Lecture 5 Flashcards
What is the cut of that makes an infant a premie?
<37wks
Premies have weak immunity, what are they more susceptible to?
Hypoglycemica
- Low glycogen stores
- decrease in gluconeogenesis and glycogenolysis
- hyperinsulinemia
Poor temp control
-decrease subcutaneous fat
Necrotizing enterocolitis (NEC)
When you’re a premie, what decreases in nutritional stores do we see?
Glycogen Fat Protein Fat soluble vits Ca P Mg Trace minerals
How does rapid growth affect these nutritional stores?
Depletes them
Since premies are early, which physiological systems are still immature?
- [Low] of digestive enzymes
- GI motility and stomach capacity limited
- Coordinated suck/swallow/breath not developed until 32-34wks
- Immature renal function
What illnesses are premies susceptible to?
Necrotizing enterocolitis (NEC) Respiratory distress syndrome Bronchopulmonary dysplasia Hyperbilirubinemia Sepsis
What is NEC?
Inflammation of the bowel
-2wks old
How much energy do infants require?
108kcal/kg/day from birth to 6 months
98kcal/kg/day from 6-12months
What are the factors that influence calorie needs in infants?
Wt and growth rate Sleep/wake cycle (active needs more) Temp and climate Metabolic response to food Health status -fever needs more energy
What is the EER equation for infants?
TEE+ Energy deposition (energy deposited as protein and fat in growing tissues and organs)
Do infants have high or low basal metabolic rate?
Infants BMR is higher per kg than adults because babies have faster heart rate and respiration rate
When are growth rates the highest in infants?
Greatest during early months of life and then decrease as baby ages
What is the recommended protein intake for infants?
- 52g/kg/day from birth to 6mth
1. 2g/kg/day 7-12mth
When do infant protein needs increase?
When:
- infection
- illness
- prematurity
- inadequate energy intake
What can protein overload lead to in infants?
Puts stress on kidney and liver
Can cause diarrhea, fever, dehydration and acidosis
Why must carb intake be sufficient in infants?
TO spare protein from being used for energy
What % of breastmilk is carbs and what is the main carb in it?
39% carbs
90% of the carbs is lactose
what kind of fat does breastmilk contain?
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
What are the uses of fat in infants?
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
How good is infant water retention?
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
Does breastmilk provide enough water for infants?
Yes, offers enough to stay hydrated
-will drink more in hot weather
What role does Ca play in infants?
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
What can cause a loss of Na in infants?
Vomitting, diarrhea can cause loss of Na and water so its important to monitor Na
What happens when you have too much K?
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
What is the purpose of Zn in infants?
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
What is the mist frequent nutrient deficiency in infants?
Fe deficiency anemia
What are the potential causes of Fe deficiency anemia?
Non fortified formula or cow milk under 12months
Incidence increase with poor socioeconomic status
How do you decrease the risk of developing Fe deficiency anemia?
Incidences decrease with increased breastfeeding and Fe fortified formula and decrease cow milk <12 months
What are the signs and symptoms of Fe deficiency anemia?
Irritability Anorexia Poort wt gain Palenss Weakness/Fatigue Decreased resistance to infection Mental retardation and developmental delays
Do infants need fluoride?
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
What can excess F cause?
fluorosis
-Change in enamel that can lead to tooth discolouration’, staining and spots
At birth what does a nutrition assessment of infants look like?
Weight
Length
and receive and APGAR score
What is an APGAR score?
Range from 0-10
- 03: profound distress
- 4-6: moderate distress
- 7-10: normal adaptation
What does APGAR stand for?
Activity Pulse Grimace (reflex irritability Appearance (skin colour) Respiration
How do do an anthropometric assessment on infants?
Look at growth parameters like length, wt, and HC and compare to growth charts
What are the interpretation of growth data?
Wt for age
Length for age
Wt for length
HC for age
What is growth retardation a sign of?
Poor nutritional status
Nutrition intervention favours growth
-1st step to increase cals or protein
What is the main indicator for future health status?
Low BW <2500g/5.5lbs
VLBW<1500g/3.3lbs
ELBW <1000g/ 2.2lbs
How do we interpret BW for gestational age?
Preterm, term and post term
Birth weight:
- Small for gestational age <10th%
- LArge for gestational age >90%
When a baby is born what are the average parameters?
37-42wks
2500-3800g (5.5-8.5lbs)
47-54cm (18.5-21.5inch)
IN one day, how much wt can an infant lose?
Up to 7% of they birth weight within the first day of life
What is FFT and how to we characterize it?
Infant wt continues to decrease for more than 10 days
Weight is not regained to reach birth wet by 3 weeks
What are the characteristics for being small for gestational age?
BW <10th% Growth retardation Cant catchup well Mentally impaired Increased risk of respiratory distress
What are the predictors for being SGA?
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
Why do we use anthropometric data?
To assess growth and development over a period of time
-individuals measurements are competed to reference standards on a growth chart
How does one fail in a growth chart?
If they fall below to the percentiles
What is the growth chart used for premature infants?
Fenton growth chart
How do we interpret WHOs HC for age ?
Less than 3 and greater than 97th
-there is a potential health nutrition or developmental problems
- Small:stopped growing
- large: extra fluids
How do we interpret wt for age WHO chart?
less than 3% or greater than 99th
- small: underweight due to recent malnutrition, dehaydration or genetic
- large: child obesity
When do bread fed babies gain the most weight?
Fast wt gain in first 6months
Slower in second 6month than formula fed infants
How quick does it take newborns to double their birth weight?
4-6months
1yr to triple
Ultimately what does growth reflect?
Nutritional adequacy
Health status
Economic and environmental adequacy
How many gram/day should infant be gaining?
0-3: 20-30
3-6: 15-21
6-12: 10-13
What are the warning signs off growth difficulties when looking at growth charts?
Lack of weight gain or length gain
Plateau in weight, length or HC for >1month
Drop in weight without regain within a few weeks
When doing biochemical and clinical data what is our main nutrient that we look for?
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
What are the 3 stages of Fe deficiency?
- decrease in serum ferreting (Fe stores)
- decrease in serum Fe and increase in blood transferrin
- Decrease in Hemoglobin and hematocrit, and increase in erythrocyte protoporphyrin
When looking at dietary assessment, what do we start with?
Look at type of diet, quality and frequency of feeding Supplements Solid food intake Feeding behaviour Allergies
