Pediatrics Flashcards
what is assessed in pediatric malnutrition
food/nutrient intake, energy/protein needs, growth parameters, weight gain velocity, mid upper arm circumference, hand grip strength
when using z scores you can meet _____ number of criteria for malnutrition in pediatrics
1
categories of pediatric malnutrition using z scores
weight/height, BMI, length for height/age, MUAC
Mild Malnutrition Criteria (peds) Z scores
- 1 to -1.9 height/weight
- 1 to -1.9 BMI
- 1 to -1.9 MUAC
Moderate Malnutrition Criteria (PEDS) z scores
- 2 to -2.9 height/weight
- 2 to -2.9 BMI
- 2 to -2.9 MUAC
Severe Malnutrition Criteria (PEDS) z scores
- 3 or less height /weight
- 3 or less BMI
- 3 or less length/ht and length/age
- 3 or less MUAC
Mild Malnutrition Criteria PEDS (2+ needed)
weight gain velocity <75% of normal
5% loss of UBW
decline in 1 standard deviation of weight for length/weight for height z score
51%-75% EEN/EPN
Moderate Malnutrition Criteria PEDS (2+ needed)
weight gain velocity <50% of normal
7.5% loss of UBW
decline in 2 std deviations for weight for length/weight for height z score
26-50% EEN/EPN
Severe Malnutrition Criteria PEDS (2+ needed)
weight gain velocity <25% of normal
10% loss of UBW or greater
at least 3 standard deviations below wt/lenght and wt/ht z score
<25% EEN/EPN
phenotypic malnutrition criteria (weight) in GLIM
> 5% in = 6 months
>10% in > 6 months
phenotypic malnutrition criteria (BMI) in GLIM
<20 if >70 years old
<22 if 77 years old
<18.5 Asians <70 years old
<20 Asians >70 years old
phenotypic malnutrition criteria (Muscle mass)
decreased muscle mass
etiologic GLIM criteria
50% < food intake >1 week
any reduction > 2 weeks for any chronic GI absorption that impacts food assimilation
acute/chronic disease related inflammation
well defined, easy to palpate, slightly seen clavicle in females, curved shoulders, scapular bones not prominent describes ______ upper body muscle
normal
muscles around the knee visible but well rounded, patella not prominent, gastrocnemius is developed and rounded describes ____ lower body muscle
normal
temporalis muscle slightly depressed, decreased pectoralis major muscle moderately visible, clavicle present in females and males, shoulder blade/acromion process is more visible with a hollow trapezius, there is somewhat prominent scapular bones describes ______ upper body muscle
mild/moderate depletion
patella slightly prominent but rounded, inner thigh with concave gap when pressed together, gastrocnemius is less developed describes____ lower body muscle
mild/moderate depletion
depressed/hollow temporalis muscle, prominent facial bones, sharply protruded clavicle, minimal prese pectoralis muscle, scapula/ acromion process are sharply angular and there is deep concave interosseous muscle describes ___ upper body muscle
severe depletion
patella is sharply prominent, there is concaved shape between thighs with a large gam and the quadriceps lack definition indicates _____ lower body muscle
severe depletion
fat pads protrude slightly or are flat indicate, the skinfold underneath the triceps with ample fat tissue, iliac crest doesn’t protrude and ribs are visible indicates ____ fat assessment
normal fat assessment
faint, dark circles with a moderately concave eye area, skin fold pinch with some fat tissue but less space between the fingers, iliac crest visible and ribs are visible but without marked depressions between them indicates _____fat assessment
mild to moderate fat depletion
visible, dark circles, extremely concave eye socket, skin is loose, skin fold pinch yields fingers touching, little to no fat tissue present, iliac crest is protruding, ribs are protruding with sharp depressions in-between them indicate ___ fat assessment
severe fat depletion
the incidence of aspiration is directly caused by EN is _______ to be determined due to the lack of clinical research. There is no standard definition of aspiration
difficult
Critically ill children have decreased strength and coordination of pharyngeal muscles and a weak cough reflex making ___ more likely
aspiration
what is considered appropriate use of powdered infant formula in healthcare facilities?
only use when alternative, sterile liquid products are not available or when clinically necessary
powdered formulas are or are not sterile
are NOT!
use extra caution when providing powdered formulas to ______ children as they have a higher risk of bacterial contamination
immunocompromised chidren
in the hospital, what is the hang time for expressed human milk when used for continuous feedings?
