Growth Flashcards
What are the actions of insulin?
- Increased glucose uptake in the muscle, fat, and liver
- Fall in the following and you will also feel faint + hungry and dizzy when there is a shortage
• Gluconeogenesis in the liver
• Amino acid release from the muscle
• Lipolysis
• Ketogenesis in the liver - Removes glucose from the circulation and into the tissues where it is stored.
How to establishing breastfeeding
- @ first not much milk is available.
- Average intake of colostrum + 7mls feed in the first 24 hours. New born has to initially meet demands from stores
- Later, milk is available as a high fat food.
What is the energy need for newborn
- The energy need for new born is 4-6g glucose/kg/day
What happens during a postnatal fast
- The baby has to utilise stores to provide glucose as energy source for the tissues
- Gluconeogenesis = process of providing glucose from stores - muscle, amino acids and glycogen, + fat via substrates such as lactate, pyruvate, alanine and glycerol
What is ketogenesis
- Is process of providing ketone bodies - act as fuel, from fat breakdown.
Fat structures + metabolism of fat
- Glycerol backbones have fatty acids attached. Can Knock off fatty acids from the glycerol back bone. Binding to AcoA = beta oxidation –>
This can also be used to make ketone bodies which babies can use
Describe fat oxidation?
- The terminal 2 carbon group is removed from fatty acid and bound to coenzyme A, as AcoA - (Beta oxidation). Acetyl groups can then be used to form ketone bodies (acetone and beta hydroxybutyrate). Acetyl groups can also go into the Krebs cycle, as an energy source.
how are ketone bodies formed?
- Beta oxidation removes 2 carbon units, which are used to make ketone bodies
- Anaerobic respiration - this works as a metabolic fuel for the brain
Describe fasting, in the post absorptive state
- Substrates get mobilised peripherally through the action of counter regulatory hormones
- Insulin gets opposed if you are fasting. When baby is born, go from having uninterrupted nutrition across placenta = to periods of time where you have to wait for food.
Describe the fed, post prandial state
- Infant diet is = 50% fat +40% carbohydrate, CHO is mainly lactose. Breast milk contains lipase.
- There are deliveries made which make: ketone bodies and blood glucose. Beta oxidation and ketone bodies are present when you have just had a meal
- Carbs from milk = from lactose. Get lots of blood glucose from the blood stream and then this is stored in the peripheral tissues. Glycogen can be rapidly broken down as an energy source when needed in a fast
What are metabolic needs for adults compared to babie
- 30 kilocalories/g/day for adults, and 4x this amount of energy needed for babies to grow because have to maintain and grow. Fastest rate of growth is mid gestation at 20 weeks.
- Cannot feed babies like this: when you feed them - they would vomit the milk out. Feed them small amounts and support with IV nutrition. Gastro tract is there from 18-20 weeks onwards. Born at 25 weeks = anatomy is there but nothing is working exactly how it should so you have a limited capacity to digest any milk that is given.
describe the The IUGR baby
Intrauterine growth restriction baby
- SJ small for gestational age (below a certain percentile level, which can be normal)
- IUGR - indicates that a pathological process has occurred to make a baby smaller than they should be.
- High demands, especially the brain
- Low stores, liver, muscle and fat - immature gluconeogenic pathways
what are the characteristics of Infant of diabetic mother
- High maternal glucose, high fetal glucose, fetal and neonatal hyperinsulinism
- Neonatal macrosomia and hypoglycaemia
Cherubic. Big chubby cheeks. Difference between this + a normally big baby =
Other cases of hyperinsulinsim
- Beckwith Wiedemann
- Macroglossia, large tounge, macrosomnia, midline abdominal wall defects (exomphalos, umbilical hernia, diastasis recti)
- Ear creases or ear pits
- Hypoglycaemia
- Islet cell dysregulation - nesiodioblastosis
What is Nesiodioblastosis
Islet cell dysregulation
Other deficiencies of counter regulatory hormones
- Hypothalamic- pituitary adrenal insufficiency = septoptic dysplasia
- Waterhouse - Friderichsen - severe adrenal haemorrhage with adrenal gland dysfunction secondary to sepsis or hypoxia.
What is Waterhouse Friderichsen
- Severe adrenal haemorrhage
Ø With adrenal gland dysfunction
Secondary to sepsis or hypoxia
What is septo-optic dysplasia caused by?
- Hypothalamic- pituitary adrenal insufficiency = septo-optic dysplasia
Inborn errors of metabolism: describe neonatal hypoglycaemia
- Causes of neonatal hypoglycaemia, include:
• Glycogen storage disease (usually type 1)
• Galactosaemia, MCAD (medium chain acyl-coA dehydrogenase deficiency)
Glycogen storage disease (type 1)
- Deficiency of G-6-Phosphatase, hypoglycaemia and lactic acidosis in new born.
Hepatomegaly in older child.
describe Galactosaemia
- Lactose in milk is broken down to galactose + glucose
Ø Galactose = then broken down to glucose
○ By galactose 1 phosphate
○ by Uridyl Transferase (Gal-I-put)
§ Uridyl transferase is missing in Galactosaemia. This leads to toxic levels of galactose 1 phosphate - If you do not have the right levels of converting enzyme you will make toxic levels of Galatcose 1 phosphate.
- Presents with:
• Hypoglycaemia, jaundice and liver disease, poor feeding and vomiting, cateracts and brain damage, E coli sepsis
describe breast anatomy
- 20 radially arranged lobes. System of ducts draining down to nipple. About 9 lobes (4-18) are functional, the rest vestigial. Each lobe = separate functional unit.
