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NICU Boards > Nutrition and GI > Flashcards

Nutrition and GI Flashcards

1
Q

List the essential amino acids?

A

branched chain (leucine, isoluecine, valine), histadine, lysine, methionine, phenylalanine, threonine, tryptophan

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2
Q

What amino acids are considered essential in the premature newborn

A

cysteine, arginine, tyrosine, taurine (CATT)

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3
Q

What are the conditionally essential amino acids in infants?

A

arginine, glutamine, glycine, proline, taurine, tyrosine

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4
Q

Where are B12, bile salts and acids absorbed?

A

ileum

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5
Q

where are lipids aborbed?

A

jejunum

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6
Q

Where are sodium, Cl and K absorbed?

A

Large intestine

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7
Q

At what GA, are sucrase, maltase and lactase at adult levels?

A

sucrase and maltase at 28 weeks and lactase at 36 weeks

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8
Q

Compare infant with SIP to those with surgical NEC

A

SIP occurs earlier (usually first week of life) compare to the timing and presentation of NEC. infants with SIP are more likely to be smaller, more premature, unlikely to be fed, have a PDA s/p indocin, receive vasopressor support, receive surf and vent support. a/w chorio

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9
Q

What meds are a/w SIP?

A

indomethacin, hydrocortisone, vasopressors

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10
Q

Where is a SIP most likely to occur?

A

terminal/ distal ileum

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11
Q

What is the most common to least common sites for jejunal-ileal atresia?

A

distal ileum, proximal jejunum, distal jejunum, proximal ileum

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12
Q

What % of patients with meconium ileus have CF?

A

90%

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13
Q

What % of patient with CF have meconium ileus?

A

10-15%

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14
Q

What other things can malrotation be associated with?

A

gastroschisis, Beckwith-Weidemann syndrome, jejunal atresia, CDH

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15
Q

Is Jejunal atresia more common in males or females?

A

its equally common in both; same for gastroschisis

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16
Q

pancreatic insufficiency (watery diarrhea, steatorrhea), bone marrow dysfunction (neutropenia), short stature, normal bicarb secretion, normal sweat test. Whats the diagnosis?

A

Schwachmann-Diamond syndrome

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17
Q

List the defects seen in Pentalogy of Cantrell

A

omphalocoele, CDH, sternal cleft, extopia cordis, intracardiac defect (VSD or diverticulum of the LV)

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18
Q

What are the abnormalities in OEIS complex?

A

omphalocoele, extropohy of the bladder, imperate anus, spinal deformity

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19
Q

What syndromes are a/w omphalocoele?

A

pentalogy of Cantrell, Beckwith-Wiedemann Syndrome, OEIS complex

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20
Q

Is omphalocoele more common in males or females?

A

males

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21
Q

True or FalsePreterm infants fed standard infant formulas gain a higher proportion of their weight as fat when compared with a fetus of the same maturity

A

TRUE

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22
Q

T or F The use of special pretmer formulas and preterm HMF results in a compositon of weight gain and bone mineralization closer to that of the reference fetus when compared to infans fed standards term formulas or straight human milk

A

TRUE

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23
Q

What fatty acids are essential in neonates?

A

linoleic and linolenic acid

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24
Q

Infant with hemorrhagic dermatitis, skin atrophy, scaly dermatitis, weakness, impaired vision, edema, high BP, and impaired growth. Name the nutritional deificiency

A

essential fatty acid deficiency

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25
Q

How is essential fatty acid deficiency diagnosed?

A

Triene:Tetraene ratio > 0.4 (AKA Holman index)

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26
Q

What oils are in preterm formulas to help with fat absorption?

A

MCT and long chain polyunsaturated triglycerides

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27
Q

Name the components of fetal composition that decrease with advancing GA and birth weight

A

Total body water, extracellular water, sodium and chloride content,

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28
Q

Name the components of fetal composition that increase with advancing GA and weight

A

intracellular water, protein, fat, Ca, phos, mag, iron

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29
Q

What the goals for nutrition content : %fat, % carbs, % protein

A

30-50% fat (no more than 60%), 35-65% as carbs, and 7-15% protein; 3-4 g.kg.day fat, 9.7-17 g/kg/day carbs and 3.5-4 grams/kg/day protein

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30
Q

What macronutrient provides 2/3 of the fetal energy source?

