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Small Baby Care Specialist > Fluid, Electrolytes, and Nutrition > Flashcards

Fluid, Electrolytes, and Nutrition Flashcards

1
Q

What organ requires the most metabolism for optimal functioning?

A

Brain

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2
Q

What do we look for in terms of daily weight gain?

A

15-20 g/kg/day (though 19-20 g/kg/day improves neurodevelopmental outcomes)

  • Reflective of short-term nutrition and growth
  • May reflect fluid shifts
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3
Q

What do we look for in terms of weekly linear growth?

A
  1. 8-1 cm/week
    - Reflective of long-term nutrition and growth quality (poor linear growth is associated with poor brain growth and neurodevelopmental outcomes)
    - Linear growth reflects fat-free mass
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4
Q

What do we look for in terms of weekly OFC growth?

A
  1. 8-1 cm/week

- Reflective of brain growth and long-term, nutrition

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5
Q

Malnutrition

A

Faulty nutrition due to inadequate or unbalanced intake or impaired ability to utilize nutrients
- Growth failure is a result of malnutrition

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6
Q

EUGR

A

Extrauterine growth restriction: a diagnosis made at discharge or when the baby is 36-40 weeks and has failed to grow properly (<10th percentile)
- 45-75% of neonates born ELBW discharge with EUGR

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7
Q

How soon do you want to delivery nutrients to an ELBW neonate?

A

Within the first hour of birth (goal is to administer glucose within 30 minutes as the brain relies on glucose)

  • Protein prevents catabolism
  • Fat prevents essential fatty acid deficiency (give within 24 hours)
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8
Q

What is the purpose of starter TPN and what is it composed of?

A

Designed to mitigate and treat metabolic shock

- Dextrose, Protein, Calcium

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9
Q

What is the general initiation rate of glucose in ELBW?

A

Dextrose is usually initiated at D5W or D10W to achieve a minimum GIR of 4-6 mg/kg/min with the goal of 12-14 mg/kg/min

  • Lower GIR is associated with neurocognitive delays
  • Maximum safe GIR is 18
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10
Q

What is the daily protein/amino acid goal for ELBW neonates?

A

3.5-4 g/kg/day (may be restricted in acidosis or renal dysfunction)

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11
Q

What is the major extracellular cation added to TPN?

A

Sodium

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12
Q

What is the suggested daily dose of sodium added to TPN?

A

2-5 mEq/kg/day

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13
Q

What is the major intracellular cation added to TPN?

A

Potassium

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14
Q

When is the ideal initiation of enteral feeds?

A

2-48 hours of life (preferably within first 24 hours)

- Helps prevent NEC

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15
Q

What are trophic feeds?

A

Trophic feeds provide small volume feeds at a constant rate for a few days (10-20 ml/kg/day)

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16
Q

What are the daily total fluid needs for micropreemies?

A

130-200 ml/kg/day

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17
Q

What are the daily total calorie needs for micropreemies?

A

120-150 kcal/kg/day

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18
Q

What are the daily total protein needs for micropreemies?

A

3.5-4.5 g/kg/day

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19
Q

What are the daily total carbohydrate needs for micropreemies?

A

10-15 g/kg/day

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20
Q

What are the daily total lipid needs for micropreemies?

A

5-7 g/kg/day

21
Q

What are the daily total calcium needs for micropreemies?

A

120-140 mg/kg/day

22
Q

What are the daily total phosphorus needs for micropreemies?

A

60-90 mg/kg/day

23
Q

What are the daily total iron needs for micropreemies?

A

2-3 mg/kg/day (4-6 if anemic)

24
Q

When is human milk fortified in the ELBW neonate?

A

When enteral feeds are tolerated at 40-50 ml/kg/day

25
Q

What are some pumping strategies to increase lipid content in milk?

A

Hand expression, shorter time between pumping sessions, complete emptying, avoid separation of hindmilk and foremilk (pool 24-hours worth of milk together), when administering by syringe, tilt syringe slightly upwards to promote lipid delivery

26
Q

When do you ideally want the neonate to return to birth weight percentile?

A

2 weeks of life

27
Q

What constitutes a diagnoses of osteopenia?

