intake
for this baby.
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to leave your answer.
Note, this will not be used as part of your
Steps to calculating calories.
The baby took in 280 milliliters in 24 hours.
The formula has 24 calories per ounce.
The baby weighs 3.7 kilograms.
Take 280 milliliters divided by 30 milliliters
and multiply by the calories of the formula
divided by the weight.
The answer is 60 calories per kilogram per
Please note, if you do not use ounces at your
institution the equation would instead read,
280 milliliters in 24 hours.
Since there are 30 milliliters in one ounce,
the formula has 24 calories per 30 milliliters
or 0.8 calories per one milliliter.
Baby weighs 3.7 kilograms.
Based on your previous answer, is this baby
receiving adequate nutrition?
This baby is not getting adequate nutrition.
60 kilocalories per kilogram per day is below
the recommended 120 to 150 kilocalories per
kilogram per day.
The plan is to start nasal cannula oxygen
to decrease the respiratory distress and improve
Elevate the head of the bed 30 degrees.
Start diuretics to remove excess lung fluid.
Monitor daily weights for fluid balance and
Calculate caloric intake and develop a feeding
plan to maximize growth and development.
What is your suggestion for providing adequate
Based on this information, a feeding plan
Increase the calorie concentration to 26 calories
Increase the 24 hour formula intake to 150
milliliters per kilogram for a total of 555
This will increase the calories to 130 calories
per kilogram per day.
Use a feeding tube as needed to reach nutritional
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