Pediatrics

Question 1

What should the MAXIMUM glucose infusion rate (GIR) be for a term infant receiving parenteral nutrition (PN)?

Answer 1

14-18 mg/kg/min

Question 2

Studies have shown that which age group is most at risk for inadequate calcium intake

Answer 2

Female adolescents; The APP recommends increased dietary intake of calcium and vitamin D-containing foods and beverages for optimal bone health. Current recommendations are for 2 to 3 servings of dairy per day for young children and 4 servings per day for adolescents.

Question 3

When indirect calorimetry is not available, which equations may be used to estimate the needs of critically ill children?

Answer 3

Schofield or World Health Organization equation may be used.

Question 4

How much vitamin D is recommended to prevent vitamin D deficiency in a 1-month-old infant fed human milk?

Answer 4

400 IU

Question 5

Preterm infant formula or fortified human milk is used for premature infants. What is the rationale for this?

Answer 5

After the first month, unfortified human milk may contain inadequate protein for the premature infant

Question 6

Standard neonatal parenteral amino acid solutions differ from standard adult parenteral amino acid solutions by having a higher content of which amino acids?

Answer 6

Taurine and tyrosine

Question 7

Which conditions are associated with delayed bone age?

Answer 7

Hypothyroidism, growth hormone deficiency and Cushing syndrome

One of the most useful diagnostic tests in assessing a child with abnormal growth is a “bone age”. The bone age is evaluated by a radiography of the patient’s knees or left wrist.

Question 8

Term infants usually have adequate iron stores up to ____ months of age.

Answer 8

Six

Question 9

Non-nutritive sucking should be used in the enterally fed neonate less than 32 weeks corrected gestational age to promote what?

Answer 9

Oral feeding when developmentally appropriate

The ability to suck and swallow is present by 28 weeks gestation, but infants are not fully coordinated until 32 to 34 weeks gestation.

Non-nutritive sucking improves digestion of enteral feedings and encourages development of sucking behavior. Non-nutritive sucking is thought to stimulate the secretion of lingual lipase, gastrin, insulin and motilin through vagal innervation in the oral mucosa.

Question 10

Which of the following preterm growth charts allows for comparison for preterm infants from 22 weeks gestational age up through 10 weeks post term age?

Answer 10

Fenton

Question 11

In the hospital, what is the hang time for expressed human milk when used for continuous enteral feedings?

Answer 11

4 hours

Expressed human milk is never sterile and contains a variety of normal skin flora. Contamination can occur during milk expression and storage, during the preparation and mixing of additives, and while assembling and handling feeding systems. To reduce potential for contamination, feeding systems that include bags, syringes, or tubing should never be reused. In the hospital setting, enteral feeding systems should not be used for more than 4 hours.

Question 12

Due to the inadequate nutritional composition, cow’s milk should not be introduced before ____ of age.

Answer 12

12 months; he iron content of cow’s milk is similar to human breast milk but the bioavailability is very low due to inhibitory effect of calcium on iron absorption.

Question 13

Which concentration is considered to be an upper limit for the osmolality of infant formulas to avoid tolerance issues?

Answer 13

460 mOsm/kg

he osmolality of standard infant formulas at a caloric density of 20 kcal/oz generally falls below this limit with a range of 200 - 380 mOsm/kg. Protein hydrolysate and free amino acid infant formulas have a slightly higher osmolality due to their smaller particle size (330-370 mOsm/kg). The osmolality of a 30 kcal/oz concentrated standard infant formula is approximately 450 mOsm/kg. The addition of a carbohydrate modular to increase caloric density of formula will increase the osmolality of the formula while the addition of a fat modular will not.

Question 14

Exclusive enteral nutrition has been shown to be effective in inducing remission of Crohn’s disease in the pediatric population. What enteral formula is recommended as first line therapy in these patients?

Answer 14

Polymetric enteral formula

Question 15

What are some common causes of reflux in children receiving enteral nutrition?

