Considerations of Nutrition Support in Pediatrics Flashcards
In pediatric intensive care patients, predictive equations for energy expenditure yield results that are not consistent with ___ ___ ___.
Measured energy expenditure
___ is the gold standard for determining baseline energy needs in critically ill children
IC
The goal of the White Equation is to estimate energy expenditure in the critically ill child by including ___, ___, and body ___ of the patient to account for their inflammatory response, but it is not widely used by pediatric practitioners.
-Age
-Weight
-Temperature
The Schofield Equation estimates ___ ___ rate with adjustments (for an individual’s sex, weight, age and height) and was developed for use in ___ children.
-Basal metabolic
-Healthy
The WHO Equation estimates ___ ___ ___, with adjustments (for an individual’s sex, weight, and age) and was developed for use in ___ children.
-Resting energy expenditure
-Healthy
The RDA for energy accounts for age and sex, but is based on the ___ ___ for groups of ___ infants that were observed during longitudinal studies.
-Median intakes
-Healthy
The RDA has been shown to usually ___ predict a critically ill infant or child’s energy requirement.
Overpredict
If IC is not available or is not feasible for an individual patient, the ___ or ___ equations may be used to estimate a critically ill infant or child’s energy expenditure with close monitoring for signs of overfeeding or underfeeding.
WHO or Schofield equations
Though growth is often the primary goal in neonatal and infant nutrition, growth cannot occur until recovery from the ___ ___ has begun.
Stress response
Critically ill and postoperative neonates and infants usually have significantly ___ energy needs compared with healthy neonates
Lower
Why do critically ill neonates have lower energy needs?
Absence of growth, decreased activity, and reduction in insensible losses during stress states
Indirect calorimetry is recommended when possible but, if IC is not available, the estimated ___ energy or ___ energy expenditure should be used for nutrition support provision for the first few days after cardiac surgery.
-Basal
-Resting
When the patient’s metabolic response is thought to have shifted from a primarily catabolic to an anabolic state, the total calories may be gradually ___.
-Increased
-To meet post-op needs for healing and growth
Energy requirements for growth for patients with complex congenital heart disease (CHD) are often found to be ___ as compared to those without CHD.
Higher
What are common symptoms of celiac disease in children?
- Diarrhea
- Constipation
- Chronic abdominal pain
- Abdominal distention
- Vomiting
- Short stature
- Weight loss
- Inadequate weight gain
- Dental enamel defects
- Dermatitis herpetaformis
- Reduced bone mineral density
- Iron deficiency anemia
- Fatigue
- Migraines
- Joint pain.
- Delayed puberty
In celiac disease: upon symptom identification, gluten needs to remain in the diet until after ___ testing and ___ are completed
-Serology
-Biopsy
Intestinal ___ is needed for formal diagnosis of celiac disease.
Biopsy
What is the recommended formula osmolality according to the American Academy of Pediatrics?
Less than 450 mOsm/kg
What is the osmolality range of standard infant formulas at a caloric density of 20 kcal/oz?
200-380 mOsm/kg
How does the osmolality of hydrolyzed protein and free amino acid infant formulas compare to standard formulas?
330-370 mOsm/kg
What is the osmolality of a 30 kcal/oz concentrated standard formula?
Approximately 450 mOsm/kg
What is cancer cachexia?
A state of malnutrition characterized by anorexia, weight loss, muscle wasting, physical weakness, depression, chronic nausea, and anemia.
What are the physiological results of cancer cachexia?
Physiological distress, changes in body composition, and alterations in macronutrient metabolism.
What types of tissue are lost due to the metabolic alterations in cancer cachexia?
Muscle and adipose tissue.
What level is often elevated in cancer patients that contributes to cancer cachexia?
Cytokine levels.
What do elevated cytokine levels contribute to in cancer cachexia?
The complex metabolic response.
Mechanisms of ___ conservation and decreased ___ ___ that allow prolonged survival in the chronic fasting state appear to be lost or inhibited in cancer.
-Protein
-Energy expenditure
What is the purpose of pancreatic enzymes?
To increase nutrient absorption and decrease the presence of steatorrhea
Steatorrhea is the presence of excess fat in feces.