4 hours
human milk is _____ sterile due to normal skin flora that is present. Never re use ___, ___ or _____ to reduce the chance of contamination
never sterile
bags, syringes, or tubing
A 1 month old has acute onset of diarrhea for 48 hours. The parents noticed that he hasn’t been wetting as many diapers and mucous membranes are slightly dry. It is anterior fontanel is soft and not sunken. He normally ingests milk based formula ad lib. What is the most appropriate intervention?
oral rehydration therapy. the infant is likely dehydrated from diarrhea/viral gastroenteritis and then return to age appropriate diet as tolerated and continue with milk
sunken eyes, sunken fontanel, poor skin turgor, dry mucous membranes and decreased numbers of wet diapers indicates
dehydration
what osmolarity is considered to be an upper limit for the osmolarity of infant formulas to avoid tolerance issues
460mOsm/kg
Osmolality of standard infant formulas has a caloric density of ______ kcal/oz with and osmolarity of _______ to ____ mOsm/kg
20 kcal/oz
200-380mOsm/kg
which infant formulas have the highest osmolarity
protein hydrolysate and free amino acid infant formulas
the osmolarity of a 30kcal/oz infant formula is
450 mOsm/kg
what distinguishes gastroesophageal reflux (GER) from gastroesophageal reflux disease (GERD) in infants?
GERD is characterized by significant complications including weight loss, failure to thrive, feeding difficulties, and back arching
GER commonly resolves spontaneously and without _____
significant complications
regurgitation is very common in infants and typically resolves between 7-12 months of age as the esophageal sphincter matures. Common causes of regurgitation are
rapid administration of EN or formula
delayed gastric emptying
Feeding tube migration
what is the max GIR for a term infant getting PN
14-18 mg/kg/min
a high eGFR in children can cause
fat production, hepatic steatosis, PNALD, hyperglycemia, hypertriglyceridemia
in an infant getting PN what is the minimum amount of soybean oil based ILE needed to prevent EFAD ?
0.5-1g/kg/day
fatty acids are important in infants/children because of their role in
brain development
standardized neonatal parenteral amino acid solutions differ from standard adult PN amino acids by having a higher content of
tyrosine and taurine
what 2 amino acids are considered essential in neonates due to enzyme immaturity
tyrosine and taurine
what 3 amino acids are given in lower amounts than adults
phenylalanine, methionine, glycine
_______ amino acid is not part of a standard infant PN amino acid solutions but can be added separately to lower the pH to optimize calcium and phosphorous solubility
cysteine
the amino acid cysteine is not part of standard pediatric amino acid solutions in PN but can be added for what benefit
optimizes calcium and phosphorous solubility by lowering the pH
What is the recommended daily intake of selenium for term infants receiving PN
2 mcg/kg/day
what are the functions of selenium
immune function, antioxidant function, thyroid hormone activity and regulation
selenium must be added ____ to PN in neonates
separately
immediately following neonatal cardiac surgery, which of the following is the best estimate of parenteral caloric requirements
55-60 kcal/kg/day (lower than 89)
what therapies most appropriate in the nutritional management of an infant with chronic lung disease
high calorie, fluid restriction using concentrated formulas
why are calorie needs increased in infants with chronic lung disease
due to increased work of breathing, emesis and chronic infections
_____ is necessary in infants with chronic lung disease to decrease fluid build up around the heart and lungs
fluid restriction
Pancreatic enzymes that are supplemented in high doses in children with cystic fibrosis could result in
fibrosing colonopathy
pancreatic enzymes are used are used in children with cystic fibrosis in order
to decrease steatorrhea, increased nutrient absorption
what is the maximum number of units of lipase/kg/day to avoid fibrosing colonopathy
<10,000 units/kg/day
Use of Lactobacillus rhamnosus GG (LGG) in pediatric practice has been found to be most effective in treating
infectious diarrhea/gastroenteritis
An infant has a complete ileal resection with preservation of the ileocecal valve. What would be the primary nutritional concern?
