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NICU Board Review > Nutrition > Flashcards

Nutrition Flashcards

1
Q

What is the difference between SGA vs IUGR?

A

SGA - BW <10% ile, can be constitutional and NOT NECESSARILY PATHOLOGIC

IUGR - fetus has not reached its growth potential due to pathological factors (ex: suboptimal in utero- placental environment, genetic factors (fetus) or maternal factors

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2
Q

Difference between whey and casein?

A

Whey has greater cysteine and less methionine than casein

Both are major protein sources in neonates

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3
Q 
What are whey to casein ratios in 
Colostrum?
Mature milk?
Casein based formulas?
Whey based formulas?
Preterm milk?
A

Whey:Casein

Colostrum 80:20
Mature milk 55:45
Casein based formulas 20:80
Whey based formulas 60:40

Whey is the liquid portion after the milk curdles - that is why BF babies poop after every feed (faster transit time due to whey)
Cysteine is a substrate for glutathione (higher with whey)

Curdles is casein (Lower solubility at pH 4.6)

Preterm milk 60:40

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4
Q

Who is at risk for Vit B12 deficiency?

Folate deficiency?

A

Risk of Vitamin B12 deficiency in breast-fed infants of vegetarian mothers who do not ingest eggs or dairy products

  • anemia
  • associated with methylmalonic acidemia and homocystinuria

 Risk of folic acid deficiency in infants fed only evaporated milk or goat’s milk

  • poor weight gain, anemia;
  • often coexists with iron deficiency
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5
Q

Risk for pyloric stenosis (PS) ?

A

If Mother has PS - 19% if boy, 7% if girl

If Father has PS - 5.5% if boy, 2.4% if girl

Sibling has PS - 4% if boy, 2.4% if girl

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6
Q

What are the fetal energy sources?

A

2/3 Maternal glucose (facilitated diffusion)
1/4 Placental lactate
Rest: Maternal amino acids (active transport)

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7
Q

How does TBW, ECF, ICF Na and Chloride content change w increasing GA?

A 
TBW ECF Na and Cl decrease
ICF increases (so does protein, fat, iron, Ca, Ph)
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8
Q

Name the Essential amino acids?

A

PVT TIM HALL

Phenylalanine
Valine
Threonine

Tyrosine
Isoleucine
Methionine

Histidine
Arginine (only if + nitrogen balance)
Leucine
Lysine

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9
Q

Which are critical fatty acids transferred across placenta to fetus?

A

Arachadonic acid and docosahexanoic acid (DHA)

Increases in 3rd trimester
Biomagnification-higher values in cord blood then maternal circulation
Critical for brain and eye development

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10
Q

Name the 2 essential fatty acids?

A

Linoleic and alpha linolenic acid

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11
Q

Which are the 2 most prevalent fatty acids in human milk?

A

Oleic

Palmitic acid

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12
Q

How long does it take to develop essential fatty acid deficiency?

A

Short delay of 3-7 days without providing linoleic and alpha linolenic acid

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13
Q

Neonate with scaly dermatitis, alopecia, thrombocytopenia and FTT. Dx?

A

Essential fatty acid deficiency

Diagnostic test:
Triene:tetraene ration>0.2 (might also describe as increase mead acid (triene) and decreased arachadonic acid (tetraenoic)
Can be prevented w as little as 0.5-1g/kg/day of intralipid

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14
Q

For a positive nitrogen balance how many grams of glucose must be provided per gram of protein?

A

6g glucose for 1g of protein

Carbs should provide 35-65% total cals
Fats 30-50%
Protein 7-15%

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15
Q

Tissue richest in long chain PUFAs?

A

Retina

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16
Q

Long chain polyunsaturated fatty acids are needed in the development of _____.

A

Brain
Neural tissue
Eyes

*specifically AA (arachidonic acid) and DHA

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17
Q

Which trace element in excess amount can cause neurotoxicity?

A

Manganese-deposition in basal ganglia leading to injury

Copper causes cirrhosis of liver

Chromium-renal failure

Zinc-decrease leukocyte and phagocyte activity

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18
Q

Which amino acid is needed for synthesis of glutathione?

A

Cysteine

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19
Q

What form of Vit D reflects a baby’s Vit D levels?

A

25 hydroxyvitamin D

Due to it’s longer half life

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20
Q

Folates are responsible for degradation of which amino acids

A

Homocysteine

Histidine

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21
Q

Folate is responsible for the synthesis of ________.

A

Purines
Pyrimidines
AA (serine and methionine)

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22
Q

Which GA is the highest growth rate?

A

32-36 weeks (peaks 31g/day)

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23
Q

What are the hormonal factors that affect growth?

A

Increase in GH and placental lactogen
Increase in glucose and lipid concentrations to stimulate fetal insulin production, fetal growth, adipose tissue, and restricts protein degradation

PL appears to be mediated by insulin-like growth factors

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24
Q

Estimated fetal energy expenditure?