What condition may result from high dose enzyme usage?
Strictures of the ascending colon, also known as fibrosing colonopathy
Fibrosing colonopathy is a rare complication associated with pancreatic enzyme replacement therapy.
What is the recommended maximum dosage of lipase per kg per day?
Less than 10,000 units of lipase/kg/day
What causes cystic fibrosis related diabetes?
Mucus obstruction of pancreatic beta cells, which prevents insulin secretion
This may lead to beta cell destruction.
What are the symptoms of meconium ileus?
Intestinal obstruction, mass in the right lower quadrant, and abdominal pain
These symptoms most often occur in neonates.
What is meconium ileus?
A bowel obstruction that occurs only in infants with signs of abdominal distension, bilious emesis, and no passage of meconium.
ILE helps maintain integrity of ___ lines
Peripheral
Peripheral lines are used for intravenous therapy.
What essential component does ILE supply for brain development?
Essential fatty acids
Essential fatty acids are crucial for neurological function.
What is the recommended dosage of soybean oil-based ILE to prevent EFAD?
0.5-1 g/kg/day
EFAD stands for Essential Fatty Acid Deficiency.
What dosage of soybean oil-based lipid may be instituted for patients with prolonged PN dependence?
1 g/kg/day
For patients where prolonged PN dependence (> 1 month) is anticipated, soybean oil-based lipid restriction to 1 g/kg/day may be instituted to help prevent PN-associated liver disease
PN stands for Parenteral Nutrition.
What is the duration of the ebb response following a burn injury?
3-5 days
List the characteristics of the ebb response.
- Depressed resting energy expenditure
- Hyperglycemia
- Low plasma insulin
- Loss of plasma volume
- Decreased oxygen consumption
- Decreased blood pressure
- Reduced cardiac output
- Decreased body temperature
What occurs after the ebb phase in response to a burn injury?
The acute phase of the flow response
List the key features of the acute phase of the flow response.
- Elevated catecholamines
- Elevated or normal plasma insulin
- Hyperglycemia
- Elevated glucagon
- Elevated glucocorticoids
- High glucagon-to-insulin ratio
- Catabolism
- Increased body temperature
- Increased cardiac output
- Redistribution of polyvalent cations (zinc, iron)
- Mobilization of metabolic reserves
- Increased urinary excretion of nitrogen, sulphur, magnesium, phosphorus, potassium
- Accelerated gluconeogenesis
When does the acute phase of the flow response peak following a burn injury?
Between the 6th and 10th day
When is anabolism established in the “flow “response following a burn injury?
During the adaptive phase
The ebb response includes a ___ resting energy expenditure.
depressed
Studies have show LGG (a probiotic) to be effective for what?
Reducing both duration and frequency in infectious diarrhea.
What is LGG?
Lacticaseibacillus rhamnosus strain GG (LGG) is a probiotic
Fluoride is highly effective in preventing ___ ___ which is the most common chronic disease in childhood.
Dental caries
Regular consumption of ___ water primarily prevents caries.
Fluoridated
Children with primary water supply deficient in ___ (defined as < 0.7 ppm) are at particular risk of ___ deficiency.
-Fluoride
-Fluoride
Well water contains variable amounts of fluoride, ranging from 0 to 7 ppm, and ___ ___ ___ ___ is the only way to know the fluoride content
Testing the water source
Using fluoride ___ and fluoride ___ application are also other recommended strategies for preventing caries in children.
-Toothpaste
-Varnish
Gastroesophageal reflux disease (GERD) is frequently seen in the children with ___ impairment.
Neurological
What interventions are recommended for patients with GERD?
- Changes to feeding regimen
- Positioning
- Medications for reflux and motility
In patients with intractable GERD, a ___ may be performed. Given the potential for postoperative complications, this should only be considered in patients who have failed medical treatment.
Fundoplication
Conversion to a ___ tube could also be considered as an alternative to fundoplication.
Gastrojejunostomy
True or false: regurgitation is rare and dangerous in infants
False! Regurgitation is very common in infants and may occur daily. It does not necessarily signify the presence of a serious health problem.
What are common causes of regurgitation in preterm infants?
