fluids and nutrition Flashcards
What happens to the intracellular and extracellular compartments after delivery.
Initially, ECV (vascular and interestitial) is greater than ICV. As the neonate ages, overall body volume increases, overall ECV % decreases and overall ICV % of body volume increases.
How do ELBW kidneys differ than preterm/neonates?
- limited ability to concentrate urine, so they diurese more because of all the solutes
- limited ability to reabsorb Na
- limited ability to excrete K
What calories are provided by different components of nutrition?
AA: 4 cal/g
dextrose: 3.4 cal/g
lipids (20%): 9 cal/g (?)
What is AAP recommended Fe supplementation?
Term: 1 mg/kg by 6 months of age, preferably though food sources.
Preterm: breast feeding - 2mg/kg at one month
Preterm: PT formula feeding - 1 mg/kg at one month
Whats a normal Na supplementation for pt baby?
Consider delaying 1-5d for VLBWs. Normal supplementation is 4-5 meq/kg/day.
What are comorbidities of hyper/hyponatremia?
Hypernatremia: G3-4 IVH
Hyponatremia: CP and SNHL
How is maternal milk in pt babies different than term?
Higher in Na and protein, but still not high enough to meet needs
What are the benefits of lactoferrin
Chelates iron and prevents pathogen growth, limits excessive immune response
Which type of pasteurization is best
Holder pasteurization is ideal, 62 deg C for 30 minutes. Preserves bacteria static activity of milk. Eradicates HIV and CMV.
Boiling is most damaging.
What does oxytocin do
Stimulates cells in mammary glands to contract, responsible for let down
What does prolactin do
Responsible for growth of mammary tissue and milk production/secretion
What are disadvantages of donor milk
Low in DHA. Pasteurization depletes a lot of the immune system benefits
How is PT formula different than term?
Whey:casein 60:40 Less lactose, more glucose Higher protein Higher mct Higher ca:ph ratio (1.8-2.1)
What is the normal urinary concentration of Na and K?
Na: 20-40, 70 when on furosemide
K: 10-30 mmol/L
What is adequate intake of Ca and Ph in:
term, enterally:
preterm, enterally:
preterm, iv:
term enterally: Ca 70mg/kg/day, Ph 100mg/day
PT enterally: Ca 150-220 mg/kg/day; Ph 60-140 mg/kg/day; Ca:P 1.8-2:1
PT iv: Ca: 65-100 mg/kgday; Ph 50-80 mg/kg/day; ca:P 1.3 -1.7 :1
Which vitamin deficiency is more common, fat soluble or water soluble?
Fat soluble (in malabsorption, liver cholestasis, short gut)
What is Vit B1 deficiency?
B1 is Thaimine. Used for pentose phosphate pathway and oxidative decarboxylation.
Thiamine deficiency is BeriBeri: neurologic and cardiac symptoms. Not seen in infants because B1 is present in breastmilk and formula
What is Vitamin B2 deficiency?
B2 is Riboflavin. Catalyzes ox-redux reactions.
Riboflavin deficiency results in dermatitis, cheilosis, glossitis
What is Vit B3 deficiency?
B3 is niacin. Niacin mediates ox-redox rxns. Deficiency is pellagra, classic 4 Ds: death, dermatitis, diarrhea, dementia
What is Vit B7 deficiency?
B7 is biotin. Deficiency = glossitis, dermatitis, loss of appetite, nausea
What is Vit B5 deficiency?
B5 is pantothenic acid, a component of coenzyme A.
Deficiency not seen in PT
What is Vit B6 deficiency?
B6 is pyridoxine. Part of coenzyme involving AA metabolism. Deficiency not seen in PT.
What is Vit C deficiency?
C is ascorbic acid. Classically deficiency causes scurvy: sore, spongy gums, loose teeth, fragile vessels, anemia, swollen joints. Not seen in PT. Vit C also increases Fe absorption
What is Vit B12 deficiency?
B12 is cyanocobalamin, important for hematopoiesis. Deficiency causes megaloblastic anemia and neuro dysfunction. Can be seen in strict vegetarian and vegan diets, or SBS where TI is removed.
What is B9 deficiency?
B9 is folate. Folate involved AA synthesis. Most common vit deficiency in US, associated with NTD in neonates.
What is Vit A deficiency?
Vita A is necessary for growth and differentiation of epithelial tissue, including lung. May contribute to BPD, so Vit A is treatment for BPD prevention.
Acute toxicity can lead to liver damage and increased ICP.
What is Vit D deficiency?
Vit D is essential for bone health. Increases gut, bone and renal absorption of Ca and Ph. 400 IU per day recommended.
Acute toxicity can cause hypercalcemia, constipation, vomiting and bone disease.
What is Vit E deficiency?
Vit E is an antioxidant and important to protect RBC from oxidative injury
Acute toxicity can cause increased risk of hemolytic anemia, ROP, BPD, and ICH
What is Vit K deficiency?
