Nutrition

Question 1

The typical postnatal weight loss in the term infant is…..?

Answer 1

5% to 10% of birth weight

Question 2

preterm infants, this postnatal weight loss can be as much as……..?

Answer 2

15% of birth weight, with the nadir by 4 to 6 postnatal days and a regain to birth weight by 14 to 21days

Question 3

Goals for weight gain in term and preterm…??

Answer 3

15 to 20 g/kg/day for infants <2 kg

and 20 to 30 g/day for larger infants.

Question 4

Protein(g/kg/day) requirement…..?

Answer 4

3.5–4.5

Human milk - 1.4

Question 5

Carbohydrate (g/kg/day )

Answer 5

10-14

Question 6

Energy. Estimates suggest that preterm infants in a thermoneutral environment require approximately ….?

Answer 6

40 to 60 kcal/kg/day

Question 7

AAP has recommended that peripheral solutions maintain an osmolarity between …….?

Answer 7

300 and 900 mOsm/L

Question 8

Dextrose concentration administered through peripheral veins be limited to…?

Answer 8

≤12.5% dextros

Question 9

Infants with renal failure and those receiving extracorporeal membrane oxygenation (ECMO) therapy may require as high as dextrose …?

Answer 9

50% dextrose due to fluid restriction

Question 10

Protein source in PN …?

Answer 10

Crystalline amino acid solutions provide the nitrogen source in PN

Question 11

Dose of aminoven in PN ….

Answer 11

Infants with a birth weight <1,500 g are provided with 2 to 3 g/kg/day of amino acids shortly after birth.

Question 12

The IV fat emulsion used in neonates is a …?

Answer 12

soybean oil–based lipid emulsion with egg phospholipids (Intralipid 20)

Question 13

The soybean oil it also contains…………, which have been associated with the development of PN-associated cholestasis (PNAC)

Answer 13

phytosterols

Question 14

What is smog …?

Answer 14

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.

Question 15

A recent recommendation suggests that lipid be given at…….?

Answer 15

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.

Question 16

Requirement of sodium and potassium …?

Answer 16

Maintenance requirements are estimated at approximately 2 to 4 mEq/kg.

Question 17

Dose of vitamins for PN ??…?

Answer 17

No pediatric vitamin is available in India. Adult multivitamin (MVI) dose of 0.5 to 1 mL/kg is used

Question 18

Calcium-to-phosphorus ratios of approximately for PN. …?

Answer 18

1.3:1 to 1.7:1 by weight (1:1 to 1.3:1 M) are suggested

Question 19

Which minerals routinely reduced or omitted if impaired biliary excretion and/or cholestatic liver disease is present…?

Answer 19

As copper and manganese

are excreted in bile

Question 20

Which Trace elements Additional supplementation may be indicated in osteomyelitis outputs …?

Answer 20

zinc and copper

Question 21

When to give carnitine supplements in PN …?

Answer 21

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.

Question 22

About cystine in PN …?

Answer 22

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.

Question 23

Vitamin A supplements during PN …?

Answer 23

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

Question 24

Triglycerides Schedule for Nutrition Laboratory Monitoring during PN …?

Answer 24

Consider during initiation and/or advancement for extremely low-gestational-age or growth-restricted infants receiving parenteral lipid nutrition

Question 25

Calcium, phosphorus, alkaline phosphatase Schedule for Nutrition Laboratory Monitoring during PN …?

Answer 25

After 14 days of PN and as clinically indicated

[ also same for Alanine aminotransferase (ALT), direct bilirubin]

Question 26

Risk factors cholestasis during PN ….?

Answer 26

duration of PN and

more so the duration of fasting (lack of enteral feeding also produces bile inspissation and cholestasis

Question 27

When to expect Azotemia, hyperammonemia, and hyperchloremic metabolic acidosis ….?

Answer 27

These complications may occur, however, with amino acid intakes exceeding 4 g/kg/day

Question 28

Mechanism for development of Indirect hyperbilirubinemia in PN ….?

Answer 28

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

Question 29

gut priming volume of milk in ELBW …?

Answer 29

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

Question 30

Deficiency in preterm milk compared to term milk…?

Answer 30

Preterm HM does contain higher amounts of protein, sodium, chloride, and magnesium than term milk.

Question 31

Additionally which product needed inHMF ..?

Answer 31

multi-vitamin and iron supplement is typically administered daily.

Question 32

When to start HMF….

Answer 32

HMF; most units start adding HMF once the baby is on 100 mL/kg feeds

Question 33

Composition of preterm formulas…?

Answer 33

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

Question 34

Suggested Type of Infant Formula in biliary atresia….?

Answer 34

Semielemental, containing reduced LCT (~45%), with supplemented MCT (~55%)
[Impaired intraluminal digestion and absorption of long-chain fats]

Question 35

Suggested Type of Infant Formula Allergy to cow’s milk protein or soy protein….?

Answer 35

Extensively hydrolyzed protein or free amino acids

[Impaired digestion/utilization of intact protein]

Question 36

Suggested Type of Infant Formula Necrotizing enterocolitis…?

Answer 36

Preterm formula or semielemental formula, if indicated

[Impaired digestion]

Question 37

Suggested Type of Infant Formula Cystic fibrosis. …..?

Answer 37

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]