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Neonatal > Neonatal Nutrition > Flashcards

Neonatal Nutrition Flashcards

1
Q

Foregut

A

Esophagus, stomach, duodenum, liver and pancreas

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2
Q

Midgut

A

Jejunum, ileum, ascending colon, and transverse colon

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3
Q

Hindgut

A

Descending colon, sigmoid colon, and rectum

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4
Q

GI development 6 wk gestation

A

Small intestine and colon herniate into the umbilical cord due to the rapid growth of the liver.

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5
Q

GI 8 to 11 wk gestation

A

Intestinal villi

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6
Q

GI 20 wk gestation

A

Abdominal cavity migrates into umbilical cord by rotating counterclockwise around superior mesenteric artery. The duodenum becomes fixed in the retroperitoneal position from the pylorus to the ligament of Treitz.

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7
Q

Contents of Amniotic Fluid

A

Water, and solute from maternal plasma. Enriched with hormones, cytokines, growth factors, nutrients and other plasma proteins.

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8
Q

Meconium Contents

A

Ingested amniotic fluid, lanugo, intestinal cells, bile salts, and pancreatic enzymes.

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9
Q

GI Development Phase I:

A

Embryonic organogenesis and primitive gut formation.

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10
Q

GI Development Phase II:

A

The GI tract becomes a tubular structure with the formation of villi, initiating the functional role of the intestinal epithelium.

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11
Q

GI Development Phase III

A

Rapid linear intestinal growth and cellular differentiation for specific physiologic functions

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12
Q

GI Development Phase IV

A

The intestinal microbiome is established immediately after birth from environmental exposures, including response to dietary factors present in human milk or formula.

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13
Q

GI Development Phase V

A

Refinement and maturation of structural intestinal development and mucosal immunity occur after weaning from breast or formula while introducing solid food

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14
Q

First layer of immune defense (GI)

A

acidic stomach environment, compounded with numerous digestive enzymes and bile salts

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15
Q

Biochemical and physiologic capacities for limited digestion and absorption are present by how many weeks gestation

A

28

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16
Q

Preterm infants have limited production of gut digestive enzymes and growth factors and decreased gut absorption of lipids due to low levels of what

A

pancreatic lipase, bile acids, and lingual lipase

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17
Q

Growth Goals for 24-32 weeks

A

15 to 20 g/kg/d

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18
Q

Growth Goals for 33-36 weeks

A

14-15 g/kg/d

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19
Q

Growth Goals for 37-40 weeks

A

7-9 g/kg/d

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20
Q

Growth Goals for 40 weeks to 3 months

A

30 g/d

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21
Q

How often should plasma triglycerides be monitored

A

After each increase in IV fat. , 200 indicates lipid tolerance

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22
Q

What does calcium, phosphorus and alkaline phosphatase assess for?

A

Metabolic bone disease and bone mineralization status. Decreased calcium and phos or increased alk phos indicate bone demineralization.

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23
Q

What is magnesium important for?

A

Plasma membrane excitability, energy storage, transfer, and production. Also calcium and bone homeostasis.

24
Q

What is Vitamin D level important for?

A

Assess for rickets, 25-OH vitamin D are usually normal while 1, 25=OH

25
Q

Term requirement of parenteral nutrition mL/kg and kcal/kg

A

100-120 mL/kg/day and 80 to 90 kcal/kg/day

26
Q

Term infant Protein requirements

A

1.5-2.5 g/kg/d

27
Q

How does early protein solutions preserve endogenous protein stores?

A

Limiting catabolism to ensure a positive nitrogen balance and promote?

28
Q

Calculation for protein in PN solution

A

gram/kg/day x wt = gram/day
(gram/day / mL/day) 100 = %AA

29
Q

Why is 20% lipids preferred over 10% lipids?

A

Fewer phospholipids per gram of fat which are associated with high triglyceride levels, increased cholesterol and low density lipoprotein levels.

30
Q

Protein requirements for term infant on enteral feed

A

2-2.5 g/kg/day

31
Q

Total protein in human milk

A

0.9 g per 100 mL

32
Q

Total fat content in human milk

A

3.5 g per 100 mL

33
Q

Term infant carbohydrate requirements on enteral feeds

A

40% or 8 to 12 g/kg/d

34
Q

The use of larger volumes of fluid to prevent weight loss in a preterm infant can result in what?

A

Development of PDA, cerebral IVH, BPD, and NEC

35
Q

Extremely preterm infants require how many kcals for weight maintenance and growth?

A

M- 50 to 70 kcal/kg/d
G- addition 45-70 kcal/kg/d

36
Q

Goal calories for full PN in the extremely preterm infants?

A

90 to 100 kcal/kg/d

37
Q

What does an increase in the enteral protein to energy ratio increase?

A

Lean body mass and decrease fat deoposition

38
Q

What are the symptoms of metabolic overload with protein intakes greater than 5 g/kg/day?

A

Irritability, late metabolic acidosis, azotemia, edema, fever, lethargy, diarrhea, elevated BUN and poor developmental outcomes.

39
Q

What are sources of omega-6 fatty acids and essential to neurologic and vision development?

A

Long-chain polyunsaturated fatty acids like arachidonic acid and docosahexaenoic acid

40
Q

What does carnitine help with, with preterm infants?

A

Increases tolerance of IV Lipids

41
Q

Carbohydrate requirements for preterm infants (Dextrose)

A

10-15 g/kg/day

42
Q

How do the kidneys contribute to acidosis?

A

Failing to reabsorb HCO3 and to excrete hydrogen.

43
Q

When does peak fetal accretion of minerals occur?

A

Third trimester

44
Q

How much parenteral calcium do preterm infants need?

A

60-90 mg/kg/day

45
Q

What is the ratio of calcium to phosphorus?

A

1.7-2:1

46
Q

What is different about preterm milk and term milk?

A

Higher in cholesterol, phospholipids, and very long chain PUFAs. Higher sodium and chloride levels,

47
Q

How does milk change when it is froze?

A

Reduces antioxidant properties, rupturing the fat globules, altering the casein component of the protein and decreasing the fat and caloric content.

48
Q

What is the leading whey protein in milk?

A

z-lactalbumin

49
Q

What are oligosaccharides?

A

Glucose polymers that function as prebiotics by promoting the development of intestinal bacterial flora and inhibiting bacterial adhesion.

50
Q

Why should powdered infant formula be avoiding in the hospital?

A

Cronobactersakazakii infection

51
Q

Which vitamins are fat soluble?

A

Vitamin A, D, E, and K

52
Q

Which vitamins are water soluble?

A

Vitamin B complex and C

53
Q

What infants are born with transient hypomagnesemia?

A

Infants born to diabetic mothers

54
Q

Nutrition required for BPD

A

High calories, low fluid

54
Q

What does Omega-3 fatty acid play a role in?

A

Visual and neurological development and immune function, protecting the body from inflammation and decreasing the risk for many chronic degenerative diseases.

Neonatal (4 decks)

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