Nutrition Flashcards
What trace elements should be removed with cholestasis
manganese and copper
Inc zinc
What trace elements should be removed with renal dysfunction
Selenium and chromium
Which component of breastmilk serves as a prebiotic
Oligosaccharides
What proteins are primarily consumed by neonate
Whey
Casein
Whey: Casein ratio
Breastmilk 80:20
Colostrum 90:10
Mature milk 55:45
What are the essential AA (9)
methionine
threonine
tryptophan
branched-chain amino acids (valine, leucine, isoleucine)
phenylalanine
histidine
lysine
What are the essential FA- derivative
linoleic (LA)- Arachinodic
alpha-linolenic acid (ALA)- docosahexaenoic acid
How to diagnose essential fatty acid deficiency
triene:tetrene ratio (Holman index) with a value greater than 0.2 suggestive of biochemical EFAD,
It is essential for retinal and brain development
Long-chain polyunsaturated fatty acids (L-PUFA)
Contraindication to breastfeeding
- galactosemia
- a mother with HIV
- a mother with active HSV lesions on her breast
- symptomatic TB
- mothers who are using street drugs should not breastfeed
other drugs: lithium, methotrexate, radioactive agents
What are the glucogenic AA
Alanine
Glutamic acid
Aspartic acid
Fetal water content increases/ decreases with GA
- TBW
- Extracellular
- Intracellular
- Dec
- Dec
- INC
Energy requirements (kcal/kg/day) for preterm infants to achieve normal growth
Enterally fed: 100-130
IV fed: 85-95
ESPGHAN: 115-130
Protein content of preterm vs term formula
greater protein and whey:casein ratio in preterm formula
Whey has greater cystein
what is the largest AA concentration in human milk
Glutamine
Calories for every gram of
1. CHON
2. CHO
3. Fat
- 4
- 3.4
- 9
Protein requirements
- %total calories
- g/k/d
- 7-15% of total calories
- Start: 1.5-3 g/kg/day max 4g/kg/day
What is majority of dietary fat
Triglycerides
Prevalent FA in human milk
Oleic and palmitic acid
DHA- variable among women
Essential FA deficiency findings
- Scaly dermatitis
- alopecia
- thrombocytopenia
- susceptibility to bacterial infection
- failure to thrive
What component of lipid emulsion is the source of ALA and LA
Soybean oil
what is the predominant carbohydrate in breastmilk
Lactose
Enhances absorption of Ca and Mg
promotes intestinal growth
In PT formula: some lactose replaced by corn syrup and short chain glucose polymers
CHO requirements: (GIR)
1. Preterm
2. Full Term
- 5-8 mg/kg/min
- 3-5 mg/kg/min
due to inc brain:body weight ratio, dec fat stores, inc total energy req
Which water soluble vitamin formed by precursor
Niacin
- from tryptophan
How are vitamins cross the placenta
Water soluble: active transport
Fat soluble: simple or facilitated diffusion
What vitamin is breastfed infant of vegetarian mother who do not ingest eggs/dairy products need or lack
Vitamin B12
What vitamin deficiency for infants fed with evap or goats milk
folic acid
Vitamin deficiency presents with megaloblastic macrocytic anemia with hypersegmented neutrophils
Vitamin B12
Folate
Vit B12 CHO and fat metab
Folate coenzyme AA and nucleic acid metab
It is recommended concurrently with iron to protect from iron-induced hemolysis
Vitamin E
Def: inc sensitivty of RBC to H2O2 and hemolysis; anemia and retic, thrombocytosis, neuro
Vitamin important for pulmonary epithelial growth and cellular diff (role in CLD)
Vitamin A (retinol)
other: photophobia, conjunctivitis
what vitamin deficieny presents with fatigue, irritability, constipation, cardiac failure?
