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FN 2241 > Lecture 5 > Flashcards

Lecture 5 Flashcards

1
Q

What is the cut of that makes an infant a premie?

A

<37wks

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2
Q

Premies have weak immunity, what are they more susceptible to?

A

Hypoglycemica

  • Low glycogen stores
  • decrease in gluconeogenesis and glycogenolysis
  • hyperinsulinemia

Poor temp control
-decrease subcutaneous fat

Necrotizing enterocolitis (NEC)

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3
Q

When you’re a premie, what decreases in nutritional stores do we see?

A 
Glycogen
Fat
Protein
Fat soluble vits
Ca
P
Mg
Trace minerals
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4
Q

How does rapid growth affect these nutritional stores?

A

Depletes them

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5
Q

Since premies are early, which physiological systems are still immature?

A
  • [Low] of digestive enzymes
  • GI motility and stomach capacity limited
  • Coordinated suck/swallow/breath not developed until 32-34wks
  • Immature renal function
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6
Q

What illnesses are premies susceptible to?

A 
Necrotizing enterocolitis (NEC) 
Respiratory distress syndrome
Bronchopulmonary dysplasia
Hyperbilirubinemia 
Sepsis
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7
Q

What is NEC?

A

Inflammation of the bowel

-2wks old

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8
Q

How much energy do infants require?

A

108kcal/kg/day from birth to 6 months

98kcal/kg/day from 6-12months

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9
Q

What are the factors that influence calorie needs in infants?

A 
Wt and growth rate
Sleep/wake cycle (active needs more)
Temp and climate
Metabolic response to food
Health status 
-fever needs more energy
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10
Q

What is the EER equation for infants?

A

TEE+ Energy deposition (energy deposited as protein and fat in growing tissues and organs)

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11
Q

Do infants have high or low basal metabolic rate?

A

Infants BMR is higher per kg than adults because babies have faster heart rate and respiration rate

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12
Q

When are growth rates the highest in infants?

A

Greatest during early months of life and then decrease as baby ages

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13
Q

What is the recommended protein intake for infants?

A
  1. 52g/kg/day from birth to 6mth

1. 2g/kg/day 7-12mth

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14
Q

When do infant protein needs increase?

A

When:

  • infection
  • illness
  • prematurity
  • inadequate energy intake
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15
Q

What can protein overload lead to in infants?

A

Puts stress on kidney and liver

Can cause diarrhea, fever, dehydration and acidosis

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16
Q

Why must carb intake be sufficient in infants?

A

TO spare protein from being used for energy

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17
Q

What % of breastmilk is carbs and what is the main carb in it?

A

39% carbs

90% of the carbs is lactose

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18
Q

what kind of fat does breastmilk contain?

A

short, medium and long chain fatty acids

-short and med are easier to digest and use because there is more breakdown that must occur in long chain fatty acids

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19
Q

What are the uses of fat in infants?

A 
Develop CNS
Maintain Body temp
Cushion for vital organs
Concentrated source of energy
Flavour and satiety
Provides essential fatty acids
Vehicle for fat soluble vitamin absorption
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20
Q

How good is infant water retention?

A

Lose water easily and there is a larger % of water in extra-cellular and vascular spaces in infants than adults

-infants have a greater % of water in their bodies than adults

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21
Q

Does breastmilk provide enough water for infants?

A

Yes, offers enough to stay hydrated

-will drink more in hot weather

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22
Q

What role does Ca play in infants?

A

Since infants undergo rapid skeletal growth and mineralization they need rapid increase in Ca content
-but if there is an excess, phosphorus can cause Ca loss from bones

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23
Q

What can cause a loss of Na in infants?

A

Vomitting, diarrhea can cause loss of Na and water so its important to monitor Na

24
Q

What happens when you have too much K?

A

Electrolyte inside cells and crucial to heart funciton

Excess can cause lower heart rate and abnormal heart rhythm and can cause that heart to stop

25
Q

What is the purpose of Zn in infants?

A

Responsible for activating growth

  • since infants growth quickly, Zn needs are higher
  • [Zn] in breastmilk is low but its adequate
  • [Zn] in formula is low
26
Q

What is the mist frequent nutrient deficiency in infants?

A

Fe deficiency anemia

27
Q

What are the potential causes of Fe deficiency anemia?

A

Non fortified formula or cow milk under 12months

Incidence increase with poor socioeconomic status

28
Q

How do you decrease the risk of developing Fe deficiency anemia?

A

Incidences decrease with increased breastfeeding and Fe fortified formula and decrease cow milk <12 months

29
Q

What are the signs and symptoms of Fe deficiency anemia?

