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Neonatology Boards > Nutrition > Flashcards

Nutrition Flashcards

1
Q

Only bacteria not killed by Holder pasteurization

A

B. cereus

“you cant be serious!”

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2
Q

Decreases with advancing GA and birthweight

A
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3
Q

Increase with advancing GA and birthweight

A
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4
Q

Fetal growth by GA

A
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5
Q

SGA vs IUGR

A
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6
Q

Estimated fetal energy expenditure

A

35-55 kcal/kg/day

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7
Q

Fetal energy sources

A
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8
Q

multiple gestation and fetal growth

A
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9
Q

neonatal caloric requirement

A

120-150 kcal/kg/day to balance energy expenditure and allow for proper growth

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10
Q

amino acids that are glucose precursors

A

Alanine
Glutamic acid
Aspartic acid

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11
Q

Essential amino acids

A
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12
Q

protein digestion

A
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13
Q
A

essential fatty acid deficiency:
- dermatitis (dry, scaly, snowflake)
- alopecia
- thrombocytopenia
- susceptibility to bacterial infection
- failure to thrive

triene:tetraene ratio of >0.2 is diagnostic
Mead (incr) : arachidonic acid ratio (dec)

can be prevented with as little as 0.5-1.0g/kg/day lipid

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14
Q

water soluble vitamins

A

vitamin B complex, vitamin C

not formed by precursors (except niacin from tryptophan)
dialy intake required to prevent deficiences
does not accumulate in the body (except vitamin B12)
most cross placenta by active transport

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15
Q

fat soluble vitamins

A

ADEK

synthesized from precursors
daily intake not typically required except in specific circumstances (ex. CF)
not easily excreted so can accumulate in the body and has potential for toxicity
placental transfer by simple or facilitated diffusion

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16
Q

Vitamin A
Retinol

A
  • important for pulmonary epithelial growth and cellular differentiation
  • deficiency may play a role in development of CLD

Deficiency:
- photophobia
- conjunctivitis
- abnormal epiphyseal bone formation and tooth enamel
- generalized scaling
- failure to thrive

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17
Q

Vitamin B1
Thiamine

A

Beriberi
- fatigue
- irritability
- constipation
- cardiac failure

Associated with pyruvate dehydrogenase complex deficiency and MSUD

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18
Q

Vitamin B2
Riboflavin

A
  • Failure to thrive
  • photophobia
  • blurred vision
  • dermatitis
  • mucositis

Associated with glutaric aciduria type 1

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19
Q

Vitamin B6
Pyridoxine

A
  • Dermatitis
  • mucositis
  • hypochromic anemia
  • possible seizures

Associated with homocystinuria

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20
Q

Vitamin B12
Cobalamin

A

High risk: breast-fed infants of vegetarian mothers who do not ingest eggs or dairy products

  • megaloblastic MACROCYTIC anemia with hypersegmented neutrophils (same as folic acid deficiency)

Associated with methylmalonic acidemia and homocystinuria

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21
Q

Biotin

A
  • Alopecia
  • dermatitis
  • scaling
  • seborrhea

Associated with:
- biotinidase deficiency
- beta-methylcrotonyl glycinuria
- propionic acidemia
- pyruvate dehydrogenase complex deficiency

think of why you take biotin as to what happens if you are deficient

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22
Q

Vitamin C
Ascorbic acid

A

Poor wound healing and bleeding gums

Associated with transient tyrosinemia

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23
Q

Vitamin D

A

Rickets
failure to thrive
possible tetany

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24
Q

Folic acid
Folate

A

HIGH risk: infants fed only evaporated milk or goat’s milk

  • poor weight gain
  • anemia- macrocytic with hypersegmented neutrophils

often coexists with iron deficiency

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25
Q

Vitamin E
Alpha-Tocopherol

A

Recommended concurrently with iron administration to protect from iron-induced hemolysis

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26
Q

Vitamin K

A
  • coagulation

Associated with hemorrhagic disease of newborns

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27
Q

Chromium

A

regulates glucose levels because of role in insulin metabolism

Deficiency: unknown in humans

28
Q

Copper

A
  • critical for production of RBCs, hemoglobin formation
  • important in absorption of iron
  • associated with multiple enzyme activities

Deficiency:
- anemia
- osteopenia
- depigmentation of hair and skin
- neutropenia
- poor weight gain
- hypotonia
- ataxia later in life

29
Q

Iron

A
  • Component of hemoglobin and myoglobin required for transport of oxygen and carbon dioxide
  • absorbed predominantly in duodenum and prox jejunum
  • Vitamin C enhances absorption

