Sodium Free Bag (10% Glucose and 2.27g Protein/100ml)

• Infants < 28/40 should start on the Sodium free bag after birth
• This PN regimen should commence at a maximum of 78ml/kg/day of aqueous solution on day 1 with 0.5ml/kg/hour (12ml/kg/day) SMOF lipid solution (ie. TOTAL aqueous and lipid solution provides 90ml/kg/day)
• This PN regimen can be increased further on day 2 to 108ml/kg of aqueous solution with 0.5ml/kg/hour (12ml/kg/day) SMOF lipid solution (ie. TOTAL aqueous and lipid solution provides 120ml/kg/day)
• This bag is not designed to meet nutritional requirements for preterm infants for more than 48 hours. If needed for longer the pharmacist/dietitian will provide individualised advice.
• After 48 hours review electrolytes and fluid balance.
• Change to the standard bag when Na falls < 145mmol/L.
• Please note further electrolyte additions cannot be made to this bag as maximum additions have already been added.

Standard Bag (12.5% Glucose and 2.88g Protein/100ml)

• Infants > 28/40 should start on the Standard bag (12.5%)
• This PN regimen should commence at maximum of 63ml/kg/day of aqueous solution on day 1 with 0.5ml/kg/hour (12ml/kg/day) SMOF lipid solution (TOTAL of aqueous and lipid solution provides 75ml/kg/day)
• After day 1 this PN regimen can increase to a gradual maximum (eg over 3-4 days) of 125ml/kg of the aqueous bag with 83ml/kg/hour (20ml/kg/day) SMOF lipid solution (ie TOTAL aqueous and lipid solution provides 145ml/kg)

Central Bag (16% Glucose and 3.1g Protein/100ml)

• This is unlikely to be used as a starting bag for PN and will instead be used as per clinical requirement. Please discuss with dietitian and pharmacist.
• This PN regimen can be used at a maximum volume of 100ml/kg/day aqueous PN for preterm infants alongside 0.83ml/kg/hour SMOF lipid solution. (Total aqueous and lipid solutions provide 120ml/kg/day)
• Additional phosphate and calcium should be added to this bag for preterm infants to meet their requirements. It is suggested that these electrolytes are prescribed at a total of 1.6mmol/kg/day of Calcium and 1.6mmol/kg/day Phosphate which meets the minimum requirements and ratio determined by ESPGHAN 2018 for preterm infants.  These should be monitored and adjusted. 
• Note there is no potassium added to this bag so an appropriate amount should be added. For reference, growing preterm infants require 2 – 5mmol/kg/day for < 1500g and 1 – 3mmol/kg/day for > 1500g (ESPGHAN 2018).

With any electrolyte additions, please be guided by serum levels to tailor individual requirements.