Vit B1 (thiamine)
Associated with pyruvate dehydrogenase, maple syrup urine disease
Vitamin deficiency associated with glutaric aciduria type I
Vitamin B2 (riboflavin)
failure to thrive, photophobia, blurred vision, dermatitis, mucositis
Vitamin def presents with hypochromic anemia, seizures
Vitamin B6 (pyridoxine)
associated with homocytinuria
What trace element deficiency presents with anemia, neutropenia, osteoporosis, depigmented hair & skin, hypotonia and ataxia
Copper
Critical for production of RBC
Where is iron predominantly absorbed
duodenum and proximal jejunum
It presents as:
* failure to thrive/ poor growth despite adequate calories
* alopecia
* diarrhea
* dermatitis/rash (crusted, erythematous involivng face, extremiites and anogenital areas)
* ocular changes
Zinc
Preterm infants may not have acrodermatitis enteropathica
It induces breast growth and ductal branching
Estrogen and HPL
Hormone establishing and maintaning lactation
Prolactin
secreted by ant pit gland thoughout preg, estrogen and progesterone inhibit milk production
Mediates milk ejection
oxytocin
via contraction of myoepithelium around milk ducts
When is IgA highest concentration in breast milk
Early breastmilk
Colostrum inc amt of lymphocytes, macrophage and Ig
Electrolyte content of breastmilk vs cows milk
dec Na, Ca, K, Cl, Mg, P
Protein content of BM as it matures
Decreases
hind and foremilk has the same CHON
Dec AA in BM vs formula
Which has greater amount of
a. CHO
b. Fats
in foremilk vs hindmilk
a. CHO foremilk
b. Fats- hindmilk
It is the most variable component of breastmilk
Fatty acid and TG
provides lipases, greater LPUFA than formula
True or false: amount of cholesterol in breastmilk is independent of maternal diet
True
- Has greater amount compared to formula
Cholesterol needed for tissue growth, precusor bile salts and steroids
Premature BM vs term BM:
Protein and electrolytes
Increased
However, inadequate (inc Ca, Phos, Vit D)
Need human milk fortifier
What decreases with pasturization of BM
IgA
Enzymes
Water soluble vitamins
Cellular activities
Bacterial growth except Bacillus cereus
Protein denaturalization
In preterm formula what nutrient is reduced
Lactose (less in PT formula)
The rest are higher or greater
Difference of 10% vs 20% IL
10%
- lower TG,
- low calories/ml
- higher lipid:TG ratio (impairs lipid lipase)
How many % of daily calories fats should provide
30-50%
20% IL ~ 2 kcal/ml
Nitrogen balance
Intake= protein intake *0.16
Lost= Urinary urea + est BM loss (4g)
Urinary urea= BUN*UO (mg/d)
0.16~ amt of N in every g of CHON
what is the role of lactoferrin
- transports and absorb iron
- bacteriostatic
What is energy intake recommendations for extremely-low-gestational-age neonates
1. enteral feeds alone
2. parental nutrition alone
3. receiving a combination of enteral feeds and parenteral nutrition.
- 120 to 130 kcal/kg/day
- 110 kcal/kg/day
- 110-120 kcal/kg/day
What is the optimal ratio for CHO:fats
60:40
Effect of excess glucose in TPN/diet
Increase lipogenesis- may further inc energy expenditure
Does not add lean muscle mass
Management for short bowel syndrome who does not tolerate feeding advancement
- slower advancement
- Slower delivery
- switch to formula with higher fat content
- Refeed ostomy output to mucous fistula
rationale: if formula fed- higher osmotic load d/t corn syrup and lactose
what is biochemical hallmark of refeeding syndrome
hypophosphatemia
- think of IUGR received early parenteral nutrition with high AA now with deranged electrolytes
- Mgt: temporarily dec AA
Excessive weight loss in late preterm infants
more than 3% of birthweight at 24 hours or more than 7% by day 3.
supplementation with small quantities of expressed milk, donor breast milk, or infant formula:
5-10 mL per feed on day 1
10-30 mL per feed afterwards
It is a mineral needed for cell proliferation, growth, and brain development
Zinc
chelates with cysteine and histidine to form zinc fingers, which are important for:
1. mRNA transcription
2. stimulates osteoblastic bone formation
3. involved in repair of oxidant lung injury
What are the risk factors for hypertriglycerdemia
- ILE dose
- ILE oil composition
- pre-maturity
- fetal growth restriction
- low birthweight
- sepsis
- physiologic stress
Based on the type of intralipid emulsion what is the dose to prevent essential FA deficiency
a. IL (100% soy bean): 0.5-1 mg/kg/day
b. SMOF (15% fish oil): 2.5-3 mg/kg/day
c. Omegaven (100% fish oil): 1g/kg/day
What is the role of ILE in IFALD development
IV phytosterols are key drivers in the development of IFALD
dietary phytosterols have been shown to protect against HTG and hypercholesterolemia
TPN mgt for babies at risk for refeeding syndrome
TPN lower AA 3 g/kg/day until phos becomes normal, Ca:Phos 1:1
