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Neo Board Review > Nutrition > Flashcards

Nutrition Flashcards

1
Q

How does total body water change through pregnancy in the fetus?

A

Decreases slowly until term (also extracellular water, sodium and chloride decrease)
Body fat, intracellular water, protein, calcium, phosphorous, magnesium, iron are slowly increasing during the first half of gestation and accelerates thereafter until term

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2
Q

Name the essential fatty acids

A

Linoleic acid

Alpha linolenic acid

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3
Q

What is the Holman index?

A

Triene/Tetraene ratio

Used to diagnose essential fatty acid deficiency (>0.2)

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4
Q

Primary carbohydrate in mother’s milk?

A

Lactose

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5
Q

Whey:casein ratio in colostrum vs mature milk

A

Colostrum 80:20

Mature milk 55:45

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6
Q

Differences between formula vs breast milk components

A

Formula is higher in Na, calcium, K, Cl, Mag, Phos and amino acids.
Lower in cholesterol

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7
Q

Estimated fetal energy expenditure per day?

A

35-55 kcal/kg/day

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8
Q

How are glucose and amino acids transported across placenta?

A

Glucose by facilitated diffusion

Amino acids by active transport

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9
Q

Recommended calorie needs for an enterally fed preterm neonate to achieve normal growth rates?

A

100-130 kcal/kg/day

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10
Q

Recommended calorie needs for a preterm neonate fed via IV/TPN to achieve normal growth rate?

A

85-95 kcal/kg/day

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11
Q

Major protein sources in neonates

A

Whey and casein

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12
Q

Protein content of preterm compared to term formula

A

Preterm formula has higher protein content and higher whey:protein ratio

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13
Q

Which amino acid is present in the largest concentration in breast milk?

A

Glutamine

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14
Q

Which amino acid is the precursor to nitric oxide?

A

Arginine

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15
Q

Amino acids that are precursors to glucose?

A

Alanine, glutamate, aspartate

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16
Q

Essential amino acids?

A 
Branched chain: valine, isoleucine, leucine
Lysine
Phenylalanine
Methionine
Histidine
Tryptophan
Threonine
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17
Q

Non essential amino acids?

A 
Alanine
Aspartate
Glutamate
Serine
Asparagine
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18
Q

Which 2 amino acids are low in amino acid solutions?

A

Cysteine, tyrosine

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19
Q

How many kCals and nitrogen does 1g of protein give?

A

4 kCal

0.16 g of nitrogen

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20
Q

Where should you start protein in TPN and max?

A

1.5 - 3 g/kg/day, max of 4

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21
Q

How much protein should be given enterally per day?

A

3.5 - 4.5 g/kg/day

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22
Q

Fatty acids that are critical for development of brain and eyes?

A

AA

DHA

23
Q

How many kCals does 1g of fat give?

A

9 kCal

24
Q

Most prevalent fatty acids in breast milk?

A

Oleic and palmitic acid

25
Q

What do linoleic and alpha linolenic acid give rise to?

A

Linoleic acid gives rise to AA via n-6 pathway (uses omega 6)
Alpha linolenic acid gives rise to DHA via n-3 pathway (uses omega 3)

26
Q

Characteristics of essential fatty acid deficiency (EFAD)

A

Scaly dermatitis, alopecia, thrombocytopenia, bacterial infections, FTT

27
Q

What is used to diagnose EFAD?

A

Triene : tetraene ratio >0.2, also known as Holman’s index
Mead acid : arachidonic acid (same name)
Mead acid is formed by omega 9 (when omega 3 and 6 are deficient)

28
Q

Main source of glucose in breast milk?

A

Lactose

29
Q

How many kCals does 1g of carbs give?

A

3.4 kCal

30
Q

How many grams of carbs should be given for each gram of protein to maintain a positive nitrogen balance?

A

6g for each g of protein

31
Q

What are the glucose utilization rates for premature and term infants?

A

Premature: 5-8 mg/kg/min
Term: 3-5 mg/kg/min

32
Q

Infants at risk for vitamin B12 deficiency?

A

Breast fed vegan mothers (no eggs or dairy)

33
Q

Infants at risk for folate deficiency?

A

Goat milk or evaporated milk

34
Q

What is Vitamin B12 deficiency associated with?

A

Methylmalonic acidemia and homocystinuria

35
Q

Lab findings with B12 and folic acid deficiency?

A

Megaloblastic macrocytic anemia with hypersegmented neutrophils

36
Q

How are water soluble vitamins transported across the placenta?

A

Active transport

37
Q

How are fat soluble vitamins transported across placenta?

A

Facilitated or simple diffusion

38
Q

Vitamin K levels in breastfed infants compared to cow’s milk?

A

Lower in breastfed

39
Q

Maternal meds that decrease vitamin K in breastmilk?

A

Anticonvulsants, warfarin, anti TB

40
Q

How does protein content change as breast milk matures?

A

Decreases

Whey:casein ratio goes from 80:20 in colostrum to 55:45 in mature milk

41
Q

Protein, carbs and fat concentrations in foremilk vs hind milk?

A

Protein: same
Carbs (lactose): greater in foremilk
Fats: greater in hind milk [to remember: fat is ‘fatty’ so its left be’hind’

42
Q

Which hormones are in breast milk?

A

Cortisol and epidermal growth factor

43
Q

How is acrodermatitis enteropathica inherited?

A

Autosomal recessive

44
Q

Contraindications to maternal breastmilk/breast feeding

A 
Maternal HIV
HSV lesions on breast
Active TB (positive PPD and CXR)
Breast abscess
Galactosemia
Drugs (cocaine, lithium, PCP, methotrexate, radioactive agents)
45
Q

Relative contraindications to maternal breastmilk

A

Premie with CMV positive mother

Maternal oral HSV lesions

46
Q

In preterm vs term formula, what is the one thing that is lower?

A

Lactose is reduced in preterm formula
All other components are higher in preterm formula: fat, medium chain TF, protein, whey, minerals (calcium, phos, iron), vitamins, trace elements. Also has greater options to increase caloric density

47
Q

Ideal Ca:Phos ratio in TPN?

A

Between 1.3:1 and 1.7:1

Ratios <1:1 are not recommended

48
Q

What trace element changes should be made to TPN in cases of TPN cholestasis?

A

Increase zinc

Decrease manganese and copper

49
Q

What trace element changes should be made to TPN in renal insufficiency?

A

Decrease chromium and selenium

50
Q

Agent thought to cause TPN related cholestasis?

A

Phytosterols from soybean oil component in Intralipid

51
Q

During which GA is the peak fetal growth rate?

A

Mid 30s (33-35)
Growth rate declines with inc plurality
Monochorionic twins growth rate < than dichorionic

52
Q

Major pathway for fetal glucose utilization?

A

Glycolysis

53
Q

Activity leading to greatest energy expenditure/day in a neonate?

A

Resting metabolic energy, 40-60 kcals/kg/day

54
Q

Which hormones regulate growth:

  1. Fetus
  2. Placenta and fetus
  3. Postnatal
A
  1. Placental lactogen regulates placental supply of nutrients for fetus
  2. IGF-1 and 2 regulate placental and fetal growth
  3. Growth hormone and thyroid hormones for postnatal growth

Neo Board Review (16 decks)

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