Neonatal and Infant Nutrition

Question 1

particular issues of infancy

Answer 1

• Immature liver function – prone to jaundice
• Immature kidney function – cannot dilute or concentrate urine
• Immature gut - ‘leaky’ epithelium, lacking commensal flora
• Immature immune system – naïve, less able to produce immune factors and discriminate bad from good (or indifferent) – prone to infection
• Period of intense neurological growth and development
• Immature blood clotting – neonatal coagulopathy

Question 2

what is best to feed a neonate

Answer 2

breast milk

Question 3

alternatives for breast milk

Answer 3

wet nurses

Question 4

population of women who are most likely to initiate breast feeding

Answer 4

• first time mother
• mothers greater than 30 years old
• higher social class scale
• longer in education

Question 5

socioeconomic and cultural factors that stop women from breast feeding

Answer 5

• medical advice
• maternal work demands
• family pressures
• commercial advertising

Question 6

biological factors that stop women from breast feeding

Answer 6

infant size, development, growth, increased appetite, maternal lactational ability

Question 7

major reasons women stop breast feeding at less than 1 week, 1 week - 4 months, greater than 4 months

Answer 7

• less than a week: baby rejected milk
• 1 week - 4 months: insufficient milk
• greater than 4 months: mother returned to work

Question 8

what is the trend of breast feeding as children get older

Answer 8

breast feeding starts higher at 1 week and decreases as child gets older

Question 9

in countries with highest burden of breast feeding, how can a good percentage of the child death be prevented

Answer 9

by breast feeding the children

Question 10

mean production of milk a day

Answer 10

700-850mL/day

Question 11

how does the content of the milk change over time

Answer 11

• colostrum: milk first produced and it has lots of protein, immunoglobulins, T and B cells
• transitional milk
• mature milk: begins watery to quench baby’s thirst but then gets more fatty by the end of breast feeding for nutrition

Question 12

important content of breast milk

Answer 12

antibodies, immune cells, stem cells

Question 13

length of time recommended for mother to breast feed

Answer 13

Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond
(the more a child suckles the breast, the more milk is produced)

Question 14

women who are breastfeeding require how much energy and protein a day

Answer 14

8.10MJ/day = 1,940Kcal/day of energy
45.0g/day of protein
but as the baby age increases, there will be increased demands for protein and energy

intake is 60-80g per day for normal adults so actually no need to increase protein intake

Question 15

does BMI affect breast milk production

Answer 15

no

Question 16

in comparison to human milk, what does cow milk have increased amount of

Answer 16

cow milk has higher protein, sodium, and casein fraction with predominant whey protein (absent in human milk)

Question 17

in comparison to cow milk, what does human milk have increased amounts of

Answer 17

lactose and whey fraction (absent whey protein)

Question 18

what is positively related to weight gain during pregnancy

Answer 18

fat content of milk

Question 19

what vitamins are adequate in breast milk and what substances are breast milk inadequate in

Answer 19

adequate - vitamin A and B6 (depending on maternal diet and nutritional status)
inadequate - vitamin D, iron, and zinc

Question 20

importance of breast milk proteins

Answer 20

• 285 different proteins have been identified in the proteome of human breast milk
• Source of amino acids
• Promote digestion and absorption of other milk nutrients
• Have a role in defence against pathogens
• Promote gut and immune maturation

Question 21

main carbohydrate in breast milk and what is it made out of

Answer 21

lactose (glucose + galactose)

Question 22

why is lactase important

Answer 22

it is useful for hydrolysis of lactose on gut mucosal border before it can be digested

Question 23

when does lactose intolerance begin and why

Answer 23

at six months because of decline of lactase activity

Question 24

importance of breast milk fats

Answer 24

• Breast milk ~ 40 g/l fat (= Cow’s milk) and provides ~50% of energy in milk
• Promotes the accumulation of body fat (insulation and energy store)
• Allows for absorption of fat soluble vitamins (A, D, E and K)
• Provides essential fatty acids important in brain and eye development, healthy skin and hair and immunity

Question 25

when does the brain grow rapidly

Answer 25

from fetus to about 1.5 years

Question 26

two essential fatty acids in human milk

Answer 26

DHA (docosahexanoic acid) and EPA

Question 27

what is DHA made out of

Answer 27

DHA has 22 carbons with 6 double bonds

Question 28

importance of pregnancy to DHA

Answer 28

- it promotes maternal DHA status - increases DHA content in breast milk - promotes fetal eye and brain development

