Nutrition

Question 1

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

Answer 1

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

Question 2

Name the essential fatty acids

Answer 2

Linoleic acid

Alpha linolenic acid

Question 3

What is the Holman index?

Answer 3

Triene/Tetraene ratio

Used to diagnose essential fatty acid deficiency (>0.2)

Question 4

Primary carbohydrate in mother’s milk?

Answer 4

Lactose

Question 5

Whey:casein ratio in colostrum vs mature milk

Answer 5

Colostrum 80:20

Mature milk 55:45

Question 6

Differences between formula vs breast milk components

Answer 6

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

Question 7

Estimated fetal energy expenditure per day?

Answer 7

35-55 kcal/kg/day

Question 8

How are glucose and amino acids transported across placenta?

Answer 8

Glucose by facilitated diffusion

Amino acids by active transport

Question 9

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

Answer 9

100-130 kcal/kg/day

Question 10

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

Answer 10

85-95 kcal/kg/day

Question 11

Major protein sources in neonates

Answer 11

Whey and casein

Question 12

Protein content of preterm compared to term formula

Answer 12

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

Question 13

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

Answer 13

Glutamine

Question 14

Which amino acid is the precursor to nitric oxide?

Answer 14

Arginine

Question 15

Amino acids that are precursors to glucose?

Answer 15

Alanine, glutamate, aspartate

Question 16

Essential amino acids?

Answer 16

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

Question 17

Non essential amino acids?

Answer 17

Alanine
Aspartate
Glutamate
Serine
Asparagine

Question 18

Which 2 amino acids are low in amino acid solutions?

Answer 18

Cysteine, tyrosine

Question 19

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

Answer 19

4 kCal

0.16 g of nitrogen

Question 20

Where should you start protein in TPN and max?

Answer 20

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

Question 21

How much protein should be given enterally per day?

Answer 21

3.5 - 4.5 g/kg/day

Question 22

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

Answer 22

AA

DHA

Question 23

How many kCals does 1g of fat give?

Answer 23

9 kCal

Question 24

Most prevalent fatty acids in breast milk?

Answer 24

Oleic and palmitic acid

Question 25

What do linoleic and alpha linolenic acid give rise to?

Answer 25

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)

Question 26

Characteristics of essential fatty acid deficiency (EFAD)

Answer 26

Scaly dermatitis, alopecia, thrombocytopenia, bacterial infections, FTT

Question 27

What is used to diagnose EFAD?

Answer 27

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)

Question 28

Main source of glucose in breast milk?

Answer 28

Lactose

Question 29

How many kCals does 1g of carbs give?

Answer 29

3.4 kCal

Question 30

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

Answer 30

6g for each g of protein

Question 31

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

Answer 31

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

Question 32

Infants at risk for vitamin B12 deficiency?

Answer 32

Breast fed vegan mothers (no eggs or dairy)

Question 33

Infants at risk for folate deficiency?

Answer 33

Goat milk or evaporated milk

Question 34

What is Vitamin B12 deficiency associated with?

Answer 34

Methylmalonic acidemia and homocystinuria

Question 35

Lab findings with B12 and folic acid deficiency?

Answer 35

Megaloblastic macrocytic anemia with hypersegmented neutrophils

Question 36

How are water soluble vitamins transported across the placenta?

Answer 36

Active transport

Question 37

How are fat soluble vitamins transported across placenta?

Answer 37

Facilitated or simple diffusion

Question 38

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

Answer 38

Lower in breastfed

Question 39

Maternal meds that decrease vitamin K in breastmilk?

Answer 39

Anticonvulsants, warfarin, anti TB

Question 40

How does protein content change as breast milk matures?

Answer 40

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

Question 41

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

Answer 41

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

Question 42

Which hormones are in breast milk?

Answer 42

Cortisol and epidermal growth factor

Question 43

How is acrodermatitis enteropathica inherited?

Answer 43

Autosomal recessive

Question 44

Contraindications to maternal breastmilk/breast feeding

Answer 44

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

Question 45

Relative contraindications to maternal breastmilk

Answer 45

Premie with CMV positive mother | Maternal oral HSV lesions

Question 46

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

Answer 46

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

Question 47

Ideal Ca:Phos ratio in TPN?

Answer 47

Between 1.3:1 and 1.7:1 | Ratios <1:1 are not recommended

Question 48

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

Answer 48

Increase zinc | Decrease manganese and copper

Question 49

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

Answer 49

Decrease chromium and selenium

Question 50

Agent thought to cause TPN related cholestasis?

Answer 50

Phytosterols from soybean oil component in Intralipid

Question 51

During which GA is the peak fetal growth rate?

Answer 51

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

Question 52

Major pathway for fetal glucose utilization?

Answer 52

Glycolysis

Question 53

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

Answer 53

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

Question 54

Which hormones regulate growth: 1. Fetus 2. Placenta and fetus 3. Postnatal

Answer 54

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