Nutrition Flashcards
The typical postnatal weight loss in the term infant is…..?
5% to 10% of birth weight
preterm infants, this postnatal weight loss can be as much as……..?
15% of birth weight, with the nadir by 4 to 6 postnatal days and a regain to birth weight by 14 to 21days
Goals for weight gain in term and preterm…??
15 to 20 g/kg/day for infants <2 kg
and 20 to 30 g/day for larger infants.
Protein(g/kg/day) requirement…..?
3.5–4.5
Human milk - 1.4
Carbohydrate (g/kg/day )
10-14
Energy. Estimates suggest that preterm infants in a thermoneutral environment require approximately ….?
40 to 60 kcal/kg/day
AAP has recommended that peripheral solutions maintain an osmolarity between …….?
300 and 900 mOsm/L
Dextrose concentration administered through peripheral veins be limited to…?
≤12.5% dextros
Infants with renal failure and those receiving extracorporeal membrane oxygenation (ECMO) therapy may require as high as dextrose …?
50% dextrose due to fluid restriction
Protein source in PN …?
Crystalline amino acid solutions provide the nitrogen source in PN
Dose of aminoven in PN ….
Infants with a birth weight <1,500 g are provided with 2 to 3 g/kg/day of amino acids shortly after birth.
The IV fat emulsion used in neonates is a …?
soybean oil–based lipid emulsion with egg phospholipids (Intralipid 20)
The soybean oil it also contains…………, which have been associated with the development of PN-associated cholestasis (PNAC)
phytosterols
What is smog …?
SMOF lipid 20% (Fresenius Kabi), a combination of soy, medium-chain triglycerides (MCTs), and olive and fish oils (Omegaven), has been tried,
but there is no definite decrease in PNAC.
SMOF has replaced Intralipid in India.
A recent recommendation suggests that lipid be given at…….?
1 to 2 g/kg/day during the first 4 days of life and then increased by 0.5 to 1 g/kg/day to a maintenance range of 3 to 4 g/kg/day.
Requirement of sodium and potassium …?
Maintenance requirements are estimated at approximately 2 to 4 mEq/kg.
Dose of vitamins for PN ??…?
No pediatric vitamin is available in India. Adult multivitamin (MVI) dose of 0.5 to 1 mL/kg is used
Calcium-to-phosphorus ratios of approximately for PN. …?
1.3:1 to 1.7:1 by weight (1:1 to 1.3:1 M) are suggested
Which minerals routinely reduced or omitted if impaired biliary excretion and/or cholestatic liver disease is present…?
As copper and manganese
are excreted in bile
Which Trace elements Additional supplementation may be indicated in osteomyelitis outputs …?
zinc and copper
When to give carnitine supplements in PN …?
infants requiring prolonged (e.g., >2 to 4 weeks) PN, a parenteral source of carnitine may be provided 10 mg/kg/day until enteral nutrition can be established.
About cystine in PN …?
Cysteine is not a component of current crystalline amino acid solutions because it is unstable over time and will form a precipitate
Supplementation with l-cysteine hydrochloride lowers the pH of the PN solution and may necessitate the use of additional acetate to prevent acidosis.
However, the lower pH also enhances the solubility of calcium and phosphorus and allows for improved mineral intake.
Cysteine is routinely supplemented in PN at a rate of approximately 30 to 40 mg/g protein.
Vitamin A supplements during PN …?
In some units, infants weighing <1,000 g at birth are supplemented with 5,000 IU vitamin A intramuscularly three times per week for the first 4 postnatal weeks, beginning in the first 72 hours
Triglycerides Schedule for Nutrition Laboratory Monitoring during PN …?
Consider during initiation and/or advancement for extremely low-gestational-age or growth-restricted infants receiving parenteral lipid nutrition
Calcium, phosphorus, alkaline phosphatase Schedule for Nutrition Laboratory Monitoring during PN …?
After 14 days of PN and as clinically indicated
[ also same for Alanine aminotransferase (ALT), direct bilirubin]
Risk factors cholestasis during PN ….?
duration of PN and
more so the duration of fasting (lack of enteral feeding also produces bile inspissation and cholestasis
When to expect Azotemia, hyperammonemia, and hyperchloremic metabolic acidosis ….?
These complications may occur, however, with amino acid intakes exceeding 4 g/kg/day
Mechanism for development of Indirect hyperbilirubinemia in PN ….?
Because free fatty acids can theoretically displace bilirubin from albumin-binding sites, the use of lipid emulsions during periods of severe hyperbilirubinemia has been questioned
gut priming volume of milk in ELBW …?
0.5 mL every 4 hours for infants, 800 g at birth).
Alternatively, a low volume per kilogram may be delivered (i.e., 10 to 20 mL/kg/day divided into eight aliquots for infants <1,250 g birth weight
Deficiency in preterm milk compared to term milk…?
Preterm HM does contain higher amounts of protein, sodium, chloride, and magnesium than term milk.
Additionally which product needed inHMF ..?
multi-vitamin and iron supplement is typically administered daily.
When to start HMF….
HMF; most units start adding HMF once the baby is on 100 mL/kg feeds
Composition of preterm formulas…?
Whey-predominant, taurine-supplemented protein source,
Carbohydrate mixtures of 40% to 50% lactose and 50% to 60% glucose polymers to compensate for preterm infants’ relative lactase deficiency
Fat mixtures containing approximately 40% to 50% MCTs, to compensate for limited pancreatic lipase secretion and small bile acid pools, as well as 50% to 60% long-chain TGs to provide a source of EFAs
Higher concentrations of protein, vitamins, minerals, and electrolytes to meet the increased needs associated with rapid growth
Suggested Type of Infant Formula in biliary atresia….?
Semielemental, containing reduced LCT (~45%), with supplemented MCT (~55%)
[Impaired intraluminal digestion and absorption of long-chain fats]
Suggested Type of Infant Formula Allergy to cow’s milk protein or soy protein….?
Extensively hydrolyzed protein or free amino acids
[Impaired digestion/utilization of intact protein]
Suggested Type of Infant Formula Necrotizing enterocolitis…?
Preterm formula or semielemental formula, if indicated
[Impaired digestion]
Suggested Type of Infant Formula Cystic fibrosis. …..?
Semielemental formula, containing reduced LCT (~45%), with supplemented MCT (~55%) or standard formula with pancreatic enzyme supplementation
[Impaired intraluminal digestion and absorption of long-chain fats]