Answer 15

Rapid administration of enteral formula, delayed gastric emptying, or feeding tube migration into the esophagus.

Regurgitation usually will resolve around 7-12 months of age with maturation of the lower esophageal sphincter.

Question 16

Which type of formula would be most appropriate in the nutritional management of an infant with chronic lung disease?

Answer 16

Use of concentrated formula; this allows for provision of adequate nutrition while restricting fluid intake. Fluid restriction is indicated due to fluid build up around the heart and lungs.

Question 17

What is the adequate intake of Calcium for children aged 4-8?

Answer 17

1,000 mg

Question 18

A seven month-old infant fed reconstituted infant formula and other age-appropriate complementary foods may be at risk of over-supplementation with what?

Answer 18

Flouride

Question 19

Children with burns covering ____% of TBSA generally cannot meet their nutrient needs by oral intake alone.

Answer 19

> 20%

Question 20

True or false: Infant formulas are fortified with sufficient iron to meet the needs of growing infants.

Answer 20

True

Question 21

The biochemical defect in phenylketonuria (PKU) is a functional deficiency of the liver enzyme phenylalanine hydroxylase, which catalyzes the para-hydroxylation of phenylalanine to yield what amino acid?

Answer 21

Tyrosine

Question 22

What is the recommended daily intake of selenium for term infants receiving parenteral nutrition?

Answer 22

2 mcg/kg/day

Current available pediatric multi-trace element products still do not contain selenium so it must be added separately to the PN.

Question 23

What is PKU and how is it treated?

Answer 23

PKU is an inborn error of phenylalanine metabolism caused by a deficiency of the hepatic enzyme phenylalanine hydroxylase (PAH). PAH catalyzes the hydroxylation of phenylalanine to tyrosine. In the absence of PAH, phenylalanine levels become extremely high and tyrosine becomes deficient.

Treatment with a phenylalanine-free diet and tyrosine supplementation is used for chronic management.

Question 24

In an infant receiving parenteral nutrition (PN), what is the MINIMUM amount of soybean oil-based lipid injectable emulsion (ILE) needed to prevent essential fatty acid deficiency (EFAD)?

Answer 24

0.5-1g/kg/day

For patients where prolonged PN dependence (> 1 month) is anticipated, lipid restriction to 1 g/kg/day may be instituted to help prevent PN-associated liver disease

Question 25

True or false: Critically ill and postoperative neonates have significantly lower energy needs compared with healthy neonates.

Answer 25

True; this is due to absence of growth, decreased activity, and reduction in insensible losses during stress states. Indirect calorimetry (IC) is recommended when possible but, if IC is not available, the basal energy/resting energy expenditure (REE) should be used for nutrition support provision.

Question 26

What are some common symptoms of Celiac disease in childhood?

Answer 26

diarrhea, constipation, chronic abdominal pain, abdominal distention, vomiting, short stature, weight loss, inadequate weight gain, dental enamel defects, dermatitis herpetaformis, reduced bone mineral density, iron deficiency anemia, fatigue, migraines, and joint pain.

Question 27

Which situation is the most appropriate indication for use of a soy-based infant formula?

Answer 27

Galactosemia; Infants with acute diarrhea,usually associated with gastroenteritis, can develop secondary lactase deficiency, but a soy formula is not recommended in those instances. Since a high percentage of children who are allergic to cow’s milk protein will also be allergic to soy protein, the American Academy of Pediatrics now recommends a trial use of either a hydrolyzed or free amino acid-containing formula

Question 28

Pancreatic enzymes supplemented at high doses in children with cystic fibrosis could result in

Answer 28

Fibrosing colonopathy.

High dose enzyme usage may result in strictures of the ascending colon, also known as fibrosing colonopathy. Enzymes should be used at less than 10,000 units of lipase/kg/day.

Question 29

What is the most common nutritional deficiency of childhood?

