GI Nutrition Flashcards
In what illnesses are there evidence for probiotics?
prevention of antibiotic-associated diarrhea
shorten the duration of acute infectious viral diarrhea
prevent NEC in preterm infants
decrease the symptoms of colic
decrease some symptoms of IBS
Benefits of breastfeeding
Decreased infectious diseases
- Bacterial meningitis, diarrhea, bacteremia, respiratory infections, AOM, UTI
Reduced hospital admissions
Reduces SIDS
Enhanced neurocognitive development
Reduced breast and ovarian cancer in mom
Greater postpartum weight loss for mom
What are benefits of human milk for prems?
Reduced incidence of NEC
Fewer severe infections
Reduced colonization by pathogenic organisms
Improved neurodevelopmental outcome
Human milk banking - benefits
Reduced incidence of NEC, Fewer severe infections, Reduced colonization by pathogenic organisms,
Improved neurodevelopmental outcome
Pasteurization of donor breast milk - what does it remove?
Inactivated bacterial and viral contaminants
Nutritional components mostly unaltered
Immunological factors: IgA remains active, IgG reduced to 70%, IgM completely removed
when to use height instead of length
2-3 years
Birth - 2years: Risk/Overwt/Obese
Risk of overweight
= Weight for length >85th
Overweight
= Weight for length >97th
Obesity
= Weight for length >99.9th
2-5 years
Risk/Overwt/Obese
Risk of overweight
= BMI >85th
Overweight
= BMI >97th
Obesity
= >99.9th
5-19 years
Overwt/Obese/Severe
Overweight
= BMI >85th
Obesity
= BMI >97th
Severe Obesity
= >99.9th
When to add lumpy textures to food
by 9 months
How much cow’s milk can infant have
max 750ml/d <1yo
max 500ml/d >1yo
Formula feeding - for how long and when to switch to cows milk
No longer than 9-12 months
Homo milk at 9-12 months
What is the best guide to assess overall health & nutrition status
Serial weight & height
What percentiles does the WHO charts use
WHO uses 0.1, 3, 15, 50, 85, 97, 99.9 percentiles
MPH
= (fathers ht + mothers ht)/2 +/- 6.5 (range +/-8.5)
Causes of growth failure
Nutritional intake inadequate:
- Eating poorly
- Anorexia with chronic disease
- Oral skills lacking
Increased energy losses
- Emesis
- Malabsorption
- -Pancreatic disease (CF, –Schwachman-Diamond)
- -Cholestatic Liver disease
- -Intestinal (celiac, Cohn’s)
Increased energy needs - Chronic condition - Recurrent infections Endocrine problem - Hypothyroidism - GH deficiency
Other
- Diencephalic tumour
- RTA
Basic w/u for poor growth
Step 1 CBC ESR, CRP Lytes, blood gas, glucose BUN, Creatinine Protein and Albumin Iron, TIBC, Transferrin saturation, Ferritin Calcium, Phos, Alk-P Liver enzymes (AST, ALT, GGT) Serum IgG, IgM, IgA TTG + IgA TSH Urinalysis
Step 2 Sweat Chloride Vitamin levels Fecal Elastase Bone Age
Step 3
Referral to specialist
Normal growth in the first few years
When does growth taper off
First year of life: gain ~7kg + 21cm
Second year of life: ~2.3kg + 12cm
2-5 years: growth slows: 1-2 kg/year + 6-8 cm/year
Slows 2-5 years
Infantile Colic - age + 3 criteria
<4mo with all of:
- paroxysms of irritability, fussiness or crying that start and stop without obvious cause
- episodes lasting 3 h or more per day and occurring at least three days per week for at least one week
- no failure to thrive.
Options for severe colic
Concern for CMPA: can try empiric time-limited (2 weeks) ther trial of a hypoallergenic diet
BF w/o concern of CMPA: can consider eliminating cow’s milk from the maternal diet
Bottle-fed w/o concern CMPA: time- limited empiric trial of an extensively hydrolyzed formula
What is a concerning component of soy formula
phytoestrogens
How should CMPA be treated
extensively hydrolyzed formulas
NOT SOY
What are the indications for using soy based formula
Galactosemia
Cultural or religious reasons
What are the known harms of soy formula
premature (↑ rate of adverse rxns to soy pn)
Congenital hypothyroidism (phytoestrogens can alter TPO = abn thyroid fn (only in congen hypothy, not healthy thryoids)
What infants should receive iron supplementation
LBW infants who are mainly breastfed: should give iron supplement
BW 2.0-2.5 kg: 1-2 mg/kg/day for the first 6 months of age.
BW < 2.0 kg: 2-3 mg/kg/day for the first year of age.
Iron absorption from human milk?
Iron absorption from human milk: 20% to 50% (10% to 20% from infant formulas)
Risk factors for iron deficiency <2yo
preterm delivery or birth weight <2500 g
low socio-economic status
infants born to mothers with anemia or obesity
early umbilical cord clamping
male sex
exclusive breastfeeding for longer than 6 months
high cow’s milk intake
prolonged bottle use
chronic infection
lead exposure
low dietary intake of iron-rich complementary foods.
Measures to prevent iron deficiency
- Delayed cord clamping
- If formula feeding, providing iron-fortified formula
- Feeding iron-rich complementary foods from age 6 months
- Not using cow’s milk as the main milk source until infants are a year old, and limiting cow’s milk intake to 500 mL/day thereafter.
treatment of iron deficiency anemia
- how to improve absorption
- length of treatment
oral iron supplements 2 - 6 mg/kg/day of elemental iron in divided doses
Absorption improves when iron is ingested with a source of vitamin C.
Supplements should be continued for a minimum of 3 months, followed by a reassessment of iron status including CBC and serum ferritin.