A

maternal glucose

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31
Q

What are the gluconeogenic substrates for in the fetus?

A

alanine, glutamic acid, aspartic acid

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32
Q

What makes up 30% of all milk protein?

A

secretory igA and lactoferrin

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33
Q

Whey to Casein ratios in colostrum, mature human milk, hydrolyzed protein based formulas, 14 day post-delivery pumped human milk from mother of 26 weeker, predominantly whey formulas: preterm formulas

A

colostrum 80:20; mature human milk is 50:50; hydrolyzed protein terms based fomulas are all hydrolyzed casein; 14 day post deliver in 26 weeker mom is 60:40 and predominantly whey formulas are 60:40: preterm formulas are 60:40

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34
Q

What is the most important amino acid that assists the metabolism of fat?

A

carnitine

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35
Q

What are the most abdundant fatty acids in human milk?

A

Oleic acid (18:1) and palmitic acid (16:0)

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36
Q

Where is iron absorbed?

A

duodenum and proximal jejunum

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37
Q

How much iron do preterms and low BW infants need?

A

at least 2 mg/kg/day

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38
Q

hemorhagic diseae of the newborn- name the vitamin deficiency

A

Vit K

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39
Q

BPD, abnormal epiphyseal formation and tooth enamel- name the vit deficiecy

A

Vit A

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40
Q

a/w pyruvate dehydrogenase complex deficiency, MSUD, and beriberi (fatigue, irritability, constipation, cardiac failure). Name the vit deficiency

A

B1 (thiamine defiency)

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41
Q

FTT, dermatitis, mucositis, a/w glutaric aciduria type 1. Name the vit deficiency

A

Vit B 2 (riboflavin)

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42
Q

dermatitis, mucositis, seizures, a/w homocystienuria. Name the vit deficiency

A

Vit B6 (pyridoxine)

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43
Q

scalring dermatitis, a/w biotinidase deficiency, proprionic acidemia, pyruvate dehydrogenase complex deficiency, and beta- methylcrotonyl glycinuria. Name the vit deficiency

A

biotin

44
Q

poor wound healing, transient tyrosinemia. Name the vit deficiency

A

Vit C

45
Q

osteopenia/rickets, FTT, tetany. Name the vit deficiency

A

Vit D

46
Q

Inuslin metabolism involves which trace element?

A

chromium

47
Q

this trace element is critial for RBC production and Hgb formation

A

copper

48
Q

This trace element activates super oxide dismutase, and involved in normal bone structure as well as carbohydrate metabolism

A

Manganese

49
Q

This trace element is a cofactro in glutathione peroxidase (RBC membrane stabilization vs oxidative stress).

A

Selenium

50
Q

Deficiency in this trace element results in cardiomyopathy

A

selenium

51
Q

Which trace element is deficient in acrodermatitis enteropathica and what is the inheritance

A

zinc and AR

52
Q

FTT, alopecia, diarrhea, perianal dermatitis, ocular changes, rash ( crusted erythematous, involving the face, extremities, and anogenital areas), nail hypoplasia or dysplasia

A

acrodermititis enteropathica

53
Q

Preterm neonates with this deficiency present with poor weight gain, malabsorption, and poor wound healing.

A

zinc

54
Q

What happens to the fetus when there is a maternal zinc deficiency?

A

fetal growth restriction and congenital anomalies

55
Q

delay or failure pass meconium, bilious emesis, abdominal distension with x-ray findings that show distension of small and large bowel with lack of rectal air. Name the diagnosis

A

Hirschsprungs

56
Q

What is the most likely long term outcome of an infant with medical NEC?

A

intestinal stricture; most commonly in the L colon

57
Q

Which maternal disease are a/w small left color or microcolon?

A

DM and hypothyroid

58
Q

What are risk factors for gastroschisis?

A

young maternal age, maternal smoking, alcohol use, illicit drug use, salicylates, and over the counter vaso-active medications

59
Q

Are the following gene polymorphisms a/w gastroschisis or omphalocoele? Endothelial NO synthase, intrcellular adhesion molecule 1, and atrial natriuretic peptide.

