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Nutrition > Neonatal and Infant Nutrition > Flashcards

Neonatal and Infant Nutrition Flashcards

1
Q

particular issues of infancy

A
  • Immature liver function – prone to jaundice
  • Immature kidney function – cannot dilute or concentrate urine
  • Immature gut - ‘leaky’ epithelium, lacking commensal flora
  • Immature immune system – naïve, less able to produce immune factors and discriminate bad from good (or indifferent) – prone to infection
  • Period of intense neurological growth and development
  • Immature blood clotting – neonatal coagulopathy
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2
Q

what is best to feed a neonate

A

breast milk

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3
Q

alternatives for breast milk

A

wet nurses

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4
Q

population of women who are most likely to initiate breast feeding

A
  • first time mother
  • mothers greater than 30 years old
  • higher social class scale
  • longer in education
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5
Q

socioeconomic and cultural factors that stop women from breast feeding

A
  • medical advice
  • maternal work demands
  • family pressures
  • commercial advertising
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6
Q

biological factors that stop women from breast feeding

A

infant size, development, growth, increased appetite, maternal lactational ability

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7
Q

major reasons women stop breast feeding at less than 1 week, 1 week - 4 months, greater than 4 months

A
  • less than a week: baby rejected milk
  • 1 week - 4 months: insufficient milk
  • greater than 4 months: mother returned to work
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8
Q

what is the trend of breast feeding as children get older

A

breast feeding starts higher at 1 week and decreases as child gets older

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9
Q

in countries with highest burden of breast feeding, how can a good percentage of the child death be prevented

A

by breast feeding the children

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10
Q

mean production of milk a day

A

700-850mL/day

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11
Q

how does the content of the milk change over time

A
  • colostrum: milk first produced and it has lots of protein, immunoglobulins, T and B cells
  • transitional milk
  • mature milk: begins watery to quench baby’s thirst but then gets more fatty by the end of breast feeding for nutrition
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12
Q

important content of breast milk

A

antibodies, immune cells, stem cells

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13
Q

length of time recommended for mother to breast feed

A

Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond
(the more a child suckles the breast, the more milk is produced)

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14
Q

women who are breastfeeding require how much energy and protein a day

A

8.10MJ/day = 1,940Kcal/day of energy
45.0g/day of protein
but as the baby age increases, there will be increased demands for protein and energy

intake is 60-80g per day for normal adults so actually no need to increase protein intake

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15
Q

does BMI affect breast milk production

A

no

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16
Q

in comparison to human milk, what does cow milk have increased amount of

A

cow milk has higher protein, sodium, and casein fraction with predominant whey protein (absent in human milk)

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17
Q

in comparison to cow milk, what does human milk have increased amounts of

A

lactose and whey fraction (absent whey protein)

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18
Q

what is positively related to weight gain during pregnancy

A

fat content of milk

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19
Q

what vitamins are adequate in breast milk and what substances are breast milk inadequate in

A

adequate - vitamin A and B6 (depending on maternal diet and nutritional status)
inadequate - vitamin D, iron, and zinc

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20
Q

importance of breast milk proteins

A
  • 285 different proteins have been identified in the proteome of human breast milk
  • Source of amino acids
  • Promote digestion and absorption of other milk nutrients
  • Have a role in defence against pathogens
  • Promote gut and immune maturation
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21
Q

main carbohydrate in breast milk and what is it made out of

A

lactose (glucose + galactose)

22
Q

why is lactase important

A

it is useful for hydrolysis of lactose on gut mucosal border before it can be digested

23
Q

when does lactose intolerance begin and why

A

at six months because of decline of lactase activity

24
Q

importance of breast milk fats

A
  • Breast milk ~ 40 g/l fat (= Cow’s milk) and provides ~50% of energy in milk
  • Promotes the accumulation of body fat (insulation and energy store)
  • Allows for absorption of fat soluble vitamins (A, D, E and K)
  • Provides essential fatty acids important in brain and eye development, healthy skin and hair and immunity
25
Q

when does the brain grow rapidly

A

from fetus to about 1.5 years

26
Q

two essential fatty acids in human milk

A

DHA (docosahexanoic acid) and EPA

27
Q

what is DHA made out of

A

DHA has 22 carbons with 6 double bonds

28
Q

importance of pregnancy to DHA

A
  • it promotes maternal DHA status
  • increases DHA content in breast milk
  • promotes fetal eye and brain development
29
Q

importance of DHA in infants and children

A
  • brain and eye development
  • improves visual acuity
  • promotes cognitive performance
30
Q

importance of DHA in children and adults

A

cardiovascular heart health

  • lowers triglycerides
  • increases HDL
  • maintains/lowers heart rate
  • modest reduction in blood pressure at higher doses
31
Q

importance of DHA in elderly

A 
brain and eye health and function
lower DHA in blood is associated with:
-cognitive decline
-higher risk of dementia
-higher risk of age related macular degneration
32
Q

