Q & A for NICU Nutrition Calculator Version 2

Feeds-related questions:

1. All of the calculations using fortifiers are using the preterm BM reference. Is there a plan to have these same options for term BM and donor milk as well?

Good point. The difficulty is that every nursery uses their own set of calculated values for breast milk with additives. Furthermore, in case of donor BM, we are now getting donor milk labeled with different caloric values. So when I started planning this app I decided to include only the information provided to me by feeding formula companies or from reputable sources. I also worked hard to implement a feature in the app whereby user could add their own formulations.

So, in this case, you have two options:

A. You can add these and other formulations to “CUSTOM” group of formulas. These formulations will be saved and listed under “Custom” button and can be used for calculations just like pre-programmed ones. Here is a link to instructions for adding custom formulas: http://avsideas-eclectic.blogspot.com/2012/12/how-to-add-custom-formulas_17.html

B. You can edit composition of formulas already included in the “BM" group to values you use in your nursery. Here is link to instructions for doing that: http://avsideas-eclectic.blogspot.com/2013/01/how-to-edit-formula-composition.html

2. Is there a plan to allow user to enter two set of feeding formula values? Some of our premies have mixed intake like this.

Yes. Next update, which is only a few weeks away, has this feature.

3. Is it possible to add calculations for % calories from various macronutrients to the next version?

This feature, too, is coming soon.

TPN-related questions:

1. Calculations seem to be incorrect when baby is on feeds as well as TPN

The most common reason for this is incorrect selection of first item in preference page. Please check that you have selected correctly. When baby is on feeds + TPN, the amount of TPN baby will actually receive will depend on the choice you have made. In the first case: amount of TPN infused will be (TPN Volume ordered - Feed volume). In the second case the entire ordered volume will be given to the baby.

Second reason is improper selection of second and third item in Preferences page. So you are entering dextrose as % value when in fact you have selected GIR option in preference page.

If you have made all the correct choices in Preferences page and are still getting unexpected results, please send me an email detailing the discrepancy using "Email comments and suggestions" in help menu.

2. Can you add ability to enter amino acids dose in TPN as % solution?

This will be part of the next update.

3. Can you include TPN Calcium and Phosphorus entry in these calculations?

There is a lot of variability among NICUs how these micronutrients are ordered. That is the reason for not including these entries. If users can leave me a feedback on this page as to how they order calcium and phosphorus in TPN and what the output values they expect, I can include these calculations in the next update.

Android version: How to edit formulas & add formulas to the database

To Edit formula composition:

Go to Menu and select "Manage Formulas"

Select either BM based or Custom formulas.
For other two groups, manufacturers require that formula compositions are not changed by the user.

 Touch the name of the formula that you want to edit.

 In formula values screen, touch the "Edit Values" button at the bottom of the screen.

Touch the field that you need to edit and make changes.
Then touch "Save Changes" button to save changes to database. Use the "Back" button on the bottom to cancel changes.

To add formulas to the BM group or custom group:

Touch the name of the group to go to list of formulas.
This view is empty because there are no formulas in Custom group when you launch the app.

Touch the "Add Custom Formula" button at the bottom (this button is titled "Add Custom BM formula"in the BM group.

You cannot add formulas to the Premie and Other group.

Using keypad enter some or all the details for the custom formula.

Touch "Add Formula" button and you are done. This formula will be added to the database and you can access it from the "feeds" screen.

Android Version of NICU Nutrition Calculator

Android Version of NICU Nutrition Calculator basically mirrors all the functionality of the iPhone app in an android environment. Some of the controls are located in different places on the screen but basically navigation through the app is the same.

Follow this link to find out how to edit or add formulas to the database.

With the first launch of the app, you will be taken to the Preferences panel:

Make selection in each of the three categories and touch "Save".


You will then see the data entry screen of the app. Select what kind of input you want to make at the top of the screen: "Feeds" only, "Both" and "TPN" only.

This is feeds screen:

Enter Weight and feed volume (ml/day or ml/kg/day depending your choice in preferences)

Touch "Select Formula 1"row and you will be taken to formula selection screen (see below). Select type of formula at the top of the screen. Then in the panel below Select name of the formula and concentration (if available by touching the concentration number and selecting concentration)

Once you have selected the formula touch "Select" button at the bottom of the screen.

