Pediatrics Flashcards
1
Q
What is a neonate?
A
Birth to 30 days
2
Q
What is an infant?
A
30 days to 1 year
3
Q
What is a child?
A
1 year to 12 years
4
Q
What is an adolescent?
A
12 years to ?
5
Q
What is growth rate?
A
Weight per time (grams/day or grams/week)
6
Q
Body composition
A
Percentage change based on age
Fat (fluctuates over time)
Protein (increases over time)
Water (decreases over time)
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)
8
Q
What factors play into energy expenditure?
A
- Basal metabolism
- Energy use efficiency
- Growth
- Metabolic response
- Physical activity
- Thermoregulation
9
Q
What is basal metabolism?
A
baseline energy used to sustain life
10
Q
What is energy use efficiency?
A
how completely energy is used
11
Q
What is growth (in terms of energy)?
A
the energy needed to develop and grow
12
Q
What is metabolic response (in terms of energy)?
A
the energy needed to process intake
13
Q
What is physical activity (in terms of energy)?
A
the energy used for motion
14
Q
What is thermoregulation?
A
energy used to maintain termperature
15
Q
Hypothermic = metabolic response _, physical activity _
A
slows down, slows down
16
Q
Hyperthermic = metabolic response _, physical activity _
A
speeds up, speeds up
17
Q
(T/F) Euthermic requires a bunch of energy
A
true
18
Q
What is the carbohydrate recommendation at 2 years old?
A
50-60% of energy intake, 10% from simple sugars
19
Q
What does the typical north american diet consist of in terms of carbs?
A
< 20% from complex carbs, >25% from sucrose
20
Q
_% of energy in human milk as lactose
A
40%
21
Q
_% of energy in cow milk as lactose
A
20%
22
Q
What are carbohydrate components?
A
Complex carbohydrates
Simple sugars
23
Q
What are simple sugars?
A
Sucrose, fructose
24
Q
What is sucrose broken down into?
A
Fructose and glucose
25
Concerns of Sucrose
Predisposition to obesity
Predisposition to insulin resistance
Risk factor for dental caries
26
Concerns of Fructose
Slower brush border diffusion than glucose
No stimulation of insulin secretion
No enhancement or leptin production
Easy conversion to hepatic triglycerides
27
What is the main source of infant energy?
Lipids
28
How much energy comes from lipids in human milk?
50%
29
What is the importance of lipids?
```
Brain development
CNS myelination
Cell membrane phospholipids
Prostaglandin and leukotriene synthesis
Fat-soluble vitamin absorption
```
30
What is the lipid recommendation in year 1?
lipids should be 40-50% of energy in year 1
31
What is the lipid recommendation in year 2 and older?
lipids should be 30% of energy in year 2 and older
32
How much lipids should come from saturated and polyunsaturated fats?
= 10%
33
The american academy of pediatrics recommends how much caloric intake from fat?
30%
34
How much protein is used for growth in neonates?
80%
35
How much protein is used for growth in 1 year olds?
20%
36
What are fat-soluble vitamins?
Vitamin A
Vitamin D
Vitamin E
Vitamin K
37
What are water-soluble vitamins related to production of energy?
```
Vitamin B1
Vitamin B2
Vitamin B3
Biotin
Panthothenic acid
```
38
What are water-soluble vitamins related to hematopoiesis?
Folic acid
| Vitamin B12
39
What are other water-soluble vitamins?
Vitamin B6
| Vitamin C
40
During the first day of life, how much fluid volume (mL/kg/day) should a preterm infant receive?
80
41
During the second day of life, how much fluid volume (mL/kg/day) should a preterm infant receive?
80-100
42
During the first day of life, how much fluid volume (mL/kg/day) should a term infant receive?
60-80
43
During the second day of life, how much fluid volume (mL/kg/day) should a term infant receive?
70-90
44
During the third day of life, how much fluid volume (mL/kg/day) should a term infant receive?
80-100
45
During the fourth day of life, how much fluid volume (mL/kg/day) should a term infant receive?
100-120
46
During the fifth or greater day of life, how much fluid volume (mL/kg/day) should a term infant receive?
120-140
47
For children older than one month with a body weight of 1-10 kg, how much fluid should they receive?
100 mL/kg/day
48
For children older than one month with a body weight of 10-20 kg, how much fluid should they receive?
1000 mL + 50 mL for each kg over 10 kg
49
For children older than one month with a body weight of >20 kg, how much fluid should they receive?