Lower esophageal sphincter immaturity and slower gastric emptying.
In term infants, regurgitation may not present until the ___ or ___ week of life as oral intake increases and usually peaks at around ___ months old.
-Second
-Third
-4
In term infants, regurgitation may seem more pronounced after a ___ ___ ___ or if the infant is fed in a ___ position.
-Larger volume feeding
-Recumbent
Regurgitation tends to resolve with time on its own around ___-___ months of age.
7-12
What is NEC?
Necrotizing enterocolitis (NEC) is a serious gastrointestinal disease primarily affecting premature or sick newborns, characterized by inflammation and death of intestinal tissue, potentially leading to complications like intestinal perforation and sepsi
The etiology of NEC is unclear, but it often occurs in infants who are being fed via the ___ tract
Gastrointestinal
True or false: Research shows that early initiation of minimum enteral feeds does NOT increase the risk of NEC
True
Name the benefits of early enteral feeds
- Shorter time to full enteral feeds
- Faster weight gain
- Improved feeding tolerance
- Decreased length of hospitalization
- Reduced incidence of serious infections in low birth weight and very low birth weight infants.
When medically possible, minimum enteral feeds can begin ___, with the preferred feeding being ___.
-On the day of birth
-Human milk
Studies have shown that female adolescents are most at risk for inadequate ___ intake.
Calcium
The American Academy of Pediatrics (AAP) currently recommends limiting juice intake to ___ oz per day for toddlers, ___-___ oz per day for preschoolers and ___ oz per day for school-age children and adolescents.
-4
-4-6
-8
The AAP also recommends increased dietary intake of ___ and vitamin ___ containing foods and beverages for optimal bone health.
-Calcium
-Vitamin D
Current recommendations for calcium and vitamin D foods are for ___ to ___ servings of dairy per day for young children and ___ servings per day for adolescents.
-2-3
-4
Why do infants with chronic lung disease often have high calorie needs?
- Gastroesophageal reflux
- Emesis
- Chronic infections
- Increased work of breathing.
In patients with chronic lung disease, fluid restriction is indicated to prevent ___?
Fluid build up around the heart and lungs
What formula is indicated for patients with chronic lung disease?
Concentrated formulas.
The use of low carbohydrate formulas, hydrolyzed protein formulas, or MCT oil predominant formulas are not indicated for use for treatment of chronic lung disease.
What is the WHO definition of acute diarrhea?
Less than 14 days in duration
The definition is crucial for understanding the classification of diarrhea types.
How does WHO define persistent diarrhea?
14 days or longer in duration
This definition helps in identifying prolonged cases that may require different management.
Some experts use “chronic” to describe episodes lasting more than ___ days
30
This classification may influence treatment approaches.
What therapy is supported for childhood diarrhea in low-income countries?
Empiric zinc therapy
This therapy is crucial for managing diarrhea in vulnerable populations.
What benefits does zinc supplementation provide in cases of diarrhea in low income countries?
Decreases duration of episodes, risk of hospitalization, all-cause mortality, and diarrheal mortality
Studies indicate an estimated decrease in mortality of 23% with zinc supplementation.
What is the WHO/UNICEF recommendation for zinc supplementation in children with acute diarrhea?
20mg of zinc per day for 10-14 days
This dosage is aimed at curtailing severity and preventing further occurrences.
What is the recommended zinc dosage for infants under six months of age?
10mg per day
This recommendation is to help manage acute diarrhea cases in very young infants.
Name contraindications to BG tube feeding?
- Upper airway secretions
- Nasal polyps
- Recurrent sinusitus
- Otitis
What is the role of Selenium in the body?
Selenium is imperative for proper immune function, antioxidant capacity, and thyroid hormone production and regulation.
What is the daily requirement of Selenium for preterm and term infants?
2 mcg/kg/day.
What is the selenium concentration in the multiple trace element formula (MultrysTM) for infants?
6 mcg/ml.
How is the selenium dosage administered for infants weighing 0.4 to 0.59 kg?
0.2 ml every other day.
How is the selenium dosage administered for infants weighing 0.6 to 9.9 kg?
0.3 ml/kg/day.
What is the maximum dosage of selenium that can be administered per day?
