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NICU Board Review Cards > Nutrition > Flashcards

Nutrition Flashcards

1
Q

What trace elements should be removed with cholestasis

A

manganese and copper

Inc zinc

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2
Q

What trace elements should be removed with renal dysfunction

A

Selenium and chromium

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3
Q

Which component of breastmilk serves as a prebiotic

A

Oligosaccharides

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4
Q

What proteins are primarily consumed by neonate

A

Whey
Casein

Whey: Casein ratio
Breastmilk 80:20
Colostrum 90:10
Mature milk 55:45

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5
Q

What are the essential AA (9)

A

methionine
threonine
tryptophan
branched-chain amino acids (valine, leucine, isoleucine)
phenylalanine
histidine
lysine

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6
Q

What are the essential FA- derivative

A

linoleic (LA)- Arachinodic

alpha-linolenic acid (ALA)- docosahexaenoic acid

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7
Q

How to diagnose essential fatty acid deficiency

A

triene:tetrene ratio (Holman index) with a value greater than 0.2 suggestive of biochemical EFAD,

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8
Q

It is essential for retinal and brain development

A

Long-chain polyunsaturated fatty acids (L-PUFA)

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9
Q

Contraindication to breastfeeding

A
  • 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

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10
Q

What are the glucogenic AA

A

Alanine
Glutamic acid
Aspartic acid

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11
Q

Fetal water content increases/ decreases with GA

  1. TBW
  2. Extracellular
  3. Intracellular
A
  1. Dec
  2. Dec
  3. INC
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12
Q

Energy requirements (kcal/kg/day) for preterm infants to achieve normal growth

A

Enterally fed: 100-130
IV fed: 85-95
ESPGHAN: 115-130

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13
Q

Protein content of preterm vs term formula

A

greater protein and whey:casein ratio in preterm formula

Whey has greater cystein

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14
Q

what is the largest AA concentration in human milk

A

Glutamine

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15
Q

Calories for every gram of
1. CHON
2. CHO
3. Fat

A
  1. 4
  2. 3.4
  3. 9
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16
Q

Protein requirements
- %total calories
- g/k/d

A
  • 7-15% of total calories
  • Start: 1.5-3 g/kg/day max 4g/kg/day
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17
Q

What is majority of dietary fat

A

Triglycerides

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18
Q

Prevalent FA in human milk

A

Oleic and palmitic acid
DHA- variable among women

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19
Q

Essential FA deficiency findings

A
  • Scaly dermatitis
  • alopecia
  • thrombocytopenia
  • susceptibility to bacterial infection
  • failure to thrive
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20
Q

What component of lipid emulsion is the source of ALA and LA

A

Soybean oil

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21
Q

what is the predominant carbohydrate in breastmilk

A

Lactose

Enhances absorption of Ca and Mg
promotes intestinal growth
In PT formula: some lactose replaced by corn syrup and short chain glucose polymers

