Category Archives: Reference

Normal Penile Length

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Table: Mean Stretched Penile Length

Age Mean +/- SD -2.5 SD
30 wk EGA 2.5 +/- 0.4 1.5
34 wk EGA 3.0 +/- 0.4 2.0
Term 3.5 +/- 0.4 2.5
0-5 mo 3.9 +/- 0.8 1.9
6-12 mo 4.3 +/- 0.8 2.3
1-2 yr 4.7 +/- 0.8 2.6
2-3 yr 5.1 +/- 0.9 2.9
3-4 yr 5.5 +/- 0.9 3.3
4-5 yr 5.7 +/- 0.9 3.5
5-6 yr 6.0 +/- 0.9 3.8
6-7 yr 6.1 +/- 0.9 3.9
7-8 yr 6.2 +/- 1.0 3.7
8-9 yr 6.3 +/- 1.0 3.8
9-10 yr 6.3 +/- 0.9 3.8
10-11 yr 6.4 +/- 0.9 3.7

TPN

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When we know that a child or infant is going to be NPO for three or more days, we generally consider giving either PPN or TPN. PPN is given via peripheral IV and is limited to 12.5% dextrose and an osmolarity of 900. TPN requires central access of some sort and can provide greater dextrose concentrations and electrolyte replacements. The following are general principles of parenteral nutrition in pediatric patients.

ENERGY AND PROTEIN REQUIREMENTS

CATEGORY Age (yr) Protein/kg/d Kcal/kg/d Kcal/d
Preterm* <38 wks GA 3.0 – 4.0 120 kg x 120
Infants : 0.0 – 0.5y 2.2 108 650
Infants : 0.0 – 0.5y 1.6 100 850
Children 1 – 3 1.2 100 1300
Children 4 – 6 1.1 90 1800
Children 7 -10 1.0 70 2000
Males 11 -14 1.0 55 2500
Males 15 -18 0.9 45 3000
Females 11 -14 1.0 47 2200
Females 15 -18 0.8 40 2200

To Calculate total calories provided by your prescribed solution use this calculation: (divide each by kg)

e=mc*2

__% Dextrose X ___cc/day / 100 / X 3.4= Kcals from dextrose

____cc Lipids X 2 = Kcals from fat

%AA X ____cc/day % 100 = gm of AA

Fluid Electrolytes and Nutrition

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Maintenance IV Fluids – D5 1/2 NS + 20 mEq KC/L:

  • 100 cc/kg/day – 1st 10 kg = 4cc/kg/hr
  • 50 cc/kg/day – 2nd 10 kg =2 cc/kg/hr
  • 20 cc/kg/day – over 20 – 30kg =1cc/kg/hr

    • *Exception: Newborn IV Fluids

    1. 1st 24 hrs – 80 cc/kg/day of D1OW with 4.8 mEq Ca gluconate/250 cc
    2. 2nd 24 hrs – 100 cc/kg/day of D10 1/4 NS + 5 meq KCl/250cc
    3. After 48 hours – 120 cc/kg/day of D10 1/2 NS + 5 meq KC1/250

  • Increase fluids by 20% if the newborn is receiving phototherapy or radiant heat.
  • In the 1st week of life, add 200 mg/kg/day of calcium gluconate IV if the patient is NPO
  • NG/GT Replacements- Many patients with a NG or GT to drainage will need replacement fluid. Generally the output is replaced either 1/2cc per cc of output or cc per cc of output q 4 hrs.
  • Fluid Bolus – 10-20 cc/kg of LR or NS
  • Blood Product Administration

    • PRBC’s, FFP, or 5% Albumin – 10 cc/kg/dose
    Whole blood – 10-20 cc/kg/dose
    25% Albumin – 4 cc/kg/dose (1 gm/kg/dose)
    Platelets – 3 units/kg

  • Other Considerations

    • 1. Peritoneal lavage – 10 cc/kg NS
    2. Total blood volume is about 80 cc/kg
    3. Oliguria is urine output <0.5 cc/kg/hr in infants