1 ml/day.
What must be done to meet total selenium requirements for patients weighing 0.4 to 0.59 kg or 4 to 9.9 kg?
Additional selenium must be added separately to PN.
The GIR (mg/kg/min) may be calculated as follows:
[dextrose (g/day) x 1000]/[24 (hr/day) x 60 (min/hr) x weight (kg)].
When developing goal PN calories from dextrose, in general the GIR should not exceed the glucose oxidation rate, as this may result in ___ production, hepatic ___ and PN-associated ___ disease.
-Fat
-Hepatic steatosis
-Liver
Infants should be monitored for glucose intolerance, which may manifest as ___ and/or ___.
-Hyperglycemia
-Hypertriglyceridemia
What is the standard deviation (SD) score also known as?
Z-score
What does a positive change in SD indicate?
Growth
What does a negative change in SD indicate?
Slowing of the growth rate
What Z-score is consistent with severe malnutrition?
Below -3
What Z-score indicates moderate malnutrition?
Below -2
A Z-score above ___ is consistent with overweight.
2
A Z-score above ___ is consistent with obesity.
3
What percentile is the median on the growth charts?
50th percentile
What condition can infants with acute diarrhea (usually associated with gastroenteritis) develop?
Secondary lactase deficiency
Associated with gastroenteritis
Is a soy protein-based formula recommended for infants with secondary lactase deficiency?
No
It is not recommended in those instances.
What percentage of children allergic to cow’s milk protein may also be allergic to soy protein?
10-14%
Indicates potential cross-reactivity.
What does the American Academy of Pediatrics recommend for infants with cow’s milk allergy?
Trial use of either a hydrolyzed or free amino acid-containing formula
Suggests alternatives to cow’s milk.
What is galactosemia?
An inborn error of metabolism affecting galactose metabolism
Leads to the need for dietary changes.
How is galactosemia currently treated?
By eliminating galactose from the diet
Essential for managing the condition.
What type of formulas are used as substitutes for milk in galactosemia?
Soy-based infant formulas
They provide an alternative source of nutrition.
The galactose content (approximately 20 mg/L) of lactose-free cow’s milk infant formula is considerably ___ than soy and hypoallergenic formulas. Therefore, lactose-free cow’s milk formula is ___ recommended for treatment of galactosemia
-Higher
-Not
Considerably higher than soy and hypoallergenic formulas.
What does GER stand for?
Gastroesophageal Reflux
GER is a common issue in infants that often resolves on its own.
Is GER associated with significant complications?
No
GER usually resolves spontaneously without major issues.
What does GERD stand for?
Gastroesophageal Reflux Disease
GERD is a more severe form of reflux that can lead to complications.
What are some complications associated with GERD?
- Weight loss or failure to thrive
- Feeding difficulties
- Arching of the back
- Irritability
These complications indicate a more serious condition compared to GER.
When is surgical intervention with fundoplication considered for GERD?
Only after other therapies have failed
Fundoplication is a surgical treatment option for severe cases of GERD.
What is one of the most useful diagnostic tests in assessing a child with abnormal growth?
Bone age
The bone age is evaluated through radiography of the patient’s knees or left wrist.
How is bone age evaluated?
By radiography of the patient’s knees or left wrist
A trained observer uses established norms for different ages and sexes.
What does an advanced bone age usually indicate in children?
Precocious puberty
Advanced bone age is a sign of early sexual maturation.
Children with genetic short stature typically have a bone age that is _______.
Similar to their chronological age
This reflects their growth pattern compared to typical development.
What conditions are associated with a delayed bone age?
- Hypothyroidism
- Growth hormone deficiency
- Cushing syndrome
These conditions can hinder normal bone maturation.
What factors can fluid rates be adjusted for in the Holliday-Segar method?
Clinical state (e.g., fever, tachypnea)
Is the Holliday-Segar method suitable for neonates less than 14 days old?
No
Fill in the blank: The Holliday-Segar method assumes that for each 100 calories metabolized, _______ mL of H2O will be required.
100
When do symptoms of cow’s milk protein allergy typically develop?
By 1 month of age
What is the typical presentation of symptoms in infants with cow’s milk protein allergy?