Vit K is crucial for clotting factors to prevent hemorrhagic disease of the newborn. One IM dose at birth.
Acute toxicity can cause hemolytic anemia
What is acrodermatitis enteropathica?
AR inborn error of zinc metabolism. Growth impairment, dermatitis with perioral and perianal involvement.
How does copper deficiency present?
hypopigmentation of skin/hair, bone abnormalities, neutropenia. Zinc toxicity can cause Cu deficiency.
what is normal energy usage and need for growth?
90-120kcal/kg/day. for growth: 100-130 kcal/kg/day
what is the estimated protein requirement for pt infants
3.5-4.5 g/kg/day
what is the whey : casein in different formulations?
colostrum: 80:20
PT formula: 60:40
mature breast milk: 55:45 (casein increases over days)
hydrolyzed/soy: all casein
how much energy is provided by fat in formula and milk?
~50%
what is the significance of DHA and ARA
docohexaonic acid and arachodinic acid are useful in neurodevelopmental and visual development
which fatty acids are essential for neonates?
linoleic and linolenic acid
what are the most common fatty acids for neonates?
stearic, oleic, palmetic (oleic and palmetic are most abundant in human milk)
what are LCPUFA >10C useful for
brain and retinal development
what is the triene:tetrene ratio?
> 0.4 = EFA deficiency. an increase in mead’s acid (20:3) to arachodonic acid (20:4) –> DECREASE IN ADA
what is the difference between whey and casein?
Whey has more cysteine and less methionine
what are significant milk proteins?
alpha lactalbumin lactoferrin igA serum albumin igA and lactoferrin make 30% of milk protein
why add cystein in tpn
drops pH so that more ca and ph can solubilize
which trace elements do you reduce in cholestasis?
manganese and copper (Yellow)
what is the ponderal index
mass:length
BW/crown-heel * 100
<10% = growth restricted
symmetric iugr = normal PI
MC is asymmetric iugr (55%) = low PI (mass is low)
combined iugr = low PI - some skeletal shortening
what is donahue syndrome?
aka leprechaunism: insulin resistance disorder with mutation of insulin receptor gene –> hyperinsulinism, severe growth failure
how does neonatal hemochromatosis present
fetal or very soon after birth, with liver failure. hyperbili, jaundice, organ failure. transaminases are normal b/c very few normal hepatocytes left. fibrosis/cirrhosis. dx: salivary gland siderosis, but not pathopneumonic
what are components preserved after holder pasteurization, vs depleted?
pereserved: oligosaccharides, lactose, vit ade, lpufas, linoleic acid, FFA, monoglycerides
depleted: igM goes to mush, igA and G decreased. lipase, lactoferrin (50%), lysozyme (75%), lymphocytes, cytokines (most immune properties)
What is an appropriate amount of Zinc intake for PT?
350-400 mcg/kg/day in the ELBW
what is increased in PT formula vs Term?
increased Ca, Ph, Na, 50% more protein
decreased lactose and Fe
what is the difference between fore milk and hind milk?
fore milk: more lactose
hind milk: more fat
same cholesterol and protein throughout
triglycerides are the most variable component
what does human milk have more of than cow milk?
more DHA/ADA, cholesterol, carnitine, choline (good for cns), LCPUFAs.
cow milk has more AA but harder to digest
what is creamtocrit measuring?
lipid variation, content and calories in breast milk
What two forms of energy can the brain use
Glucose and ketones (broken down from tgc)
In what maternal condition do you see hypoCa and hypoMg in the fetus?
Maternal diabetes
which electrolytes require active transport across placenta?
Ca, Mg, Ph (all at end of fishbone)
- also AA
what is the role of lactoferrin?
most common whey protein in human milk. After pepsis does proteolysis of lactoferrin, acts as bacteriocidal agent. H2 blockers can hinder this effect
what is non-nutritive sucking ratio?
suck:swallow 6-8:1
nutritive sucking ratio: 1-3:1 (neonates have 1-2:1)
patients with NEC vs those without have:
higher predominance of proteobacteria and less diversity of species
what are Arachadonic acid and DHA derivatives of?
linoleic –> AA (omega 6)
linolenic –> DHA (omega 3)
what is the major whey protein in human milk vs cow milk?
HM: a-lactalbumin
CM: b-lactoglobulin
what is intralipid
100% soybean oil. On autopsy, lipid droplets sometimes found in the lungs.
when does neonatal creatinine stabilize by? how is it different than adult creatinine?
stabilizes by 1-2 weeks
initially, renal tubules are leaky so some actually gets reabsorbed
what constitutes IL vs smof vs omegaven?
IL: 100% soy bean
SMOF: soy, MCT, olive, fish
omegaven: 100% fish
non IL assc with less cld, rop and cholestasis. higher dha and ara.