Deficiency:
- anemia (microcytic, hypochromic)
- Failure to thrive

30
Q

Manganese

A
  • role in enzyme activation (ex. superoxide dismutase)
  • important for normal bone structure
  • role in CHO metabolism

Deficiency: unknown

31
Q

Selenium

A
  • cofactor for glutamine peroxidase

Deficiency: cardiomyopathy

32
Q

Zinc

A
  • important component of several enzymes (ex. carbonic anhydrase)
  • important for growth

Deficiency:
Acrodermatitis enteropathica:
- AR
- abnormality of zinc absorption or transport
- FTT, alopecia, diarrhea, dermatitis (perianal), ocular changes, rash, nail hypoplasia/dysplasia

Acquired deficiency:
- preterm infants receiving inadequate amounts of zinc
- maternal zinc deficiency–> FGR, congential anomalies
- infants with malabsorption, poor weight gain, poor wound healing, anemia (iron deficiency)

33
Q

SGLT1

A

apical surface
galactose and glucose
active transport
less efficient in newborn- especially preterm

34
Q

GLUT5

A

apical surface
fructose
facilitated/passive transport

35
Q

GLUT2

A

basal surface
galactose, glucose, fructose

36
Q

TPN cholestasis

A

reduce copper and manganese

37
Q

Bacteriocidal in breastmilk

A

secretory IgA
lactoferrin

38
Q

colostrum ratio W:C

A

80:20

39
Q

Mature milk W:C

A

55:45

40
Q

preterm BM has more ?? than mature milk

A

PROTEIN!

41
Q

Formula is higher in ??? compared to human milk

A

Na
Ca
K
Cl
Mg
Ph
amino acids

42
Q

Normal magnesium

A

1.7-3.6

Symptoms of <1.2

43
Q

components preserved with pasteurization

A

vit A, D, E
lactose
LCPUFA
epidermal growth factor
IgA, IgG

44
Q

which Ig is destroyed with pasteurization?

A

IgM

45
Q

zinc deficiency

acrodermatitis enteropathia

A

defective zinc uptake in the duodenum and jejunum because of abnormality in zinc transporter protein ZIP4

FTT, alopecia, diarrhea, perianal dermatitis, rash (crusted, erythematous involving face/extremeties/anogenital areas)

46
Q

at what age does fetal lactase reach adult concentrations?

A

36 weeks

47
Q

what % of protein should be in the diet to prevent a negative nitrogen balance?

A

7-15%

48
Q

what requires the greatest amount of energy expenditure in a neonate?

A

resting metabolic rate
40-60 kcals/kg/day

49
Q

selenium

A

essential component of glutathione peroxidase, protecting the body from oxidant damage

50
Q

chromium

A

plays a role in carbohydrate and lipid metabolism
clinical deficiency remains to be described

51
Q

copper

A

red blood cell production
hemoglobin formation
iron absorption

52
Q

iron

A

not routinely included in TPN due to :
- concerns about iron overload
- suppression of immune function
- propagation of free oxygen radicals

53
Q

zinc

A

important for bone formation
function of transcriptional factors and steroid receptors

54
Q

cause of renal agenesis

A

ureteric bud fails to develop

55
Q

hormon that plays the biggest role in placental regulation of fetal nutrient supply

A

placental lactogen

56
Q

brain and eye development

A

LCPUFA
omega 3 and omega 6

57
Q

decreases with advancing GA/BW

A

total body water
extracellular water
sodium content
chloride conten

58
Q

increases with advancing GA/BW

A

intracellular water
protein
fat
calcium, phosphorus, magnesium
iron

59
Q

Differences in body composition in SGA vs AGA

A

SGA infants have:
1. reduced total body mass
2. reduced lean mass
3. reduced bone mineral contant
4. reduced muscle mass –> lower nitrogen content
5. lower fetal plasma glucose/insulin –> lower glycogen contant in liver and muscle

60
Q

glucose and galactose transport

A

ACTIVE transport across apical surface via SGLT1 (help from N/K pump)

less efficient in the newborn, especially preemie

crosses into circulation via GLUT2

61
Q

fructose transport

A

FACILITATED/PASSIVE transport via GLUT 5

crosses into circulation via GLUT2

62
Q

neonate has adequate carb DIGESTION because of?

A

normal glucoamylase
normal glucosidases/disaccharidases

except for lactase

63
Q

neonate has adequate carb ABSORPTION becaues of?

A

largely adequate digestion
colonic salvage pathway

64
Q

fat malabsorption minimized in preemie due to:

A
  1. lingual lipase, gastric lipase, lipases in BM –> TG breakdown
  2. increased amounts of more easily digested MCFA in BM
65
Q

intestinal absorption

A

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