The majority present with 2 or more symptoms
List the possible symptom categories of cow’s milk protein allergy.
- Gastrointestinal (blood in stool, diarrhea)
- Cutaneous (rash, eczema)
- Respiratory (wheezing)
What type of formula do most infants with cow’s milk protein allergy do well on?
Extensively hydrolyzed protein formula
Some may require a free amino acid formula
Is soy protein based formula recommended for infants with cow’s milk protein allergy?
Technically yes, but studies show cross-reactivity of up to 10-15%
Should lactose free formulas be recommended for infants with cow’s milk protein allergy?
No, as they still contain cow’s milk protein
What type of formula would be indicated if there are concerns for fat malabsorption?
High MCT oil formula
At what age does BMI screening begin for children?
BMI screening begins for children over 2 years of age.
This age threshold is important for accurate assessment of growth and development.
What BMI classification applies to children with a BMI less than the 5th percentile?
Underweight
This classification indicates that the child’s weight is significantly below what is considered healthy for their age and sex.
What BMI classification applies to children with a BMI between the 5th percentile and 85th percentile?
Healthy weight
This range indicates that the child’s weight is considered healthy for their age and sex.
What BMI classification applies to children with a BMI between the 85th and 94th percentiles?
Overweight
This classification suggests that the child may be at risk for obesity-related health issues.
What BMI classification applies to children with a BMI greater than or equal to 95th percentile?
Obesity
This classification indicates a significant health risk due to excess body weight.
What is the challenge in determining the incidence of aspiration caused by enteral nutrition?
There have not been standardized definitions of what constitutes aspiration
Inadequate descriptions in studies contribute to this challenge.
Are increased GRVs linked to an increased risk for aspiration?
NO.
This indicates that higher gastric residuals do not necessarily indicate a higher risk of aspiration.
What factors make aspiration more likely in critically ill children?
Decreased strength and coordination of pharyngeal muscles and a weak cough reflex
These physiological factors contribute to the increased likelihood of aspiration.
What % Total Body Surface Area (TBSA) is considered small burns?
<20% TBSA
What conditions can complicate small burns?
Facial injury, psychologic problems, inhalation injury, pre-burn malnutrition
What type of diet can usually support patients with small burns not complicated by certain conditions?
Oral high protein, high calorie diet
Can children with burns covering >20% TBSA meet their nutrient needs by oral intake alone?
No
What enzyme is deficient in classic PKU?
Phenylalanine hydroxylase
The deficiency of this enzyme leads to metabolic issues in the body.
PKU prevents the hydroxylation of phenylalanine to ___
Tyrosine
This process is crucial for the conversion of one amino acid to another.
What accumulates in the blood due to PKU?
Phenylalanine
High levels of phenylalanine can lead to toxic effects in the body.
What deficiency occurs as a result of phenylalanine buildup in PKU?
Tyrosine deficiency
Tyrosine is essential for various bodily functions, including neurotransmitter production.
What type of diet has been shown to improve outcomes in classic PKU?
Phenylalanine restricted, tyrosine supplemented diet
This dietary approach helps manage the levels of phenylalanine and provides necessary tyrosine.
What is the consequence of tyrosine deficiency in individuals with PKU?
Impaired synthesis of neurotransmitters and other important compounds
Tyrosine is a precursor for dopamine, norepinephrine, and epinephrine.
Is expressed human milk sterile?
No, expressed human milk is never sterile and contains a variety of normal skin flora.
Normal skin flora refers to the microorganisms that normally reside on the skin and can be present in expressed human milk.
What are potential sources of contamination in expressed human milk?
Contamination can occur during:
- Milk expression
- Storage
- Preparation and mixing of additives
- Assembling and handling feeding systems
Each of these steps involves interactions that can introduce bacteria or other contaminants.
How can potential contamination occur in feeding systems?
Feeding systems that include bags, syringes, or tubing should never be reused.
Reusing feeding systems increases the risk of contamination.
In a hospital setting, how often should enteral feeding systems containing expressed human milk be exchanged?
Every 4 hours.
Regular exchange of feeding systems helps minimize the risk of bacterial growth and contamination.
At what age is the ability to suck and swallow present?