Enter Liquid protein value if required.

Repeat the same process to enter Formula 2 volume and select formula 2 if necessary.







Formula Selection screen below:




This is the TPN screen:

In this screen enter all the values using numeric keypad.

Remember:

1. Do not include lipid volume in TPN volume
2. Glucose entry will be as % or as GIR depending on you selection in preferences panel
3. Lipid entry is optional
















Touch "Calculate" once you have completed entering required information.

From here you can either touch "back" arrow at top left corner and start a new calculation OR use Android "Back" button at the bottom of the screen to go back to a previous screen to change some intake parameter to see it's effect on nutritional intake.

NICU Nutrition Calculator 2.0

Please follow this link for Q & A for this version.

Please follow this link for information about this update and further links to different new functionality in the app.

There are two walk-through videos below

1. Preferences panel: this is new in version 2 so that users can individualize how data is entered and how calculations are performed.

Preferences panel

2. How to use the app:

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How to "Edit" formula Composition

One of the common improvement suggestions I have received is to allow users to edit formula compositions, especially for BM based formulations. Thus in this app you can only modify compositions of "BM based" formulas or Custom formulas.

Here is how:

In the formula composition screen, there will be an "Edit" button in right upper corner 

for formulas that you can edit composition of.

Touch the edit button and the screen will change to one below

Touch inside any field and using the keyboard which pops-up 

make desired change to the composition.

Then touch the "Done" button and changes will be saved.

That's it.

How to add formulas to "Custom" group

This update of the app allows you to add your own custom formulas to the database.

Go to the "Help & Info" section &

Touch "Manage Formulas"

Touch "BM based" or "Custom Formulas"

Touch the "+" button

Enter details of the formula and touch "Done"

The new formula will now be listed in the "Custom Formulas" list.

What's new in the "NICU Nutrition Calculator" update 2

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Click here to watch walk-through videos of the version 2.0 of the app.

Four main changes are:

1. Easier selection of formulas: The original version of the app had a long list of formulas in scroll wheel. With this update selecting formula at a specific concentration is much easier. First you first select the formula name in the first scroll wheel and then select the desired concentration from the second scroll wheel. The second scroll wheel will only load concentrations available for each specific formula.

2. Ability to add formulas to BM based group or to custom formulas: Follow this link for instructions.

YOU MUST SYNC YOU DEVICE WITH iTUNES SO THAT BACK-UP OF YOUR CUSTOM LIST IS SAVED.

3. Edit composition of BM-based or Custom formulas: follow this link for instructions.

4. Set up preferences: There is a wide variability in how TPN is ordered in different NICUs. This form allows you to specify how you would like to enter values and how calculations are performed. You must set preferences in Help menu before you use the app. 

There are three items in this form:

a. Calculation of total fluids when baby is on combined feeds and TPN intake.

aa. Select first segment if, in you NICU, TPN + IL are ordered for the entire total fluid volume. Actual amount of TPN baby receives in this case depends on how much feeds baby is on. TPN volume is reduced by the corresponding amount.

bb. Select second segment if in your nursery feed volume is calculated for the day and TPN + IL is ordered for the remainder of total fluids. In this case entire TPN volume is delivered to the baby.
For example: Say you have a baby who is on total fluids of 160cc/kg/d of which 50ml/kg/d are feeds. Select option aa (first segment) if you would write TPN+IL for volume of 160cc/kg/d. Select option bb (second segment) f you would write TPN+IL for a volume of 110cc/kg/d (160 - 50). 

b. Glucose entry: select whether you will enter glucose as % or as GIR i.e. glucose infusion rate

c. Feed volume: select whether you will enter feed volume as ml/day or ml/kg/d.

Other improvements in the app are:

1. Inclusion of feeding formulas made by Nestle Nutrition and Prolacta Bioscience.
2. Calculation of PE ratio when baby is on full feeds.

3. Calculation of iron intake.

4. Tailor the list of formulas under each segment selection. Go to Help menu, touch manage formulas, select the specific type of formula and in the next screen touch the “check mark” button or the button titled “Select”. All the formulas in that category will be loaded in the table. You can touch and uncheck formulas that you want to remove from the list (“check mark” will be removed from those formulas) and then touch “Done”. When you next go to the feeds entry screen formulas which you un-selected will not clutter up the list.