1500 mL + 20 mL for each kg over 20 kg
50
In PN, how much total energy does lipids give?
30-50% of total energy requirements
51
In PN, how much total energy does dextrose give?
50-60% of total energy requirements
52
In PN, how much total energy does proteins give?
10-20% of total energy requirements
53
What is breast feeding?
neonate/infant to breast
54
What is expressed human milk?
pumped breast milk or donor breast milk
55
What does the WHO recommend?
Exclusive breast feeding for first 6 mo of life, continued with complementary foods for 2 years
56
Benefits of human milk
Protection against infections
Appropriate nutritional components needed for growth and development
Improves maternal/offspring bonding
57
Maternal contraindication to breast feedings
1. Active, untreated TB
2. HIV (relative to US)
3. Illicit drug use
4. Medications
58
Neonate/infant contraindication to breast feedings
1. Galactosemia
59
What types of infant formulations are avaliable?
1. Cow milk based
2. Soy protein based
3. Prematurity
4. Transitional
5. Semi-elemental/elemental
60
When is cow milked based formulation used?
Normal, healthy neonates/infants
61
When is soy protein based formulation used?
1. Lactase deficiency or intolerance
2. Galactosemia
3. Excess diarrhea
4. Vegetarian diet preference
62
When is prematurity formulation used?
Preterm neonates/infants under 3 kg
63
When is transitional formulation used?
Preterm neonates/infants under 3 kg and ready for discharge
64
When is semi-elemental/elemental formulation used?
1. Malaborption
2. Food/protein allergies
3. Cystic fibrosis
4. Short bowel syndrome
65
What is the kcal/oz of cow milk based formulations?
20-24 kcal/oz (ready to use)
Concentrated: 40 kcal/oz
66
How does cow milk based formulations come prepared?
powder
67
What is the kcal/oz of soy milk based formulations?
20 kcal/oz (ready to use)
Concentrated: 40 kcal/oz
68
How does soy milk based formulations come prepared?
powder
69
How does prematurity milk based formulations come prepared?
20, 24, 30 kcal/oz
70
What is the differences of prematurity milk?
increased protein, vitamins, minerals, and elecrolytes
71
How does transitional milk based formulations come prepared?
22 kcal/oz (ready to use
72
What is the differences of transitional milk?
increased calcium and phosphorus
73
How does semi-elemental/elemental milk based formulations come prepared?
20 kcal/oz (ready to use)
74
What is the differences of semi-elemental milk?
Hydrolyzed proteins and amino acids
Some contain ARA and DHA
Lactose-free
Fat component uses MCT
75
When is enteral nutrition fortification used?
More caloric intake needed
| Less fluid intake needed
76
How does enteral nutrition fortifiation work?
A stepwise process from 20 to 24 to 27 to 30 kcal/oz if needed
77
How do we fortify premature neonates/infants' human milk?
add human milk fortifier
78
What is formula fortification?
Use ready to use increased caloric density formulas
79
How do we fortify term neonates/infants' human milk?
Low volume producing mom: add ready to use increased caloric density formulas (liquid)
High volume producing mom: add powder to increase caloric density
80
EN Administration Methods
Continuous
Cyclic
Bolus
Intermittent
81
What is continuous EN?
- enhance tolerance (decreased osmotic load on GI tract)
| - administered in mL/hr
82
What is cyclic EN?
- nighttime administration
| - administered in mL/hr (faster rates due to shorter duration)
83
What is bolus EN?
- given over 5-10 minutes
| - stimulates normal intake via "meals"
84
What is intermittent EN?
- given over 30-60 minutes
| - stimulates normal intake via "meals"
85
EN Initiation Steps
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
What is the EN initiation administration rate for premature neonates/infants?
10-20 mL/kg/day
Advancement:
Same increments daily as initiation
87
What is the EN initiation administration rate for premature term neonates/infants/children?
1-2 mL/kg/hr continuous administration
2-4 mL/kg/hr intermittent administration
Advancement:
Advance in same increments every 4-24 hr
88
Parenteral to enteral nutrition transition
- Decrease parenteral administration flow rate with increases in enteral nutrition
- At 80 mL/kg/day of enteral volumes, often discontinue intravenous lipid product
89
How do we monitor nutrition?
Growth over time: weight, height, head circumference
Lab monitoring (metabolic panel): electrolytes, albumin/prealbumin, triglycerides
