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CNSC Exam > Neonates > Flashcards

Neonates Flashcards

1
Q

a neonate is considered the first ___ days of life

A

28 days

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2
Q

premature infants usually need to start off with what type of artificial nutrition

A

parenteral nutrition

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3
Q

what are the indications to begin PN in neonates

A 
very low birth weight <1500 grams
severe respiratory distress syndrome
Volvulus
Meconium ileus
atresia
gastrochisis
severe Hirschprung's
enteric fistula 
diaphragmatic hernia
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4
Q

the time of starting PN on neonates depends on

A

their weight at birth

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5
Q

when is PN ideally started in Very Low Brith Weight Neonates

A

the first few hours of life

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6
Q

what type of PN is started in neonates

A

Vanilla/Starter/Base PN

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7
Q

how much grams of protein do neonates need when starting on PN

A

3-3.5g/kg/day

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8
Q

when is PN ideally started in low brith weight premature babies

A

within 24-48 hours

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9
Q

when can PN be stopped in premature babies

A

when adequate EN is established

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10
Q

what is the purpose of starter PN in premature infants

A

to provide immediate protein

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11
Q

what range of dextrose is given in base PN

A

5-10%

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12
Q

what range of amino acids is given in base PN

A

3-4%

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13
Q

why is heparin added to neonatal PN

A

there is not enough forward pressure in the baby’s lines this will prevent back flow and clotting

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14
Q

how much heparin is recommended for neonatal PN

A

0.25-1 unit/mL

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15
Q

what prevents clotting in the neonatal PN line

A

heparin 0.25-1 unit/mL

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16
Q

neonates require ______ fluid in the first 48 hours of life (about 70-90mL/kg/day) *it is better for the lungs

A

decreased fluid

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17
Q

over time, neonates will have _____ fluid needs from insensible losses associated with prematurity and phototherapy

A

increased

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18
Q

a preterm infant requires ____mL/kg/day of water

A

75-120mL/kg/day

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19
Q

a term infant requires ____mL/kg/day of water

A

60-120 mL/kg/day

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20
Q

an infant over 1 month old or 3-10 kg requires _____mL/kg/day of water

A

100mL/kg/day

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21
Q

how are total fluid needs calculated for neonatal TPN

A

Total fluid from calculation - fluid from drips - ILE volume- volume in feeds = volume left over for PN

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22
Q

Example: a 25 week gestational male is admit to the NICU. his brith weight is 515 grams, head circumference 21.5 cm and length is 30 cm. He is at the 4th percentile weight, 17% percentile HC and 14% tile length. On the Fenton curve his z-score is - 1.7. On his first day your hospital gives 70mL/kg/day of fluids, what is his hourly rate?

A

515 grams / 1000 = kg - .515 kg

.515 x 70mL/day = 36mL of fluid in 24 hours = 36/24= 1.5mL/kg/day

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23
Q

why do neonates usually have high ammonia and BUN when given PN

A

they have higher protein needs due to an immature urea cycle activity This is common)

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24
Q

when is adding insulin considered in neonatal PN

A

when BG consistently >200mg/dL (response is variable)

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25
Q

should insulin be added to PN in neonates

A

no you’ll have better control if given separately

26
Q

be careful when providing insulin to neonates as they are

A

very insulin sensitive

27
Q

premature neonates can be deficient in fatty acids within ___ days

A

3-7 days

28
Q

fatty acids are essential for neonates because t

A

they are essential for central nervous system development

29
Q

if ____ lipids are used for ILE they need to be given at a higher rate to meet essential fatty acid requirements

A

SMOF

30
Q

neonates can safely be at a GIR rate up to

A

14mg/kg/min

31
Q

Calculate the GIR of a patient getting 12g/kg/day of dextrose

A

GIR: a mg per kg per min
12 grams * 1000 mg = 12000mg
24 hrs , 1 hr= 60 min x 24 = 1440 min
12000/1440= 8.3 mg/kg/min

32
Q

how much sodium is required for preterm neonates in PN

A

2-5 meq/kg/day

33
Q

why do neonates require higher amounts of calcium and phos

A

bone growth

34
Q

___ and ____ are extremely important to prevent metabolic bone disease (they have lost out on bone mass accrual in their third trimester)

A

calcium and phos

35
Q

what is the optimal calcium to phos ratio to promote the greatest retain

A

2.6 to 1 mEq:mM or 1.7 to 1.0 mg:mg

36
Q

premature neonates may need a calcium to phosphorous ratio up to _____ especially if they were categorized as intrauterine growth restriction (they tend to reseed a little)

A

2:1 mEq/mM

37
Q

if a neonate is <2.5 kg how much PEDI trace is needed

A

2mL/kg/day

38
Q

if a neonate is greater than or equal to 2.5 kg how much PEDI trace is needed

A

5mL/day

39
Q

_____ is the precursor too glutathione. It acts as an antioxidant, allows for the reduction of methionine, and lowers pH to improve calcium and phos solubility

A

L-cysteine

40
Q

L-cystiene is not required unless

A

giving at least 4g/kg/day protein in PN

41
Q

how much carnitine is given in neonatal PN

A

5-10mg/kg/day

42
Q

_____ is added or given to neonates on PN to help better utilize triglycerides as it is required for transport of long chain fatty acids across the mitochondrial membrane for oxidation

A

Carnitine

43
Q

when is supplemental carnitine required for premature neonates on PN

A

<32-34 weeks gestational age

44
Q

_____ is added to neonatal PN to maintain catheter patency

A

heparin

45
Q

when are labs typically drawn in neonates when started on PN

A

after the first 24 hours of life

46
Q

a baby only has ____mL of blood/kg body weight

A

80 mL

47
Q

some electrolytes are naturally _____ in neonates especially potassium and phosphorous

A

higher

48
Q

what is the average potassium level in a neonate

A

4-6.2 Meq/L

49
Q

what is the average BUN in a neonate

A

4-15 mg/dL

50
Q

what is the average serum creatinine in a neonate

A

4-15 mg/dL

51
Q

what is the average phosphorous level in neonates

A

4.1-9 mmol/L

52
Q

what osmolarity is allowed In central PN

A

> 900mOsm/L

53
Q

pediatric patients can tolerate a slightly higher ___ in PN due to increased elasticity of their veins

A

osmolarity about 1,000 mOsm

54
Q

ILE in neonates is often y-site or piggy backed in order to

A

prevent phlebitis

55
Q

what factors affect calcium and phos solubility

A

amino acids (not enough)
calcium and phos concentration (if exceeds 55)
calcium salt form (gluconate is preferred over chloride)
pH: lower pH is more desirable
temperature; don’t let it get hot
order of mixing : ALWAYS ADD PHOS FIRST in pn and ALWAYS ADD CALCIUM LAST in pn

56
Q

what calcium salt form is preferred for mixing PN for optimal calcium-phosphorous solubility

A

calcium gluconate

57
Q

should pH be low or high to promote optimal calcium-phosphorous solubility

A

LOWER (can add L cysteine to lower_

58
Q

what can be added to PN to lower its pH for better ca-Phos solubility

A

L-cysteine amino acid

59
Q

when mixing PN _____ should always be added first and _____ should always be added last

A

PHOS FIRST

CALCIUM LAST

60
Q

on a calcium phosphorous curve does your calcium phos level want to be above or below the curve

A

BELOW THE CURVVE will decrease the risk of precipitation

CNSC Exam (32 decks)

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