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Nutrition > Pediatrics > Flashcards

Pediatrics Flashcards

1
Q

What is a neonate?

A

Birth to 30 days

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2
Q

What is an infant?

A

30 days to 1 year

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3
Q

What is a child?

A

1 year to 12 years

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4
Q

What is an adolescent?

A

12 years to ?

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5
Q

What is growth rate?

A

Weight per time (grams/day or grams/week)

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6
Q

Body composition

A

Percentage change based on age
Fat (fluctuates over time)
Protein (increases over time)
Water (decreases over time)

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7
Q

Composition of new growth

A

Percentage change based on age
Fat (decreases over time)
Protein (increases over time)
Water (typically increases over time)

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8
Q

What factors play into energy expenditure?

A
  1. Basal metabolism
  2. Energy use efficiency
  3. Growth
  4. Metabolic response
  5. Physical activity
  6. Thermoregulation
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9
Q

What is basal metabolism?

A

baseline energy used to sustain life

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10
Q

What is energy use efficiency?

A

how completely energy is used

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11
Q

What is growth (in terms of energy)?

A

the energy needed to develop and grow

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12
Q

What is metabolic response (in terms of energy)?

A

the energy needed to process intake

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13
Q

What is physical activity (in terms of energy)?

A

the energy used for motion

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14
Q

What is thermoregulation?

A

energy used to maintain termperature

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15
Q

Hypothermic = metabolic response _, physical activity _

A

slows down, slows down

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16
Q

Hyperthermic = metabolic response _, physical activity _

A

speeds up, speeds up

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17
Q

(T/F) Euthermic requires a bunch of energy

A

true

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18
Q

What is the carbohydrate recommendation at 2 years old?

A

50-60% of energy intake, 10% from simple sugars

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19
Q

What does the typical north american diet consist of in terms of carbs?

A

< 20% from complex carbs, >25% from sucrose

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20
Q

_% of energy in human milk as lactose

A

40%

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21
Q

_% of energy in cow milk as lactose

A

20%

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22
Q

What are carbohydrate components?

A

Complex carbohydrates

Simple sugars

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23
Q

What are simple sugars?

A

Sucrose, fructose

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24
Q

What is sucrose broken down into?

A

Fructose and glucose

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25
Q

Concerns of Sucrose

A

Predisposition to obesity
Predisposition to insulin resistance
Risk factor for dental caries

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26
Q

Concerns of Fructose

A

Slower brush border diffusion than glucose
No stimulation of insulin secretion
No enhancement or leptin production
Easy conversion to hepatic triglycerides

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27
Q

What is the main source of infant energy?

A

Lipids

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28
Q

How much energy comes from lipids in human milk?

A

50%

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29
Q

What is the importance of lipids?

A 
Brain development
CNS myelination
Cell membrane phospholipids
Prostaglandin and leukotriene synthesis
Fat-soluble vitamin absorption
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30
Q

What is the lipid recommendation in year 1?

A

lipids should be 40-50% of energy in year 1

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31
Q

What is the lipid recommendation in year 2 and older?

A

lipids should be 30% of energy in year 2 and older

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32
Q

How much lipids should come from saturated and polyunsaturated fats?

A

= 10%

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33
Q

The american academy of pediatrics recommends how much caloric intake from fat?

A

30%

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34
Q

How much protein is used for growth in neonates?

A

80%

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35
Q

How much protein is used for growth in 1 year olds?

A

20%

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36
Q

What are fat-soluble vitamins?

A

Vitamin A
Vitamin D
Vitamin E
Vitamin K

37
Q

What are water-soluble vitamins related to production of energy?

A 
Vitamin B1
Vitamin B2
Vitamin B3
Biotin
Panthothenic acid
38
Q

What are water-soluble vitamins related to hematopoiesis?

A

Folic acid

Vitamin B12

39
Q

What are other water-soluble vitamins?

A

Vitamin B6

Vitamin C

40
Q

During the first day of life, how much fluid volume (mL/kg/day) should a preterm infant receive?

A

80

41
Q

During the second day of life, how much fluid volume (mL/kg/day) should a preterm infant receive?

A

80-100

42
Q

During the first day of life, how much fluid volume (mL/kg/day) should a term infant receive?

A

60-80

43
Q

During the second day of life, how much fluid volume (mL/kg/day) should a term infant receive?

A

70-90

44
Q

During the third day of life, how much fluid volume (mL/kg/day) should a term infant receive?

A

80-100

45
Q

During the fourth day of life, how much fluid volume (mL/kg/day) should a term infant receive?

A

100-120

46
Q

During the fifth or greater day of life, how much fluid volume (mL/kg/day) should a term infant receive?

A

120-140

47
Q

For children older than one month with a body weight of 1-10 kg, how much fluid should they receive?

A

100 mL/kg/day

48
Q

For children older than one month with a body weight of 10-20 kg, how much fluid should they receive?

A

1000 mL + 50 mL for each kg over 10 kg

49
Q

For children older than one month with a body weight of >20 kg, how much fluid should they receive?

A

1500 mL + 20 mL for each kg over 20 kg

50
Q

In PN, how much total energy does lipids give?