vitamin B 12 deficiency w/ bile acid deficiency
preterm infant formula or fortified human milk is used for premature infants becuase
after the 1st month, unfortified human milk may have inadequate protein amounts
preterm formulas contain ___ to __% of carbohydrate calories from lactose and medium chain triglycerides to aid with absorption
40-50%
premature infant formulas are higher in what macronutrient
protein
Necrotizing Enterocolitis (NECT) etiology is unclear. but ____ has been found not to increase the risk
early minimum enteral feeding does not increase the risk of NEC
what is the benefit of starting minimum enteral feedings on infants
shortens the time to get to full feeds faster weight gain improved feeing tolerance decreased hospital length of stay decreased incidence of infection for LBW/VLBW
in premature infants, when medically possible starting ))) can begin on the day of birth
minimum enteral feedings
exclusive EN has been shown to be effective in inducing remission of Chron’s disease in the pediatrics population. What EN formula is recommended as the first line treatment
polymeric formula
biliary atresia in infants is most frequently associated with
fat malabsorption
atrophy of the bile ducts causing obstruction of bile flow from the liver to the biliary system & small intestine is called
biliary atresia
biliary atresia will result in
a significant decrease in bile acids required for fat absorption, causing fat and fat soluble vitamin malabsorption . Essential fatty acid deficiency will not occur as long as LCTs are supplemented
what is a characteristic of cachexia in pediatric oncology patients
progressive lean tissue & body fat
what method of estimating energy requirements in critically ill children is LEAST accurate when compared to resting energy expenditure measurement by indirect calorimetry
RDA (recommended dietary allowance)
In the pediatric ICU, predictive equations are ___ consistent with measured energy expenditure leading to over or underfeeding
NOT
what is the gold standard for estimated energy needs in the pediatric ICU
Indirect Calorimetry
Nutrition therapy for pediatric patients with <20% total body surface area burn typically includes
oral intake of high calorie, high protein diet
In Chron’s disease ___ is thought to positively alter the gut microbiome and ______ is recommended unless there are symptoms of malabsorption of GI dysfunction
EN
polymeric
what are the clinical symptoms of celiac disease
failure to thrive, constipation, anemia, diarrhea, abd pain/distention, vomiting, short stature, weight loss, inadequate weight gain, dermatitis, decreased bone mineral density, fatigue, delayed puberty
a 2 month old infant who has been exclusively fed with cow’s milk based formula develops a full body rash, what would be the next step
switch to a protein hydrolysate based formula
what are signs/symptoms of a cow’s milk allergy
blood in stool diarrhea skin rash eczema wheezing
The biochemical defect in Phenylketonuria (PKU) prevents the hydroxyl of phenylalanine to tyrosine which causes a build up of phenylalanine in the blood and a subsequent deficiency of tyrosine
provide a phenylalanine restricted, tyrosine supplemented diet
what are the metabolic alterations noted during the ebb response following a burn injury to a pedi patient
decreased resting energy expenditure hyperglycemia low insulin low oxygen consumption decreased blood pressure, cardiac output and decreased body temperature
after the EBB phase of a burn, comes the flow phase which exhibit these metabolic alterations
increased catecholamines, increased insulin, increased glucagon/corticosteroids with hyperglycemia, catabolism, increased body temp, increased losses of nitrogen, magnesium, phos and potassium and accelerated gluconeogenesis
what is the diagnostic criteria of infantile anorexia
refusal to eat adequate amounts of food for 1 month or greater and or growth deficiency
what nutrition support therapy is essential to intestinal adaptation following significant bowel resection
Enteral nutrition (human milk preferred)