A

Gastroschsis. Having these increaes your risk 2 fold

60
Q

What is the most common cause of neonatal liver failure?

A

neonatal hemochromatosis aka gestational alloimmune liver disease

61
Q

What are the two most common causes of conjugated hyperbili and what is the pathology?

A

biliary atresia (extrahepatic obstruction) and idiopathic neonatal hepatitis (intrahepatic); Biliary atresia pathology: bile duct proliferation and idiopathic neonatal hepatits is mult-nuleated giant cells and increased AFP

62
Q

What are the intrahepatic obstructive causes of conjugted hyperbili?

A

neonatal idiopathic hepatitis, Alagilles (paucity of intrahepatic bile ducts with extrahepatic ducts, unusal facies, vertebral anomalies), non-syndromic paucity of bile ducts

63
Q

What the extra-hepatic obstructive cause of direct hyperbili?

A

biliary atresia, sclerosing cholangitis, bile duct stenosis, choledocal cyst (cystic dilation of the common bile duct), bile plug syndrome

64
Q

What are the metabolic causes of direct hyperbili?

A

galactosemia, glycogen storage disease, tyrosinemia, alpha 1 antitrypsin deficiency, hypopituitarism, hypothyroidism, CF, and Zellwger syndrome

65
Q

Lis the genetic causes of conjugated hyperbili?

A

Turner, T21

66
Q

What percent of the Total bilrubin should the direct component be?

A

no more than 15%; conjugated hyperbili is when direct is >1 when TB is <5 or more than 20% of the TB if > 5 OR > 1.5 if > 10% of TB

67
Q

Is polyhydramnios more common in jejunal atresia or ileal atresia?

A

polyhydramnios occurs in in ~1/3 of fetuses with jejunal atresia and is less common in fetuses with ileal atresia

68
Q

How the pathology of duodenal atresia differ from jejunal/ileal atresia?

A

duodenal atresia occurs due to fialure of recanalization of the intestinal tube durinr the 8th and 10th week of gestation after obliteration of thje lumen by epithelial proliferation (6-7 weeks). Jejunal-ileal atresia occurs b/c of the presence of bile droplets, meconium, and lanugo distal to the atresia and occlusion occurs after intestinal development

69
Q

What is the most common etiology behind jejunal-ileal atresia

A

intrauterine ischemic injury 2/2 volvulus, malrotation, intestinal strangulation

70
Q

What the genetic inheritance and gene mutation for Schwachman Diamond syndrome

A

rare autosomal recessive disorder that is most commonly due to a mutation in the SDS gene on chromosome 7q11. This gene plays are role in the maturation of the ribosomal subunit

71
Q

What is the most common cause of an abdominal flank mass?

A

hydronephrosis

72
Q

What are the infectious causes of conjugated hyperbili?

A

viral (m ost common), toxo, syphilis, TB and listeria

73
Q

What is the most likely etiology behind biliary atresia?

A

perinatal viral infection followed by exaggerated inflammation and bile duct obstruction

74
Q

For infants with syndromic or complex CDH, what is the most common other organ system that is affected?

A

cardiac (60%)

75
Q

What is the most common associated anomaly with tracheoesophageal atresia?

A

congenital heart disease.associated anomalies occure in >50% of cases of TE artresia and esophageal atresia

76
Q

In patiuent with short gut that retain their colon, what hormone if important for intestinal transit

A

Glucagon-like peptide -2 ; secreted by L cells in the terminal ileum and colon and increases intestinal blood flow.; it is an anti-secretory hormone that regulates intestinal transit

77
Q

What is the most common inherited RBC enzyme defect and what is the inheritance pattern?

A

G6PD, x-linked recessive

78
Q

Heinz bordies on a periheral smear

A

G6PD

79
Q

What is the most common hereditary hemoolytic anemia among people of Northern European background?

A

Hereditary spherocytosis; autosomal dominant,

80
Q

What hemophilia is a/w Noonan’s syndrome

A

Hemophilia C, AR, Factor XI deficiency

81
Q

What is the timing of presentation of HDN for early, classic, and late>

A

early within 24 hours of life, classic 2-7 days, late 2w-6 months

82
Q

What are the causes of early HDN?

