Growth and Nutrition Flashcards
Highest growth velocity in-utero
28-32 weeks
Stage 3 intrauterine growth pattern
Hypertrophy: 28-40 weeks, cell growth
Ponderal index
PI <10% for GA: growth restricted
Symmetric IUGR
Growth inhibition during stage one/hyperplasia
Produces undersized fetus with fewer cells that are normal cell size
Normal PI, weight/length/HC all <10%
Asymmetric IUGR
Growth inhibition during stage 2/3 (hypertrophy)
Decreased cell size
Normal cell number
Low PI, weight <10%, length/HC preserved
IGF I
Occurs late in gestation
Increased expression associated with increased brain growth
IGF II
Predominant IGF for majority of gestation
Important for early growth
IGF binding proteins
Balance between IGFs and IGF BPs essential for normal growth
Placenta and growth
Direct relationship between growth of the placenta and growth of the fetus
After 20 weeks the placenta produces growth factors and growth regulating hormones
Placental growth hormone
Produced by syncyciotrophoblasts
Regulator of maternal insulin resistance
May influence fetal growth by modifying substrate availability
Causes of an LGA infant
Maternal diabetes
Beckwith Wiedemann (high IGF2)
SGB
Sotos syndrome
What causes IUGR due to wasting?
Post dates
Donahue syndrome
Stage one intrauterine growth pattern
Hyperplasia: 4-20 weeks GA, cell division
Stage two intrauterine growth pattern
Hyperplasia and hypertrophy: 20-28 weeks GA, division and cell growth
Causes of symmetric IUGR
Genetic abnormalities Early in-utero infections Substance abuse Chronic maternal anemia Cigarettes Radiation Maternal lupus
Causes of asymmetric IUGR
Utero placental insufficiency Chronic HTN/renal disease Hemoglobinopathies Placental infarcts/problems Altitude Substance abuse
Combined type IUGR
Low PI
Skeletal shortening
Decrease in soft tissue mass
Vitamin B1 (Thiamine) deficiency
Beriberi: Fatigue Irritability Constipation Cardiac failure
Syndromes associated with thiamine deficiency
Pyruvate dehydrogenase complex deficiency
Maple syrup urine disease
Vitamin B2 (riboflavin) deficiency
Failure to thrive
Photophobia/blurred vision
Dermatitis
Mucositis
Syndromes associated with vitamin B2 (riboflavin) deficiency
Glutaric aciduria type 1
Vitamin B6 (pyridoxine) deficiency
Dermatitis
Mucositis
Hypochromic anemia
Possible seizures
Syndromes associated with vitamin B6 deficiency
Homocystinuria
Biotin (vitamin B7) deficiency
Alopecia
Dermatitis
Scaling
Seborrhea
Syndromes associated with biotin (vitamin B7) deficiency
3-methylcrotonyl glycinuria
Propionic acidemia
Biotinidase deficiency
Pyruvate dehydrogenase complex deficiency/pyruvate carboxylase deficiency
“Baby Michelangelo painted bad pantyhose”
Vitamin C deficiency
Poor wound healing
Bleeding gums
Syndromes associated with vitamin C deficiency
Transient tyrosinemia
Function of chromium
Regulates insulin levels 2/2 role in insulin metabolism
Chromium deficiency
Humans -> diabetes
Copper
Critical for production of RBCs
Absorption of iron
A/w multiple enzyme activities
Copper deficiency
Anemia Osteoporosis Depigmentation of hair/skin Neutropenia Poor weight gain Hypotonia, ataxia later in life
Iron
Component of hemoglobin
Absorbed in duodenum and proximal jejunum
Vitamin C enhances absorption
Iron deficiency
Microcytic, hypochromic anemia
Failure to thrive
Manganese
Enzyme activation
Important for normal bone structure
Role in carbohydrate metabolism
Selenium
Cofactor for glutamine peroxidase
Selenium deficiency
Humans - muscle disease
Animals - cardiomyopathy
Zinc
Important component of several enzymes (carbonic anhydrase and carboxypeptidase)
Important for growth
Acrodermatitis enteropathica
Autosomal recessive
Abnormality of zinc absorption or transport
Zinc deficiency
Failure to thrive Alopecia Diarrhea Dermatitis Ocular changes Rash (crusted, erythematous) Nail hypoplasia/dysplasia
Trace elements and TPN cholestasis
Decrease manganese and copper
Increase zinc
Trace elements and renal disease
Decrease chromium and selenium
Essential fatty acids
Linoleic acid
Linolenic acid
Essential amino acids
PVT TIM HaLL
Phenylalanine Valine Threonine Tryptophan Isoleucine Methionine Histidine Leucine Lysine
Conditionally essential amino acids
GG PATT
Glutamine Glycine Proline Arginine Taurine Tyrosine
Calcium:phosphorus ratio in TPN
1.3:1
What is the concern with giving high amounts of calcium and phosphorus in TPN?
Precipitation
Preterm breastmilk versus term breastmilk
Pretterm breastmilk has more: Protein Sodium Chloride Long chain polyunsaturated FAs (LC PUFAs)
It has less lactose
Hindmilk versus foremilk
Foremilk has higher lactose but lower fat
Both have the same amount of protein
Symptoms of essential fatty acid deficiency
Hemorrhagic dermatitis Skin atrophy Weakness Impaired vision Edema Hypertension Poor growth Thrombocytopenia
Triene:Tetraene Ratio (Hollman ratio)
T:T ratio >0.4 considered essential fatty acid deficiency
Characterized by a decrease of arachidonic acid and increase in mead’s acid (produced in excess during EFAD)
Goals for TPN
30-50% calories as fat
35-65% calories as carbohydrate
7-15% calories as protein
Whey:casein 80:20
Colostrum
Whey:casein 50:50
Mature human milk
Whey:casein 60:40
Preterm breastmilk, formulas
What is the most important amino acid that assists in the metabolism of fat?
Carnitine
What is the most prevalent fat in human milk?
Triglycerides
What are some whey proteins?
Alpha lactalbumin
Lactoferrin
Secretory IgA
Iron absorption
Human milk 50%
Preterm infants 33%
Human milk has less iron than formula but more is absorbed
Neonatal nitrogen absorption is
Normal
How does hyponatremia lead to poor growth
Inhibition of Na/H antiporter 
Human breast milk has more ____ than cows milk formula
Long chain polyunsaturated FAs
Carnitine
Cholesterol
DHA
Human breast milk has less ____ than cows milk formula
Protein
In human milk palmitic acid is present in the ___ Position which makes it more easily absorbed
Beta
Syndromes associated with vitamin B12 (cobalamin) deficiency
Methylmalonic acidemia
Folate
Vitamin B9
Effects of pasteurization on breastmilk
Fats, fat soluble vitamins, lactose all retained
Lymphocytes, Alk Phos, cytokines, growth factors, lipoprotein, lipases are destroyed
All of IgM is destroyed
Cholesterol in breastmilk
Doesn’t depend on maternal diet