A

Alkaline Phosphatase >900 IU/L and Serum Phosphorus <5.6 mg/dL or reduced bone mineralization on x-ray

28
Q

What are the total daily calorie recommendations for the VLBW neonate at discharge?

A

115-130 kcal/kg/day

29
Q

What are the total daily protein recommendations for the VLBW neonate at discharge?

A

2.5-3.4 g/kg/day

30
Q

What are the total daily calcium recommendations for the VLBW neonate at discharge?

A

70-140 mg/kg/day

31
Q

What are the total daily phosphorus recommendations for the VLBW neonate at discharge?

A

35-90 mg/kg/day

32
Q

What are some GI benefits to human breastmilk in ELBW infants?

A

Empties from the stomach faster, fewer residuals, quicker progression to full feeds, fewer days with parenteral nutrition/central lines

  • Factors in breastmilk stimulate GI growth, motility, and maturation
  • Babies with exclusively human milk diets face a 77% reduction in risk of NEC and associated surgeries
33
Q

How does human milk decrease risk of infection?

A

Human milk has WBCs (90% are neutrophils and macrophages which help boost the immune system)
- Promotes intestinal colonization with healthy microbiome versus bacteria like e. coli and strep.

34
Q

What are some benefits of Lactoferrin?

A

The presence of lactoferrin in breastmilk is associated with fewer respiratory tract infections, less inflammation, promotes proliferation and growth of intestinal cells, is active against CMV, HSV, and other viral infections, and overall supports a healthy microbiome

35
Q

What are the two primary hormones of breastfeeding?

A

Prolactin (stimulates breast development, causes milk cells to produce, is released in response to sucking/breast emptying)

Oxytocin (released from posterior pituitary gland, causes uterine contractions and milk letdown, las a euphoric effect on the mother)

36
Q

When is human milk highest in protein content?

A

Early during colostrum phase, as milk matures, fortification may be required to increase protein content

37
Q

List 6 maternal complications in which breastfeeding is not contraindicated

A 
Hepatitis B+
Hepatitis C
Maternal Fever
CMV
Smoking
Covid-19
38
Q

When should pumping be initiated?

A

Within 1-2 hours after delivery

39
Q

What are some hindrances to milk production?

A

Stress, lack of sleep, dehydration, not fully emptying the breast (if it doesn’t fully empty, it won’t make more milk)

40
Q

How much amniotic fluid daily do babies begin to suck and swallow in the third trimester?

A

600-800 mL

41
Q

What does swallowing amniotic fluid help develop?

A

Muscles, suck-swallow skills

42
Q

What are methods to reduce insensible water loss (IWL)?

A
  1. Double-walled, heated isolettes (convective)
  2. Humidified, NTE (evaporative)
  3. Semipermeable skin coverings (evaporative, radiant)
  4. Pre-warming of surfaces (convective)
  5. Prevention of forced air movement (convective)
  6. Inspiring warm, humidified air (evaporative)
43
Q

What do we expect hourly urine output to be by DOL 3 in neonates with normal kidneys?

A

1-3 ml/kg/hour

44
Q

Oliguria

A

Urine output <1 ml/kg/hour

45
Q

What is the recommended initial GIR to promote euglycemia in term infants?

A

5-7 mg/kg/min

46
Q

What is the recommended initial GIR to promote euglycemia in preterm infants?

A

4-6 mg/kg/min

47
Q

Gluconeogenesis

A

Synthesis of glucose from molecules that aren’t carbohydrates (amino and fatty acids)

48
Q

What hormonal changes happen at birth for the neonate to meet energy requirements without assistance of the placenta/mother?

A

Epinephrine, norepinephrine, and glucagon levels increase, while insulin levels fall

  • This stimulates hepatic glycogen utilization and stimulates gluconeogenesis
  • Glucose is maintained this way until IVF or enteral feedings are established
49
Q

Describe the clinical presentation of hypoglycemia

A

Irritability, apnea, seizures, jitteriness, lethargy, grunting, tachypnea, hypothermia, sweating, hypotonia, tachycardia

Small Baby Care Specialist (6 decks)

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