28 weeks gestation
When do infants achieve full coordination of sucking and swallowing?
32 to 34 weeks gestation
What is the effect of non-nutritive sucking on digestion?
Improves digestion of enteral feedings
What is thought to be stimulated by non-nutritive sucking through vagal innervation?
Secretion of lingual lipase, gastrin, insulin, and motilin
What potential benefit does non-nutritive sucking provide for infants not receiving nutrients orally?
Prevents the development of an oral aversion
Meta-analysis data on exclusive enteral nutrition (EEN) suggests that it is ___ in efficacy to corticosteroids in inducing clinical remission of IBD in the pediatric population
Equal
EEN alters the ___ resulting in remission of Crohn’s.
Microbiome
What type of enteral formulas are recommended for first line therapy in Crohn’s patients?
Polymeric enteral formulas.
Under what conditions are polymeric enteral formulas not recommended as first line therapy in Crohn’s patients?
If symptoms of malabsorption or gastrointestinal dysfunction are present.
What is the world’s most common single-nutrient deficiency?
Iron
Iron deficiency may impact long-term neurodevelopment.
At what age does the AAP recommend universal screening for iron status in infants?
12 months of age
AAP guidelines were last revised in 2010.
What risk factors may prompt selective screening for iron deficiency in infants?
- Prematurity
- Low socioeconomic status
- Poor growth
- Exclusive breastfeeding without supplementation
Selective screening can be performed at any age.
Why is screening for iron deficiency unnecessary before 6 months of age in healthy, term infants?
They have sufficient iron stores until approximately 6 months of age
How do formula-fed infants typically meet their iron needs during infancy?
Iron fortification of infant formula
What is the limitation of human milk regarding iron for older infants?
Contains insufficient levels of iron to meet the needs of the older infant
When should breastfed infants start receiving additional iron from complementary foods?
Approximately 4 months of age
Are powdered formulas sterile?
No
When should powdered infant formulas be used?
Powdered infant formulas should only be used in health care facilities when clinically necessary and when alternative commercially sterile liquid products are not available.
What type of patients should be considered when using powdered infant formulas?
Immunocompromised patients (given they are not sterile)
How is cysteine synthesized in adults?
Cysteine can be synthesized from methionine via a liver-specific transsulfuration pathway
Why is cysteine considered a conditionally essential amino acid in neonates and infants?
It is not synthesized in adequate amounts in neonates and preterm infants
Is cysteine included in standard PN solutions?
No, it is not a part of amino acids solution due to solubility concerns
How can cysteine be added to amino acid solutions?
As cysteine HCl at a dose of 30 to 40 mg per gram of AAs
What effect does cysteine HCl have on calcium and phosphate solubility?
It increases the solubility by lowering the pH of the solution
What are infants fed human milk dependent on for vitamin D?
Sunlight exposure or dietary sources of vitamin D
Sun exposure for cutaneous synthesis can be difficult to determine and may increase skin cancer risk.
How long can an infant’s vitamin D status remain sufficient after birth if the mother had a sufficient supply while in utero?
A couple weeks after birth
Is human milk sufficient in providing adequate levels of vitamin D intake?
No
What is the recommended daily intake of vitamin D for exclusively breastfed infants?
400 IU (10 mcg) daily
When should exclusively breastfed infants begin receiving vitamin D supplementation?
Soon after birth
What percentage of carbohydrate calories in preterm formulas is lactose?
40-50%
Compared to standard term infant formulas which contain 100% lactose.
What percentage of carbohydrate calories in preterm formulas is made up of glucose polymers?
50-60%
This is part of the carbohydrate composition alongside lactose.
Term formulas contain only ___ chain fatty acids
Long
This contrasts with the composition of preterm formulas.
What percentage of fat calories in preterm formulas are medium chain triglycerides?
40-50%
Medium chain triglycerides are easier to absorb than long chain fatty acids.
Why are medium chain triglycerides easier to absorb?
They do not require pancreatic lipase or bile salts for digestion or absorption
This makes them beneficial for premature infants.
How does the protein concentration in human milk change over time?
It decreases by 28 days of lactation
This is important for understanding nutrient needs.
