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fluids and nutrition Flashcards

1
Q

What happens to the intracellular and extracellular compartments after delivery.

A

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.

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2
Q

How do ELBW kidneys differ than preterm/neonates?

A
  • limited ability to concentrate urine, so they diurese more because of all the solutes
  • limited ability to reabsorb Na
  • limited ability to excrete K
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3
Q

What calories are provided by different components of nutrition?

A

AA: 4 cal/g
dextrose: 3.4 cal/g
lipids (20%): 9 cal/g (?)

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4
Q

What is AAP recommended Fe supplementation?

A

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

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5
Q

Whats a normal Na supplementation for pt baby?

A

Consider delaying 1-5d for VLBWs. Normal supplementation is 4-5 meq/kg/day.

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6
Q

What are comorbidities of hyper/hyponatremia?

A

Hypernatremia: G3-4 IVH
Hyponatremia: CP and SNHL

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7
Q

How is maternal milk in pt babies different than term?

A

Higher in Na and protein, but still not high enough to meet needs

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8
Q

What are the benefits of lactoferrin

A

Chelates iron and prevents pathogen growth, limits excessive immune response

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9
Q

Which type of pasteurization is best

A

Holder pasteurization is ideal, 62 deg C for 30 minutes. Preserves bacteria static activity of milk. Eradicates HIV and CMV.
Boiling is most damaging.

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10
Q

What does oxytocin do

A

Stimulates cells in mammary glands to contract, responsible for let down

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11
Q

What does prolactin do

A

Responsible for growth of mammary tissue and milk production/secretion

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12
Q

What are disadvantages of donor milk

A

Low in DHA. Pasteurization depletes a lot of the immune system benefits

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13
Q

How is PT formula different than term?

A 
Whey:casein 60:40
Less lactose, more glucose
Higher protein
Higher mct 
Higher ca:ph ratio (1.8-2.1)
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14
Q

What is the normal urinary concentration of Na and K?

A

Na: 20-40, 70 when on furosemide
K: 10-30 mmol/L

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15
Q

What is adequate intake of Ca and Ph in:
term, enterally:
preterm, enterally:
preterm, iv:

A

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

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16
Q

Which vitamin deficiency is more common, fat soluble or water soluble?

A

Fat soluble (in malabsorption, liver cholestasis, short gut)

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17
Q

What is Vit B1 deficiency?

A

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

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18
Q

What is Vitamin B2 deficiency?

A

B2 is Riboflavin. Catalyzes ox-redux reactions.

Riboflavin deficiency results in dermatitis, cheilosis, glossitis

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19
Q

What is Vit B3 deficiency?

A

B3 is niacin. Niacin mediates ox-redox rxns. Deficiency is pellagra, classic 4 Ds: death, dermatitis, diarrhea, dementia

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20
Q

What is Vit B7 deficiency?

A

B7 is biotin. Deficiency = glossitis, dermatitis, loss of appetite, nausea

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21
Q

What is Vit B5 deficiency?

A

B5 is pantothenic acid, a component of coenzyme A.

Deficiency not seen in PT

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22
Q

What is Vit B6 deficiency?

A

B6 is pyridoxine. Part of coenzyme involving AA metabolism. Deficiency not seen in PT.

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23
Q

What is Vit C deficiency?

A

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

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24
Q

What is Vit B12 deficiency?

A

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.

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25
Q

What is B9 deficiency?

A

B9 is folate. Folate involved AA synthesis. Most common vit deficiency in US, associated with NTD in neonates.

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26
Q

What is Vit A deficiency?

A

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.

27
Q

What is Vit D deficiency?

A

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.

28
Q

What is Vit E deficiency?

A

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

29
Q

What is Vit K deficiency?

A

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

30
Q

What is acrodermatitis enteropathica?

A

AR inborn error of zinc metabolism. Growth impairment, dermatitis with perioral and perianal involvement.

31
Q

How does copper deficiency present?

A

hypopigmentation of skin/hair, bone abnormalities, neutropenia. Zinc toxicity can cause Cu deficiency.