A 
Irritability
Anorexia
Poort wt gain
Palenss
Weakness/Fatigue
Decreased resistance to infection
Mental retardation and developmental delays
30
Q

Do infants need fluoride?

A

For 6-12months
-Breastfed infants dont need F supplement if mom is dreaming fluorinated water

Formula should have 0.25mg/day supplement is they are getting:

  • Read to use formal made with water that has <0.3ppm of F
  • Or concentrate or powder that is made with water that has <0.3ppm of F
31
Q

What can excess F cause?

A

fluorosis

-Change in enamel that can lead to tooth discolouration’, staining and spots

32
Q

At birth what does a nutrition assessment of infants look like?

A

Weight
Length
and receive and APGAR score

33
Q

What is an APGAR score?

A

Range from 0-10

  • 03: profound distress
  • 4-6: moderate distress
  • 7-10: normal adaptation
34
Q

What does APGAR stand for?

A 
Activity
Pulse
Grimace (reflex irritability
Appearance (skin colour)
Respiration
35
Q

How do do an anthropometric assessment on infants?

A

Look at growth parameters like length, wt, and HC and compare to growth charts

36
Q

What are the interpretation of growth data?

A

Wt for age
Length for age
Wt for length
HC for age

37
Q

What is growth retardation a sign of?

A

Poor nutritional status
Nutrition intervention favours growth
-1st step to increase cals or protein

38
Q

What is the main indicator for future health status?

A

Low BW <2500g/5.5lbs
VLBW<1500g/3.3lbs
ELBW <1000g/ 2.2lbs

39
Q

How do we interpret BW for gestational age?

A

Preterm, term and post term

Birth weight:

  • Small for gestational age <10th%
  • LArge for gestational age >90%
40
Q

When a baby is born what are the average parameters?

A

37-42wks
2500-3800g (5.5-8.5lbs)
47-54cm (18.5-21.5inch)

41
Q

IN one day, how much wt can an infant lose?

A

Up to 7% of they birth weight within the first day of life

42
Q

What is FFT and how to we characterize it?

A

Infant wt continues to decrease for more than 10 days

Weight is not regained to reach birth wet by 3 weeks

43
Q

What are the characteristics for being small for gestational age?

A 
BW <10th%
Growth retardation 
Cant catchup well
Mentally impaired
Increased risk of respiratory distress
44
Q

What are the predictors for being SGA?

A

Maternal factors
-malnutrition, substance abuse

Factors involving the uterus and placenta
-infection, decreased blood flow

Factors related to the developing baby
-infection, birth defect, multiples

45
Q

Why do we use anthropometric data?

A

To assess growth and development over a period of time

-individuals measurements are competed to reference standards on a growth chart

46
Q

How does one fail in a growth chart?

A

If they fall below to the percentiles

47
Q

What is the growth chart used for premature infants?

A

Fenton growth chart

48
Q

How do we interpret WHOs HC for age ?

A

Less than 3 and greater than 97th
-there is a potential health nutrition or developmental problems

  • Small:stopped growing
  • large: extra fluids
49
Q

How do we interpret wt for age WHO chart?

A

less than 3% or greater than 99th

  • small: underweight due to recent malnutrition, dehaydration or genetic
  • large: child obesity
50
Q

When do bread fed babies gain the most weight?

A

Fast wt gain in first 6months

Slower in second 6month than formula fed infants

51
Q

How quick does it take newborns to double their birth weight?

A

4-6months

1yr to triple

52
Q

Ultimately what does growth reflect?

A

Nutritional adequacy
Health status
Economic and environmental adequacy

53
Q

How many gram/day should infant be gaining?

A

0-3: 20-30
3-6: 15-21
6-12: 10-13

54
Q

What are the warning signs off growth difficulties when looking at growth charts?

A

Lack of weight gain or length gain
Plateau in weight, length or HC for >1month
Drop in weight without regain within a few weeks

55
Q

When doing biochemical and clinical data what is our main nutrient that we look for?

A

Fe status is assess to help determine signs and symptoms of malnutrition
-increased risk in Fe deficiency >6months because of possible switch to cow milk or solid food

56
Q

What are the 3 stages of Fe deficiency?

A
  1. decrease in serum ferreting (Fe stores)
  2. decrease in serum Fe and increase in blood transferrin
  3. Decrease in Hemoglobin and hematocrit, and increase in erythrocyte protoporphyrin
57
Q

When looking at dietary assessment, what do we start with?

A 
Look at type of diet, quality and frequency of feeding
Supplements 
Solid food intake
Feeding behaviour
Allergies

FN 2241 (12 decks)

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