What should be added to human milk to meet the needs of premature infants?
Human milk fortifiers
These help meet protein, calcium, phosphorous, and sodium needs.
How do nutrient absorption rates in human milk compare to those in preterm or term formulas?
Nutrients in human milk are more readily absorbed
This applies to both fortified and unfortified human milk.
What is the most common nutritional deficiency in childhood?
Iron deficiency anemia
This emphasizes the prevalence of iron deficiency anemia in pediatric populations.
Up to what age do term infants usually have adequate iron stores?
6 months of age
This indicates that infants are born with sufficient iron reserves that last for the first half year.
At what age do exclusively breastfed infants require additional iron?
4-6 months of age
This is critical for preventing iron deficiency as infants start to deplete their stores.
How does the iron content of cow’s milk compare to human breast milk?
Similar
However, despite similar iron content, cow’s milk is less beneficial due to bioavailability issues.
What inhibits iron absorption from cow’s milk?
Calcium
The presence of calcium in cow’s milk negatively affects the absorption of iron.
Before what age should cow’s milk not be introduced into an infant’s diet?
12 months of age
This guideline helps prevent nutritional deficiencies in infants.
What factor may influence a child’s risk of iron deficiency anemia?
Picky eating habits
The risk may vary based on the types of foods consumed by the child.
What is the primary site of absorption for most water-soluble vitamins?
Jejunum
What happens if the jejunum is resected?
Malabsorption of water-soluble vitamins
Where is vitamin B12 primarily absorbed?
Ileum
What effect does complete ileal resection have on vitamin B12?
Precludes absorption of vitamin B12
What is a consequence of complete ileal resection aside from vitamin B12 deficiency?
Deficiency of bile acids
What syndrome is likely to develop if all or part of the stomach has been removed?
Dumping syndrome
Which parts of the digestive system are the primary sites of cholecystokinin and secretin secretion?
Duodenum and jejunum
Infant formula concentrated higher than ___ calories per ounce increases the osmolality
24
What do higher osmolality formulas lead to?
- Slow gastric emptying which leads to:
- Abdominal distention
- Discomfort
- Vomiting
- Reflux
- Constipation
- Diarrhea.
The suggested daily amount of potassium in TPN for preterm infants, term infants, and children is ___-___ mEq/kg.
2-4
In newborns, ___ is generally not added to the PN solution until kidney function is established.
Potassium
What is the Fenton growth chart?
Data was collected from a large sample size and validation of the chart occurred by using data from the National Institute of Child Health and Human Neonatal Research Network; CDC growth charts; intrauterine growth data, and postnatal growth data.
The data is cross sectional and is best used to assess growth over time
What is a major advantage of the Fenton growth chart?
It allows for tracking of growth from 22 weeks gestational age up through 10 weeks post term age.
What is infantile anorexia characterized by?
A child’s refusal to eat adequate amounts of food for at least 1 month
What are common behaviors of children with infantile anorexia?
Do not communicate hunger, lack interest in food and eating, exhibit growth deficiency
Is infantile anorexia associated with gastrointestinal disorders or traumatic events?
No, it is not due to an associated gastrointestinal disorder or other medical condition and does not follow a traumatic event
At what age does infantile anorexia typically onset?
Between 6 months to 3 years of age
During which transition does infantile anorexia often occur?
During the transition to spoon- and self-feeding
What is an important aspect of treatment for infantile anorexia?
Understanding the child’s temperament and level of arousal
What does the treatment for infantile anorexia include?
Establishing a regular feeding schedule, incorporation of behavioral techniques and feeding guidelines
What symptoms occur with viral gastroenteritis?
Mild dehydration from diarrhea
This condition commonly resolves in 72-96 hours.
Viral gastroenteritis will commonly resolve in ___-___ hours
72-96
What is the preferred treatment for an otherwise healthy infant with acute dehydration?
Oral rehydration solutions
This provides adequate fluid and electrolyte replacement.
What dietary approach is superior during a diarrheal illness in infants?
Return to an “age-appropriate” diet early. No need for special formulas
This is better than providing diluted formula or full strength elemental formula.
Name some clinical indications that dehydration is worsening in infants.