Answer 29

Anemia

Question 30

When should powdered infant formulas be used in health are facilities?

Answer 30

They should only be used in health care facilities when clinically necessary and when alternative commercially sterile liquid products are not available.

Question 31

What distinguishes gastroesophageal reflux (GER) from gastroesophageal reflux disease (GERD) in infants?

Answer 31

GERD is characterized by the presence of significant complications

Question 32

What is the recommended daily enteral elemental iron dose for preterm infants, one month after birth?

Answer 32

2-4 mg/kg/d

An exogenous source of 2-4 mg/kg/day of elemental iron is recommended during the period of stable growth, beginning at 4-8 weeks and continuing until 12-15 months of age. The American Academy of Pediatrics recommends that infants not receiving human milk receive an iron-fortified formula and that preterm infants receive at least 2 mg/kg per day of elemental iron from 1-12 months of age.

Question 33

In patients with intractable GER, which procedure may be performed?

Answer 33

A fundoplication.

Given the potential for postoperative complications, this should only be considered in patients who have failed medical treatment. Conversion to a gastrojejunostomy tube could also be considered as an alternative to fundoplication.

Question 34

The use of Lactobacillus rhamnosus GG (LGG) in pediatric practice has been found to be MOST effective in treating what?

Answer 34

Infectious diarrhea

Question 35

What trace element should be supplemented in a child with chronic diarrhea?

Answer 35

Zinc

Question 36

What is the Holiday Seagar method for calculating fluid needs for children?

Answer 36

1st 10 kg-100 mL/kg/d
2nd 10 kg- 50 mL/kg/d

Each additional kg-20 mL/kg/d (<= 50 kg.) or 15 mL/kg (> 50 kg.).

Question 37

Exclusively breastfed infants require additional iron starting at ____ months of age

Answer 37

4-6; his can be provided by complementary foods or iron supplementation.

Question 38

Which situations put premature infants at risk for metabolic bone disease?

Answer 38

cholestasis, chronic steroid use, very low birth weight (<1500 grams), chronic diuretic use, prolonged duration of parenteral nutrition,

Question 39

What is galactosemia?

Answer 39

An inborn error of metabolism that affects the body’s ability to metabolize galactose; Currently, the only way to treat galactosemia is to eliminate galactose from the diet.

Question 40

When does the American Academy of Pediatrics (AAP) recommend universal screening for iron deficiency be performed in young children?

Answer 40

12 months of age

Question 41

For neonates, which amino acid should be added separately to parenteral nutrition solutions due to solubility concerns?

Answer 41

Cysteine

Question 42

What is the best choice for feeding a pancreatic insufficient infant with cystic fibrosis?

Answer 42

Human milk

Human milk or standard infant formula with appropriate enzyme dosing is recommended. Protein hydrolysate or free amino acid formulas containing MCT are not indicated for infants with cystic fibrosis (CF) unless there is another medical reason such as bowel resection resulting in malabsorption or liver abnormalities.

Question 43

In children, which BMI percentiles are considered overweight?

Which percentile is considered obese?

Answer 43

Children with age and sex specific BMIs between the 85th and 94th percentiles are classified as overweight

Children with BMIs greater than or equal to 95th percentile are classified as obese.

BMI is a screening tool used to identify children over 2 years of age and adolescents who are outside of their healthy weight ranges

Question 44

Which of the following is considered to be diagnostic criteria of infantile anorexia?

Answer 44

Refusal to eat adequate amounts of food for >1 month

Question 45

An infant with a complete ileal resection with preservation of the ileocecal valve is at risk for which nutrient deficiency?

Answer 45

Vitamin B12

Question 46

What is the suggested daily amount of potassium required for maintenance in an infant receiving parenteral nutrition?

Answer 46

2-4 mEq/kg; The suggested daily amount of potassium is 2-4 mEq/kg for preterm infants, term infants, and children. In newborns, potassium is generally not added to the PN solution until kidney function is established.