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22
Q

CHO requirements: (GIR)
1. Preterm
2. Full Term

A
  1. 5-8 mg/kg/min
  2. 3-5 mg/kg/min

due to inc brain:body weight ratio, dec fat stores, inc total energy req

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23
Q

Which water soluble vitamin formed by precursor

A

Niacin
- from tryptophan

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24
Q

How are vitamins cross the placenta

A

Water soluble: active transport
Fat soluble: simple or facilitated diffusion

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25
What vitamin is breastfed infant of vegetarian mother who do not ingest eggs/dairy products need or lack
Vitamin B12
26
What vitamin deficiency for infants fed with evap or goats milk
folic acid
27
Vitamin deficiency presents with megaloblastic macrocytic anemia with hypersegmented neutrophils
Vitamin B12 Folate ## Footnote Vit B12 CHO and fat metab Folate coenzyme AA and nucleic acid metab
28
It is recommended concurrently with iron to protect from iron-induced hemolysis
Vitamin E ## Footnote Def: inc sensitivty of RBC to H2O2 and hemolysis; anemia and retic, thrombocytosis, neuro
29
Vitamin important for pulmonary epithelial growth and cellular diff (role in CLD)
Vitamin A (retinol) ## Footnote other: photophobia, conjunctivitis
30
what vitamin deficieny presents with fatigue, irritability, constipation, cardiac failure?
Vit B1 (thiamine) ## Footnote Associated with pyruvate dehydrogenase, maple syrup urine disease
31
Vitamin deficiency associated with glutaric aciduria type I
Vitamin B2 (riboflavin) ## Footnote failure to thrive, photophobia, blurred vision, dermatitis, mucositis
32
Vitamin def presents with hypochromic anemia, seizures
Vitamin B6 (pyridoxine) ## Footnote associated with homocytinuria
33
What trace element deficiency presents with anemia, neutropenia, osteoporosis, depigmented hair & skin, hypotonia and ataxia
Copper ## Footnote Critical for production of RBC
34
Where is iron predominantly absorbed
duodenum and proximal jejunum
35
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 ## Footnote Preterm infants may not have acrodermatitis enteropathica
36
It induces breast growth and ductal branching
Estrogen and HPL
37
Hormone establishing and maintaning lactation
Prolactin ## Footnote secreted by ant pit gland thoughout preg, estrogen and progesterone inhibit milk production
38
Mediates milk ejection
oxytocin ## Footnote via contraction of myoepithelium around milk ducts
39
When is IgA highest concentration in breast milk
Early breastmilk ## Footnote Colostrum inc amt of lymphocytes, macrophage and Ig
40
Electrolyte content of breastmilk vs cows milk
dec Na, Ca, K, Cl, Mg, P
41
Protein content of BM as it matures
Decreases | hind and foremilk has the same CHON Dec AA in BM vs formula
42
Which has greater amount of a. CHO b. Fats in foremilk vs hindmilk
a. CHO foremilk b. Fats- hindmilk
43
It is the most variable component of breastmilk
Fatty acid and TG ## Footnote provides lipases, greater LPUFA than formula
44
True or false: amount of cholesterol in breastmilk is independent of maternal diet
True - Has greater amount compared to formula ## Footnote Cholesterol needed for tissue growth, precusor bile salts and steroids
45
Premature BM vs term BM: Protein and electrolytes
Increased | However, inadequate (inc Ca, Phos, Vit D) Need human milk fortifier
46
What decreases with pasturization of BM
IgA Enzymes Water soluble vitamins Cellular activities Bacterial growth except Bacillus cereus Protein denaturalization
47
Between term and preterm formula which nutrient is reduced
Lactose (less in PT formula) | The rest are higher or greater
48
Difference of 10% vs 20% IL
10% - lower TG, - low calories/ml - higher lipid:TG ratio (impairs lipid lipase)
49
How many % of daily calories fats should provide
30-50% ## Footnote 20% IL ~ 2 kcal/ml
50
Nitrogen balance
Intake= protein intake *0.16 Lost= Urinary urea + est BM loss (4g) | Urinary urea= BUN*UO (mg/d) ## Footnote 0.16~ amt of N in every g of CHON
51
what is the role of lactoferrin
1. transports and absorb iron 2. bacteriostatic
52
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.
1. 120 to 130 kcal/kg/day 2. 110 kcal/kg/day 3. 110-120 kcal/kg/day
53
What is the optimal ratio for CHO:fats
60:40
54
Effect of excess glucose in TPN/diet
Increase lipogenesis- may further inc energy expenditure | Does not add lean muscle mass
55
Management for short bowel syndrome who does not tolerate feeding advancement
1. slower advancement 2. Slower delivery 3. switch to formula with higher fat content 4. Refeed ostomy output to mucous fistula ## Footnote rationale: if formula fed- higher osmotic load d/t corn syrup and lactose
56
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
57
Excessive weight loss in late preterm infants
more than 3% of birthweight at 24 hours or more than 7% by day 3. ## Footnote 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
58
It is a mineral needed for cell proliferation, growth, and brain development
Zinc ## Footnote 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
59
What are the risk factors for hypertriglycerdemia
1. ILE dose 2. ILE oil composition 3. pre-maturity 4. fetal growth restriction 5. low birthweight 6. sepsis 7. physiologic stress
60
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
61
What is the role of ILE in IFALD development
****IV phytosterols**** are key drivers in the development of IFALD ## Footnote **dietary phytosterols** have been shown to **protect** against HTG and hypercholesterolemia

NICU Board Review Cards (19 decks)

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