Sunken eyes, sunken fontanel, loss of skin turgor and dry mucous membranes.
Other indications include sunken fontanel, loss of skin turgor, and dry mucous membranes.
What is the purpose of standard neonatal AA solutions?
To mimic the plasma AAs patterns of breastfed infants
This design is crucial for supporting the nutritional needs of neonates.
Which amino acids are considered essential in neonates due to enzyme immaturity?
Taurine and tyrosine
These amino acids play critical roles in neonatal development.
How do the contents of phenylalanine, methionine, and glycine in neonatal parenteral AA solutions compare to adult and pediatric solutions?
Lower in neonatal parenteral AA solutions
This difference reflects the specific nutritional needs of neonates.
What is the status of cysteine in standard neonatal parenteral AA solutions?
Not a component due to conflicting data on if it’s essential or not
The debate on cysteine’s role in neonates highlights the complexity of neonatal nutrition.
Why is cysteine added immediately prior to administration if included in neonatal AA solutions?
Cysteine is unstable in aqueous solution
This precaution helps maintain the integrity of the solution.
What effect does the addition of cysteine have on the pH of the solution?
Lowers the pH
Lowering the pH is important for optimizing calcium and phosphorus solubility.
___ ___ is a complex process that occurs following a massive loss of intestinal surface area.
Intestinal adaptation
Intestinal adaptation is crucial for recovery after significant intestinal damage.
What is necessary for the intestinal adaptation process to occur?
Enteral Nutrition (EN)
EN provides essential nutrients that support the adaptation of the intestines.
What is the preferred source of EN for infants?
Human milk
Human milk is associated with decreased duration of parenteral nutrition (PN) in infants.
What is MBD?
MBD is a multifactorial condition characterized by osteopenia and osteomalacia.
In which population is MBD most often seen?
MBD is most often seen in very low birth weight infants, particularly those weighing <1500 grams.
What are some antenatal (before birth) risk factors for MBD?
- Placental insufficiency
- Intrauterine growth deficiency
- Maternal preeclampsia
- Chorioamnionitis
- Intraventricular hemorrhage
- Genetic polymorphisms that affect bone generation
- Male gender
What are some postnatal risk factors for MBD?
- PN for greater than four weeks
- Bronchopulmonary dysplasia
- Necrotizing enterocolitis
- Immobilization
- Cholestasis
Which medications increase the risk of MBD?
- Diuretics
- Methylxanthines (theophylline or aminophylline)
- Glucocorticoids
Fill in the blank: MBD is characterized by _______ and osteomalacia.
osteopenia
Why is iron critical during the neonatal period?
It is critical for neurodevelopment.
What are the potential adverse outcomes related to iron levels?
Both iron deficiency and iron overload may cause adverse outcomes to neurodevelopment.
What is the recommended iron supplementation for VLBW infants receiving human milk?
Elemental iron supplementation of 2-4 mg/kg/day.
When should VLBW infants begin receiving iron supplementation?
Beginning at 2 weeks of age.
Until what age should VLBW infants continue to receive iron supplementation?
Until 6 months of age.
What is biliary atresia?
Atrophy of the bile ducts causing obstruction of bile flow from the liver into the biliary system and small intestine.
What is the consequence of biliary atresia on bile acids?
Significant decrease in the concentration of intraluminal bile acids needed for micelle formation and fat absorption.
What are the nutritional deficiencies associated with biliary atresia?
- Fat malabsorption
- Fat soluble vitamin malabsorption
- Essential fatty acid deficiency
What type of formula may lead to essential fatty acid deficiency in biliary atresia?
Medium chain triglyceride (MCT) oil predominant formula that does not contain adequate long chain triglycerides (LCT).
What factors may lead to zinc deficiency?
- Chronic malnutrition
- Cirrhosis
- Chronic stress
Why is zinc deficiency difficult to assess?
Due to laboratory limitations.
What is chylothorax?
Accumulation of chyle in the pleural space due to thoracic duct damage.
Is chylothorax more frequently associated with cardiac surgery or biliary atresia?
More frequently associated with cardiac surgery.
Fill in the blank: Biliary atresia causes obstruction of bile flow from the liver into the _______.
Biliary system and small intestine