32
Q

what is normal energy usage and need for growth?

A

90-120kcal/kg/day. for growth: 100-130 kcal/kg/day

33
Q

what is the estimated protein requirement for pt infants

A

3.5-4.5 g/kg/day

34
Q

what is the whey : casein in different formulations?

A

colostrum: 80:20
PT formula: 60:40
mature breast milk: 55:45 (casein increases over days)
hydrolyzed/soy: all casein

35
Q

how much energy is provided by fat in formula and milk?

A

~50%

36
Q

what is the significance of DHA and ARA

A

docohexaonic acid and arachodinic acid are useful in neurodevelopmental and visual development

37
Q

which fatty acids are essential for neonates?

A

linoleic and linolenic acid

38
Q

what are the most common fatty acids for neonates?

A

stearic, oleic, palmetic (oleic and palmetic are most abundant in human milk)

39
Q

what are LCPUFA >10C useful for

A

brain and retinal development

40
Q

what is the triene:tetrene ratio?

A

> 0.4 = EFA deficiency. an increase in mead’s acid (20:3) to arachodonic acid (20:4) –> DECREASE IN ADA

41
Q

what is the difference between whey and casein?

A

Whey has more cysteine and less methionine

42
Q

what are significant milk proteins?

A 
alpha lactalbumin
lactoferrin
igA
serum albumin
igA and lactoferrin make 30% of milk protein
43
Q

why add cystein in tpn

A

drops pH so that more ca and ph can solubilize

44
Q

which trace elements do you reduce in cholestasis?

A

manganese and copper (Yellow)

45
Q

what is the ponderal index

A

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

46
Q

what is donahue syndrome?

A

aka leprechaunism: insulin resistance disorder with mutation of insulin receptor gene –> hyperinsulinism, severe growth failure

47
Q

how does neonatal hemochromatosis present

A

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

48
Q

what are components preserved after holder pasteurization, vs depleted?

A

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)

49
Q

What is an appropriate amount of Zinc intake for PT?

A

350-400 mcg/kg/day in the ELBW

50
Q

what is increased in PT formula vs Term?

A

increased Ca, Ph, Na, 50% more protein

decreased lactose and Fe

51
Q

what is the difference between fore milk and hind milk?

A

fore milk: more lactose
hind milk: more fat
same cholesterol and protein throughout
triglycerides are the most variable component

52
Q

what does human milk have more of than cow milk?

A

more DHA/ADA, cholesterol, carnitine, choline (good for cns), LCPUFAs.
cow milk has more AA but harder to digest

53
Q

what is creamtocrit measuring?

A

lipid variation, content and calories in breast milk

54
Q

What two forms of energy can the brain use

A

Glucose and ketones (broken down from tgc)

55
Q

In what maternal condition do you see hypoCa and hypoMg in the fetus?

A

Maternal diabetes

56
Q

which electrolytes require active transport across placenta?

A

Ca, Mg, Ph (all at end of fishbone)

- also AA

57
Q

what is the role of lactoferrin?

A

most common whey protein in human milk. After pepsis does proteolysis of lactoferrin, acts as bacteriocidal agent. H2 blockers can hinder this effect

58
Q

what is non-nutritive sucking ratio?

A

suck:swallow 6-8:1

nutritive sucking ratio: 1-3:1 (neonates have 1-2:1)

59
Q

patients with NEC vs those without have:

A

higher predominance of proteobacteria and less diversity of species

60
Q

what are Arachadonic acid and DHA derivatives of?

A

linoleic –> AA (omega 6)

linolenic –> DHA (omega 3)

61
Q

what is the major whey protein in human milk vs cow milk?

A

HM: a-lactalbumin
CM: b-lactoglobulin

62
Q

what is intralipid

A

100% soybean oil. On autopsy, lipid droplets sometimes found in the lungs.

63
Q

when does neonatal creatinine stabilize by? how is it different than adult creatinine?

A

stabilizes by 1-2 weeks

initially, renal tubules are leaky so some actually gets reabsorbed

64
Q

what constitutes IL vs smof vs omegaven?

A

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.

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