A

maternal medications like anticonvulsants, cephalosporin, nd wafarin

83
Q

What the causes of classic HDN? How does it present?

A

inadequate Vit K; p/w GI bleeding, ICH, oozing

84
Q

What are the causes of late HDN?

A

inadequate intake, hepatobiliary disease. ( high risk for ICH and death, more common in boys)

85
Q

What components of breastmilk are destroyed in the paturization proess?

A

IgM, lymphocytes, alk phos, cytokines, lipoprotein and some lipases, lactoferrin concentration decreased, lysozyme concentration decreased

86
Q

What components of breastmilk are preserved in the paturization proess?

A

oligosaccharides, Vit A,D,E, lactose, long chain polyunsaturated fatty acids and epidermal groth factor; IgA and IgG

87
Q

infant with Pierre Robin sequence changed from breastfeeding to formula. Developed poor weight gain, severe diaper dermatitis, hypoalbinemia, crusted erythematous rash around peri-oral area. Name the diagnosis and vit deficiency?

A

acrodermititis enteropathica; zinc deficiency

88
Q

What drug is prescribed to moms with mastitis?

A

dicloxicillin, if resistant to Diclox, then erythromycin and is resistant to both, Vanco

89
Q

At how many months of age does ECF = ICF?

A

3 months, 35% each

90
Q

How much of the cardiac output goes to infant kidneys? Adults?

A

infant is 10% while adults is 25%

91
Q

What are the differences between cows milk formula and breastmilk?

A

human milk contains more long chain polyunsaturated fatty acids, more carnitine, cholesterol, DHA; Cows milk formulas have more amino acids

92
Q

What are the differences between preterm human milk and term milk?

A

preterm milk contains more protein, sodium, Cl but less lactose. Protein amt is still insufficient so it needs to be fortified

93
Q

Compared to term infant formula, what are the contents of protein, lactose, sodium and iron?

A

compared to term formula, preterm formula has a high protein content, lower lactose, higher sodium, less iron. Preterm formulas are iso-osmolar until fortified beyond 24 kcal/oz

94
Q

What portion of the small intestine is responsible for protein, fat and carbohydrate absoprtion as well as iron, calcium, and magnesium

A

jejunum

95
Q

What portion of the small intestine is responsible for uptake of Vit b12, release of neurologically important hormones, and absorption of bile salts, fats, and fat solube vitamins and zinc?

A

ileum

96
Q

True or false. The ileum has the ability to compensate for some of the functions of the jejunum

A

TRUE

97
Q

What hormone plays the largest role in fetal growth?

A

IGF-2

98
Q

What hormone plays the biggest role in placental regulation of fetal nutrient supply?

A

placental lactogen

99
Q

What fatty acid has been found to play a role in brain and retinal development?

A

long chain poly unsaturated fatty acids

100
Q

What are contraindications to breastfeeding?

A

maternal HIV, mother with active HSV lesion on the breast, symptomatic mother with a pos PPD and CXR (presumed active TB), and active breast abscess

101
Q

What are relative contraindications to breastfeeding?

A

mother who is CMV sero-positive with preterm infant; maternal oral HSV lesions (mother to cover lesions)

102
Q

What are indications for dialysis in a newborn?

A

Acidosis (metabolic), electrolyte issues (hyperkalemia, hyperphosphatemia, hypocalcemia, hyponatremia with volume overload), inability to provide adequate nutrition, overload with fluids, uremia. Notice NOT elevated Cr but that will often coincide with these indications

103
Q

compared to LGA infants, SGA infant have an decrease in these 3 body composition metrics

A

reduced total body mass, lean mass, and bone mineral content and therefore less nitrogen

104
Q

Preterm neonates loss weight in the first several days of life. What happens to TBW, ECF, and ICF?

A

TBW and ECF decreases and specifically the interstitial compartment of the ECF decreases; ICF increases

105
Q

What are the main glucogenic amino acids?

A

alanine, glycine, glutatmate. Others include aspartate, cysteine, and proline

106
Q

What are the amino acids that are both glucogenic and ketohgenic?

A

isoluecine, phenylalanine, tyrptophan, tyrosine

107
Q

What amino acids are ketogenic?

A

leucine and lysine

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