US average intake of DHA vs. the recommended

A

US intake is very low at 30-80mg

recommended is 200mg

33
Q

how are the neonates micronutrients met

A

by drinking breast milk with the exception of vitamin D, zinc, and iron

34
Q

other milk components

A

LICIO

• Lactoferrin
– Plays a role in iron uptake and in immune defence
• Immunoglobulins (antibodies)
– Involved in immune defence (secretory IgA makes
up 10% of human breast milk protein)
• Cytokines (“hormones of the immune system”)
– Involved in immune defences
• Immune cells
– Involved in immune defences
• Oligosaccharides
– Involved in immune defences and in gut and immune maturation

35
Q

infant benefits of breast feeding

A
  • reduces risk of neonatal infections
  • promotes development of the immature gut
  • reduces risk of infant allergy
36
Q

what do bottle fed infants have an increased risk of getting

A

diarrhea and pneumonia

37
Q

downside to breast feeding

A

areas where HIV is prevalent, there is transmission of the virus through breast milk

38
Q

population with HIV mother that has highest risk of children being infected with HIV

A

the kids that drink mixed milk (mother’s milk + formula) then it’s the kids who drink mother’s milk then it’s those who are never breast fed

39
Q

why is there an increased risk of mortality and morbidity in children whose parents are HIV positive and decide not to breast feed

A

tends to be in undeveloped areas where formula is being mixed with contaminated water

40
Q

what are WHO’s recommendation for breastfeeding when anti retroviral drugs are available

A

exclusively breast feed the child for six months as long as baby and mother are on anti retroviral drugs

41
Q

what are WHO’s recommendation for breastfeeding when there are no anti retroviral drugs available and formula is affordable

A

completely avoid breast feeding

42
Q

what are WHO’s recommendation for breastfeeding when there are no anti retroviral drugs available and formula is not affordable or safe

A

breastfeed child but for the first few months of life

43
Q

what is the US CDC policy on breast feeding baby if mother is infected with HIV

A

DO NOT BREAST FEED!

44
Q

what are some breast feeding contraindications in infants

A

inborn errors of metabolism

  • galactosemia (unable to metabolize galactose)
  • congenital lactase deficiency
  • PKU
45
Q

what are some breast feeding contraindications in mothers

A
  • Maternal infections in which transmission occurs (HIV, Human t-cell lymphotrophic virus, cytomegalovirus, tuberculosis)
  • Mother receiving therapeutic drugs which are transferred into the breast milk and may harm the infant
  • Mother consuming other drugs (alcohol, opiates etc.)
46
Q

short term advantages of breast milk over formula

A
  • ↓ necrotising enterocolitis (6 x less)
  • ↓ diarrhoea (50% less)
  • ↓ gastrointestinal infections
  • ↓ respiratory infections
  • ↓ otitis media
  • ↓ risk of type 1 diabetes
47
Q

long term advantages of breast milk over formula

A
  • ↓ incidence inflammatory bowel disease
  • ↓ diastolic blood pressure
  • ↓ systolic blood pressure
  • ↓ risk of type 2 diabetes
  • ↓ risk of obesity
  • ↓ risk of CVD
  • ↓ severity and delayed onset of coeliac disease
48
Q

what does chronic nutritional deficiency lead to

A

failure to thrive

49
Q

causes of nutritional deficiency in industrialized places in preschool children aged 1-5years old

A

– Refusal of solids/high intake of liquids
– Intake of low-density foods (healthy diet)
– Behavioral eating problems
– Physical illness

50
Q

WHO charts of growth patterns for breast fed infants uses what measurements

A

head circumference, length/height, weight

51
Q

what changes in percentiles should be followed up according to the growth chart

A

if child has an increase or decrease by 2 percentiles

52
Q

early nutrition is important for calcium deposition so what happens if calcium needs are not met during early nutrition

A

there is a decreased threshold for increased risk of osteoporosis, falls, and fractures

Nutrition (15 decks)

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