Question 29

importance of DHA in infants and children

Answer 29

- brain and eye development - improves visual acuity - promotes cognitive performance

Question 30

importance of DHA in children and adults

Answer 30

cardiovascular heart health - lowers triglycerides - increases HDL - maintains/lowers heart rate - modest reduction in blood pressure at higher doses

Question 31

importance of DHA in elderly

Answer 31

``` brain and eye health and function lower DHA in blood is associated with: -cognitive decline -higher risk of dementia -higher risk of age related macular degneration ```

Question 32

US average intake of DHA vs. the recommended

Answer 32

US intake is very low at 30-80mg | recommended is 200mg

Question 33

how are the neonates micronutrients met

Answer 33

by drinking breast milk with the exception of vitamin D, zinc, and iron

Question 34

other milk components

Answer 34

LICIO • Lactoferrin – Plays a role in iron uptake and in immune defence • Immunoglobulins (antibodies) – Involved in immune defence (secretory IgA makes up 10% of human breast milk protein) • Cytokines (“hormones of the immune system”) – Involved in immune defences • Immune cells – Involved in immune defences • Oligosaccharides – Involved in immune defences and in gut and immune maturation

Question 35

infant benefits of breast feeding

Answer 35

- reduces risk of neonatal infections - promotes development of the immature gut - reduces risk of infant allergy

Question 36

what do bottle fed infants have an increased risk of getting

Answer 36

diarrhea and pneumonia

Question 37

downside to breast feeding

Answer 37

areas where HIV is prevalent, there is transmission of the virus through breast milk

Question 38

population with HIV mother that has highest risk of children being infected with HIV

Answer 38

the kids that drink mixed milk (mother's milk + formula) then it's the kids who drink mother's milk then it's those who are never breast fed

Question 39

why is there an increased risk of mortality and morbidity in children whose parents are HIV positive and decide not to breast feed

Answer 39

tends to be in undeveloped areas where formula is being mixed with contaminated water

Question 40

what are WHO's recommendation for breastfeeding when anti retroviral drugs are available

Answer 40

exclusively breast feed the child for six months as long as baby and mother are on anti retroviral drugs

Question 41

what are WHO's recommendation for breastfeeding when there are no anti retroviral drugs available and formula is affordable

Answer 41

completely avoid breast feeding

Question 42

what are WHO's recommendation for breastfeeding when there are no anti retroviral drugs available and formula is not affordable or safe

Answer 42

breastfeed child but for the first few months of life

Question 43

what is the US CDC policy on breast feeding baby if mother is infected with HIV

Answer 43

DO NOT BREAST FEED!

Question 44

what are some breast feeding contraindications in infants

Answer 44

inborn errors of metabolism - galactosemia (unable to metabolize galactose) - congenital lactase deficiency - PKU

Question 45

what are some breast feeding contraindications in mothers

Answer 45

* Maternal infections in which transmission occurs (HIV, Human t-cell lymphotrophic virus, cytomegalovirus, tuberculosis) * Mother receiving therapeutic drugs which are transferred into the breast milk and may harm the infant * Mother consuming other drugs (alcohol, opiates etc.)

Question 46

short term advantages of breast milk over formula

Answer 46

* ↓ necrotising enterocolitis (6 x less) * ↓ diarrhoea (50% less) * ↓ gastrointestinal infections * ↓ respiratory infections * ↓ otitis media * ↓ risk of type 1 diabetes

Question 47

long term advantages of breast milk over formula

Answer 47

* ↓ incidence inflammatory bowel disease * ↓ diastolic blood pressure * ↓ systolic blood pressure * ↓ risk of type 2 diabetes * ↓ risk of obesity * ↓ risk of CVD * ↓ severity and delayed onset of coeliac disease

Question 48

what does chronic nutritional deficiency lead to

Answer 48

failure to thrive

Question 49

causes of nutritional deficiency in industrialized places in preschool children aged 1-5years old

Answer 49

– Refusal of solids/high intake of liquids – Intake of low-density foods (healthy diet) – Behavioral eating problems – Physical illness

Question 50

WHO charts of growth patterns for breast fed infants uses what measurements

Answer 50

head circumference, length/height, weight

Question 51

what changes in percentiles should be followed up according to the growth chart

Answer 51

if child has an increase or decrease by 2 percentiles

Question 52

early nutrition is important for calcium deposition so what happens if calcium needs are not met during early nutrition

Answer 52

there is a decreased threshold for increased risk of osteoporosis, falls, and fractures