A

35-55kcal/kg/day

Source 
Maternal glucose (2/3)-facilitated
Placental lactate (1/4)
Maternal AA (rest)-active
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25
Which AA are glucose precursors?
Alanine Glutamic acid Aspartic acid
26
What are neonatal caloric requirements?
120-150 kcal/kg/d To allow energy expenditure and growth
27
Which pancreatic proteases are decreased in PT and term babies
Trypsin’s and chymotrypsin
28
Describe fat digestion
(1) bile acid emulsification of fat globules (form micelles) (2) triglyceride hydrolysis by lipase (3) fatty acid transfer across intestinal mucosa PT and FT infants have decreased bile acids and pancreatic lipases
29
Which FA are absorbed directly into blood? How is total fat absorption not affected?
• Short and Medium-chain fatty acids are absorbed directly into the blood via intestinal capillaries and travel through the portal vein. Bile acids are not needed for short or medium chain fatty acid processing. • Despite reduced bile acids and pancreatic lipase, total fat malabsorption is minimized: • Lingual lipase, gastric lipase • Lipase in breast milk
30
Carbohydrate Metabolism in Neonate
Salivary & Pancreatic Amylase hydrolyzes starch, glycogen, and dextrin to glucose, maltose, and limit-dextrins: decreased secretion in newborn Glucosidases (lactase, sucrase, maltase, isomaltase) adult levels at 28 weeks* Lactase adult levels at 36 weeks Glucose transport across epithelium less efficient in newborn, especially PT Colonic salvage pathway: microflora ferments non-absorbed nutrients to energy-rich products that are ahsorhed hv the colon
31
Composition of human milk
Fat globules cholesterol and Phospholipids Micelles Cells Aqueous phase
32
Which is the primary carbohydrate in human milk?
Lactose Human milk oligosacharides Protein delivers 75% nitrogen Fat provides 50% of calories
33
What makes up mother’s milk?
• Lactose is primary carbohydrate Protein delivers 75% of nitrogen Fat provides 50% of calories
34
Major Fats in human milk
Fat Short-chain and Medium chain FA (mature Gi tract) Long chain FA, sphingomyelins and cholesterol (CNS myelination)
35
Fat breakdown in milk
Fat Greatest source of energy (50-60% caloric intake) • Highly variable component Transfer of fat soluble vitaminds Some fatty acids have antimicrobial properties Short Chain FA Maturation of the gastrointestinal tract Peripheral glucose utilization Médium chain FA Maturation of the gastrointestinal tract Long Chain FA Infant visual and neural development Antiviral and antiprotozoal effects Modulate the immune system Sphingomyelin Central nervous system myelination Neurobehavioral and visual development Cholestérol Decreases as lactation progresses
36
Major proteins in human milk
``` Casein-AA, Micelle has Ca/Ph Lactoferrin-iron binding, antimicrobial effect Secretory IGA- neutralizes toxins Mucins-binge pathogens Cytokins Growth factors ```
37
Preterm milk
Higher in protein (decreases over time)
38
Preterm and term milk changes over time?
Highest in protein in 1st week Then energy increases and fat
39
Immune Components that are HIGHER in preterm breast milk?
ß-defensin 1 (colostrum and mature milk) CD 14 receptor Transforming growth factor- ß2 (colostrum) • Lysozyme (equivocal)
40
Compared to human milk, what does formula have more of?
``` Compared to human milk, formula is higher in sodium, calcium, potassium, chloride, magnesium, phosphorus, and most amino acids ``` Formula is lower in cholesterol
41
What’s the role of prolactin and oxytocin in breastmilk production?
Prolactin is involved in synthesis (anterior pituitary) | Oxytocin in milk ejection (post pituitary)
42
Benefit of DMB over formula
Decrease risk for NEC
43
How does pasteurization affect donor milk?
Decrease in water soluble vitamins
44
Mother’s milk has which medical benefits compared to DBM?
Decreases in NEC, Late onset sepsis, feeding intolerance and ROP DBM decreases only NEC
45
Omegaven vs SMOF
``` SMOF 1/4 Soy bean 1/4 MCT 1/4 olive oil 1/4 Fish oil ``` Omegaven Fish oil
46
Describe the role of trace elements
Chromium: Role in insulin metabolism/glucose regulation Copper: Impt for Hb formation/Fe absorption/oxidative metabolism/myelination, Deficiency > anemia, neutropenia, osteoporosis, hypotonia, hair/skin depigmentation, poor weight gain Manganese: Role in enzymatic systems for bone growth, Role in enzyme activation (superoxide dismutase, pyruvate carboxylase) Selenium: Cofactor for glutathione peroxidase, preterm < term levels at birth, Deficiency > cardiomyopathy Zinc: Impt in gene expression, neurotransmission, apoptosis, metabolism of protein CHO & lipids; interferes with Cu absorption, Deficiency- rash, alopecia, diarrhea, FT, oral candidiasis/Staph, irritability, photophobia Congenital > Acrodermatitis Enteropathica- AR, abl absorption/transport (nail dysplasia/ocular findings) Acquired > Premature at risk, Maternal Def (assoc w/ IUGR), malabsorption Responds well to zinc supplementation, dermatitis resolves in days
47
Mothers own milk is better than donor breast milk T or F
True
48
How does PT formula compare to human milk?