A

30-50% of total energy requirements

51
Q

In PN, how much total energy does dextrose give?

A

50-60% of total energy requirements

52
Q

In PN, how much total energy does proteins give?

A

10-20% of total energy requirements

53
Q

What is breast feeding?

A

neonate/infant to breast

54
Q

What is expressed human milk?

A

pumped breast milk or donor breast milk

55
Q

What does the WHO recommend?

A

Exclusive breast feeding for first 6 mo of life, continued with complementary foods for 2 years

56
Q

Benefits of human milk

A

Protection against infections
Appropriate nutritional components needed for growth and development
Improves maternal/offspring bonding

57
Q

Maternal contraindication to breast feedings

A
  1. Active, untreated TB
  2. HIV (relative to US)
  3. Illicit drug use
  4. Medications
58
Q

Neonate/infant contraindication to breast feedings

A
  1. Galactosemia
59
Q

What types of infant formulations are avaliable?

A
  1. Cow milk based
  2. Soy protein based
  3. Prematurity
  4. Transitional
  5. Semi-elemental/elemental
60
Q

When is cow milked based formulation used?

A

Normal, healthy neonates/infants

61
Q

When is soy protein based formulation used?

A
  1. Lactase deficiency or intolerance
  2. Galactosemia
  3. Excess diarrhea
  4. Vegetarian diet preference
62
Q

When is prematurity formulation used?

A

Preterm neonates/infants under 3 kg

63
Q

When is transitional formulation used?

A

Preterm neonates/infants under 3 kg and ready for discharge

64
Q

When is semi-elemental/elemental formulation used?

A
  1. Malaborption
  2. Food/protein allergies
  3. Cystic fibrosis
  4. Short bowel syndrome
65
Q

What is the kcal/oz of cow milk based formulations?

A

20-24 kcal/oz (ready to use)

Concentrated: 40 kcal/oz

66
Q

How does cow milk based formulations come prepared?

A

powder

67
Q

What is the kcal/oz of soy milk based formulations?

A

20 kcal/oz (ready to use)

Concentrated: 40 kcal/oz

68
Q

How does soy milk based formulations come prepared?

A

powder

69
Q

How does prematurity milk based formulations come prepared?

A

20, 24, 30 kcal/oz

70
Q

What is the differences of prematurity milk?

A

increased protein, vitamins, minerals, and elecrolytes

71
Q

How does transitional milk based formulations come prepared?

A

22 kcal/oz (ready to use

72
Q

What is the differences of transitional milk?

A

increased calcium and phosphorus

73
Q

How does semi-elemental/elemental milk based formulations come prepared?

A

20 kcal/oz (ready to use)

74
Q

What is the differences of semi-elemental milk?

A

Hydrolyzed proteins and amino acids
Some contain ARA and DHA
Lactose-free
Fat component uses MCT

75
Q

When is enteral nutrition fortification used?

A

More caloric intake needed

Less fluid intake needed

76
Q

How does enteral nutrition fortifiation work?

A

A stepwise process from 20 to 24 to 27 to 30 kcal/oz if needed

77
Q

How do we fortify premature neonates/infants’ human milk?

A

add human milk fortifier

78
Q

What is formula fortification?

A

Use ready to use increased caloric density formulas

79
Q

How do we fortify term neonates/infants’ human milk?

A

Low volume producing mom: add ready to use increased caloric density formulas (liquid)

High volume producing mom: add powder to increase caloric density

80
Q

EN Administration Methods

A

Continuous
Cyclic
Bolus
Intermittent

81
Q

What is continuous EN?

A
  • enhance tolerance (decreased osmotic load on GI tract)

- administered in mL/hr

82
Q

What is cyclic EN?

A
  • nighttime administration

- administered in mL/hr (faster rates due to shorter duration)

83
Q

What is bolus EN?

A
  • given over 5-10 minutes

- stimulates normal intake via “meals”

84
Q

What is intermittent EN?

A
  • given over 30-60 minutes

- stimulates normal intake via “meals”

85
Q

EN Initiation Steps

A
  1. Determine maintenance fluid requirements
  2. Calculate daily energy requirements
  3. Determine appropriate enteral nutrition for patient (at initiaiton, goal caloric requirements)
  4. Determine administration method (administration rate and administrations per day)
  5. Maintenance fluids and nutrition relationship
  6. Parenteral to enteral nutrition transition
  7. Nutrition monitoring
86
Q

What is the EN initiation administration rate for premature neonates/infants?

A

10-20 mL/kg/day

Advancement:
Same increments daily as initiation

87
Q

What is the EN initiation administration rate for premature term neonates/infants/children?

A

1-2 mL/kg/hr continuous administration
2-4 mL/kg/hr intermittent administration

Advancement:
Advance in same increments every 4-24 hr

88
Q

Parenteral to enteral nutrition transition

A
  • Decrease parenteral administration flow rate with increases in enteral nutrition
  • At 80 mL/kg/day of enteral volumes, often discontinue intravenous lipid product
89
Q

How do we monitor nutrition?

A

Growth over time: weight, height, head circumference

Lab monitoring (metabolic panel): electrolytes, albumin/prealbumin, triglycerides

Nutrition (3 decks)

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