Ø Non-lactating breast = 50% fat
Ø Lactating about 30% fat.
describe Drainage of the mammary gland
- This system of ducts drains into “lactiferous sinuses” underneath the breast areola.
- There are subcutaneous, intraglandular and retromammary fat deposits
Structure of the mammary gland
- Around the alveolar there are myoepithelial cells.
- The basic secretory unit = alveoli set within connective tissue structure, which are lined by mammary epithelial cells (cuboidal or low columnar cells). Myoepithelial cells surround the alveoli.
Myoepithelial cells are contractile + responsible for milk ejection
Preparations in pregnancy
- “Lactogenesis I”
- There is placental lactogen + prolactin which promote breast development, prepped for milk production in pregnancy. Will start to cause hyperplasia of glandular tissues within the breast.
- There is also autokine inhibition from duct cells.
- If milk is not removed from the breast = no more milk produced.
What inhibits milk secretion?
- Progesterone and oestrogen both inhibit milk secretion
Lactogenesis post partum - lactogenesis
- Fall in progesterone and oestrogen levels reduces inhibition
- Suckling stimulus will release prolactin; which will drive milk synthesis. Suckling = releases oxytocin driving milk ejection. There is also some autocrine inhibition from duct cells
Describe what suckling will do
- Suckling stimulus will release prolactin. Prolactin drives milk synthesis
- Sucking + higher centres will release oxytocin which drives the ejection of milk
Control of milk synthesis
- Prolactin released in response to sucking, from the anterior pituitary.
- Milk synthesis is led by infant demand
- Suckling > nerve pathways > ant. Pituitary > prolactin in the blood > milk producing alveolus
- Sucking episode = synthesis for next feed.
Describe the let-down reflex
- Oxytocin release causes milk ejection. The reflex might become conditioned. The surrounding myoepithelial cells that surround contract and let out milk.
Effect of drugs that suppress lactation?
- Fall in prolactin secretion
- Dopamine agonist
• Bromocriptinne
• Cabergolie
Effect of drugs that Augment lactation?
- Increased prolactin secretion
- Dopamine antagonists
• Domperidone
• Metoclopramide
breast secretory pathways?
- Produce protein which is packaged in the vesiclce and goes to the golgi apparatus.
- Vesicle then fused.
- Lipids make in the ER. Fat globules are surrounded by membrane and then pinch off into the lumen. Water, ions etc move across by osmosis and then other elements like sectory IgA binds with a binding protein on the inside of the cell membrane.
Paracellular pathways + Transcellular Pathways
What are the components of breast milk?
- Nutrients = macronutrients and trace elements (low solute load)
- Ig, Secretory IgA, Cells
- Non-specific immune components
- Growth factors
what are the components of human breast milk? [lipids]
- Human milk has LCPUFA.
Ø Important for brain and retinal development - Cows milk only contains C18 LCPUFA, linoleic, n6 and linolenic n3 precursors
- As adults = can make DHA + acids from these precursors. Harder for babies to do so.
- Populations of those who have long chain PUFA acids = have lower rate of CVS, metabolic, and dementia syndromes in old age + omega 3 from fish gives these effects.
what are the components of human breast milk? [proteins]
- Human milk =
• Whey 70%, casein 30%
Casein makes curds which sit in the stomach and satisfy baby
What special component does human milk contain
LCPUFA. Which is important for brain + neuronal development
- Long chain PUFA acids = lower rates of CVS + metabolic + dementia issues
What component does cow milk contain
- C18 LPUFA only
• Linoleic, n6, linolnic n3 precursors
• As adults we can make DHA + acids that we need from these precursors
Effect of breast feeding on GI
- Human milk = improves gastric emptying.
- Human milk is important in preventing NEC in preterm infant. Looks like a string of beads.
- If you give premie formula milk = much higher chance of getting this condition, or inflammation which can cause brain injury.
- Higher morbidity associated with formula.
Immunity in breast milk : things that included in breast milk
Immune factor sIgA complement lactoferrin Lysozyme Cytokines PAF acetyl hydrolase Oligosaccharides Epidermal growth factors Cellular elements
Describe the immune effect of sIgA in breast milk
- Specific immune resp. binds bacterial adherence sites
Describe the immune effect of complement in breast milk
- C1 to C9 present in low conc in human milk.
- Higher amounts of C3 (can opsonise bacteria in conjctation with IgA)
Describe the immune effect of lactoferrin in breast milk
- Inhibits bacterial growth by binding iron
Describe the immune effect of cytokines in breast milk
- Anti inflammatory cytokines predominate in human milk
- Allows human milk to protect but not injure the gastro tract
Describe the immune effect of PAF acetyl in breast milk
Inhibits platelet activating factor
Describe the immune effect of oligosaccharides in breast milk
- Inhibits the binding of enteric / resp pathogens epithelial cells
• Probiotics and prebiotics. = non digestible oligos which go through to the colon and act for food for normal baterial flora.
• Not like the bacterial flora of formula milk that infants have. (pre)
• Probiotics are the actual bugs.
Describe the immune effect of epidermal growth factor in breast milk
Enhance the development of GI epithelium
Describe the immune effect of cellular elements in breast milk
Neutrophils and macrophages
Describe the immune effect of lysozyme in breast milk
- Cleaves peptidoglycans of bacterial walls
what is the enteromammary axis?
- Gut lumen of mother contains Peyers patches.
Antigens stimulate lymphocytes, to go to circulation = secretion of IgA into breast milk.