Energy in PT matches Human milk Protein similar as early HM Carb content higher than human milk Fat matches Hm after first week of lactation
49
Lipase is not present in formula T or F
True
50
With hypoalbunemia, how does Ca get affected?
For every 1g of Albumin that is low your Ca drops by 0.8
51
Why are newborns predisposed to Vit K deficiency?
Initial lack of GI microorganism that synthesize vitamin K Immature newborn liver Maternal meds (anticonvulsants, warfarin and anti-tuberculosis meds)
52
Which vitamin deficiency is associated with pyruvate dehydrogenase complex defiency and maple syrup urine disease?
Vitamin B1 (thiamine)
53
Which is common vitamin b deficiency in homocystinuria?
Vitamin B6 (pyridoxine)
54
Which trace element deficiency is associated with anemia, neutropenia, depigmentation of hair and skin?
Copper
55
Which hormones augment breast growth and ductal system branching?
Estrogen and human placental lactogen
56
Which hormone stimulate milk production and which one promotes release?
Prolactin (from anterior pituitary) stimulate milk production Oxytocin (post pituitary) promotes milk release with smooth muscle contraction
57
Which trace elements should you adjust with cholestasis?
Decrease manganese and copper | Increase zinc
58
Which trace elements should you change in TPN with renal insufficiency?
Chromium and selenium
59
What component in PN is thought to contribute to cholestasis?
Phytosterols from soybean oil in intralipid
60
Reasons for decreased milk supply in exclusively pumping mothers of preterm babies
Ineffective pumping Tight breast shield Progesterone based contraception
61
Breast milk is screened for
HIV HTLV Hepatitis B & C Syphilis
62
Where is zinc predominately stored
Bone (40%) | Liver (25%)
63
Highest concentratuon of LCPUFA?
Brain (greatest in synapses) | Eyes (photoreceptor cells)
64
Pasturization decreases _____ in human milk
Eliminates HIV + CMV | Decreases lactoferrin, IgA, lysozymes
65
What are the three major roles of glucose in fetal life?
Acquired glucose has three major roles in fetal life: • Glycolysis (major pathway for fetal glucose utilization) • Carbon source (essential for fetal growth) Glycogen storage
66
When does lactase reach adult levels?
36 weeks gestation
67
What characteristics do preterms have that affect fat digestion and absorption?
Reduced bile acid secretion Decrease pancreatic lipase activity Total fat malabsorption is reduced bc of lingual lipase gastric lipase ans lipases in breastmilk->aid TG breakfown More easily digestible MCTs in BM however, (arachadonic acid and docosahexaenoic acid) not hydrolyzed or absorbed well
68
TEF Incidence and GA when abnormality occured?
1/4500 Often isolated, think vacterl Abnormality during 4 week of gestation Can p/w polyhydramnions prenatally
69
Which hormones induce breast growth and ductal’ system branching
Estrogen | Human placents’ lactigen
70
What hormone chsnges happen with breastfeeding at birth
Decrease estrogen Decrease progesterone Prolactin released (ant pituitarty) Oxytocin increases (helps with augmenting contractions and ejection of milk)
71
Optimal position for picc placement in UE and LE placement
UE between T3-T5 | LE T8-T10, if below L4 its peripheral
72
Which amino acid is NOT present in TPN?
Glutamine | Aspartate
73
Which are the essential amino acids present in preterms?
Cysteine Arginine Tyrosine
74
Which component of human milk us known for prebiotic effects? Ie to stimulate growth or activity of desired intestinal bacteria?
Human milk oligosaccharides (maintained despite pasteurization so present in donor milk) Promotes growth of select bifidobacteria which tighten mucosal ohysical barriers, compete w pathogenic bacteria and bind to toll-like receptors.
75
Describe role of lactoferrin
Proteolysis resistant iron binding glycoprotein in human milk Its bacteriocidal, antiviral and immunomodulating Adsorbs enteric iron and prevents pathogenic bacteria from obtaining iron needed for survival
76
Which component of human milk increases progressively after 6 months, aiding host defense of maturing infant?
Lysozyme Has bactericidal and antiinflammatory effects Cleaves bacterial cell walls of GP and GN bacteria
77
Dermatitis, mucositis, seizures, which vitamin deficiency?
B6 (pyridoxine) Associated with homocystinuria
78
Alopecia, dermatitis, scaling, seborrhea. Which vitamin deficiency?
Biotin Associated w biotinisaae deficiency, propionic acidemia and pyruvate dehydrogenase complex deficiency
79
Poor wound healing and bleeding gums. Vitamin deficiency?
Vitamin C (ascorbic acid) Associated with transient tyrosinemia
80
Vitamin B1 (thiamine) deficiency is assoc’s with _____?
Pyruvate dehydrogenase conpmex deficiency | MSUD
81
Vitamin B2 (riboflavin) deficiency us assoc’d with _____?
Glutaric acuduria type 1
82
Holder pasteurization process destroys which components of breastmilk
IgM
83
ECF:ICF in 24 weeker vs term. When do the volumes become equivalent?
Preterm 24 weeks 65:25 Term 45:35 3 months 35:35

NICU Board Review (19 decks)

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