Medications are not recommended to be mixed with TPN for many reasons:
– TPN-Drug interactions (chemical or physical).
– TPN or Drug may interfere in each others kinetics.
– And, most importantly medication or TPN may be asked to change their rate of infusion allover the day, which is kinda common in NICU, so it is difficult to keep both TPN and medicine rates on the optimum track.
Some hospitals are used to mixing Insulin, H2 antagonists, or Carnitine with TPN, even this practice is controversial and there is a big debate of its benefits.
Regarding the caloric contents of Ambisome, we neglect it for the next reason. If you sum all the lipid contents of Ambisome additives, they don’t exceed 350 mg for the whole vial (50mg), and given that the usual doses for ambisome varies from 1-6 mg/Kg/Day, so your baby is almost taking at maximum 35 mg/Kg of the lipid contents of the vial, which is an obsolete caloric value.
I recommend you use Ambisome totally apart from the TPN.