LSU Neonatology study set > nutrition > Flashcards

nutrition Flashcards

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1
Q

hormones that impact fetal growth

A

placental lactogen
fetal insulin
insulin-like growth factor

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2
Q

decrease with advanced gestational age

A

total body water
extracellular water
sodium content
chloride content

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3
Q

increase with increased gestation age

A

intracellular water
protein
fat
calcium, phos, mag
iron

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4
Q

glucose gets to fetus how

A

facilitated diffusion

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5
Q

amino acids get to fetus how

A

active transport

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6
Q

majority of energy requirements come from which two area

A

resting energy expenditure and energy storage (growth)

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7
Q

essential AA

A

branched: valine, leucine, isoleucine

histidine
lysine

treonine

methionine
phenylalanine

tryptophan

“Hit the lights 4 me please “

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8
Q

protein should provide how much of total calories

A

7-15 percent

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9
Q

AA solutions are lacking which to amino acids

A

cysteine and tyrosine

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10
Q

essential fatty acids

A

linoleic and alpha-linolenic

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11
Q

most common FAs in human milk

A

palmitic acid and oleic acid

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12
Q

symptoms of essential fatty acid deficiency

A

scaly dermatitis , alopecia, thrombocytopenia, increased risk of bacterial infections and FTT

can happen in 3-7 days without fats,
can be prevented with as little as 0.5-1g/kg/d

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13
Q

Holman index

A

triene:tetraene ratio

diagnoses essential fatty acid deficiency, if greater than 0.2

triene = mead acid, metabolic
tetraene = derivatives of the omega 3 and 6, diet derived

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14
Q

fat cals

A

1 g fat = 9 cals

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15
Q

fats should make up how much of daily intake

A

30-50 %

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16
Q

primary carb in breast milk and standard formula

A

lactose

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17
Q

lactose helps what minerals

A

increased absorption of mag and calcium

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18
Q

1 g of carbs

A

= 3.4 cals

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19
Q

grams of glucose for positive nitrogen balance

A

6 g of glucose

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20
Q

b12 deficiency

A

vegetarians

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21
Q

folate deficiency

A

goats milk / evaporated milk

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22
Q

B 12 linked to

A

megaloblastic anemia

methylmalonic acidemia

homocystinuria

folate deficiency

required intrinsic factor for absorption

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23
Q

Copper use

A

red cell production, iron absorption

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24
Q

chromium use

A

regulates insulin and glucose levels

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25
iron is absorbed
duodenum and proximal jejunum , enhanced by vit c
26
selenium
needed for help with oxidative stress, can cause cardiomyopathy if deficiency
27
hormones that promote breast growth and ductal branching
estrogen and human placental lactogen
28
triggers of milk production
decrease in estrogen and progesterone lead to allowing prolactin to stimulate milk production
29
milk release stim by
oxytocin
30
liver disease what do you do with TPN
decrease copper and manganese, but increase zinc
31
kidney disease and TPN
decrease chromium and selenium
32
TPN cholestasis cause
phytosterols from soybean oil
33
GIR
% Dextrose( as a whole number) x rate / 6 x wt
34
nitrogen balance
(protein g/d x 0.16 ) - (urine loss + 4)
35
large placenta association with kidney disease
congenital nephrotic syndrome
36
can see polyuria due to decreased corticomedullary concentration gradient which is seen with
cystic kidney disease, obstructions, nephritis
37
can see polyuria due to decreased ADH on tubules
seen with hypercalcemia, pristine, bartter and proximal RTA
38
Most common Renal anomalies
Horseshoe kidney unilateral renal, genesis more common with left in pelvic kidney, also more common on the left
39
proteinuria, hypoproteinemia, hyperlipiddemia, edema
congenital nephrotic syndrome 2 types : Finnish (MC) anddd diffuse mesangial sclerosis fisnish is associated with elevated AFP, large placenta
40
multi cystic dysplastic kidney disease Who Where How Looks like
males, left, can be bilateral , sporadic, multiple non-communicating cysts embedded in dysplastic tissue 90% have other anomalies
41
polycystic kidney disease does not have
dysplasia
42
ArPKD Age Ch Cells Where are the cysts Profession
infantile = little r Chromosome 6 cilia- related disorder for kidney and bile ducts cysts in renal collecting ducts kidney disease first then liver disease later in life, HTN, 50% ESRD by 10 yrs
43
ADPKD
AD = Adult cysts along nephrons involves liver, pancreas, spleen, GU , brain increased risk for cerebral aneurysms ESRD late in life
44
proximal tubule dysfunction leading to urinary losses of AA, glucose, phosphate and bicarb ; may be polyuric and dehydrated
Fanconi syndrome
45
Caracas, mental deficiency, tubular dysfunction, proteinuria, congenital nephrotic syndrome ; increased maternal AFP
Lowe dyndrome oculocerebrorenal syndrome X - linked recessive
46
Exstrophy of cloaca sequence
Primary defect of early mesoderm -common opening for bladder, vagina and rectum Extra for your bladder, basil, incomplete vertebrae, cryptorchidism and other anomalies XY low change of fecal continence
47
extrophy of bladder sequence
more common in males high reoccurrence risk of parents affects too exposed posterior wall of bladder epispadias
48
Zellwger syndrome/ cerebralhepatorenal syndrome
hepatomegaly, glaucoma, brain anomalies, chondrodydtrophy , cortical renal cysts
49
meckle-gruber
encephalocele, microcephaly, polydactyly, cryptorchidism, cardiac problems, liver disease, polycystic or dysplastic kidneys
50
renal artery vs vein thrombus
artery is more likely from a catheter vein can be from catheter or not hematuria in both
51
risks for renal vein thrombosis
hyperoosmolarity, polycythemia, hypovolemia, hypercoagulable
52
enlarged kidney, hematuria, renal failure
renal vein thrombosis
53
Tissue with the largest amount of fatty acids
Brain and retina
54
Amino acid that is considered semi essential to newborns and is often added to amino acid preparation
Cysteine
55
Best level of vitamin D deficiency
25-oh vit d
56
What is needed for converting homocysteine to methionine
Folate
57
Fecal energy loss
10c/kg/d
58
Extremely preterm, resting energy expenditure
50 c/kg/d
59
Trace element optimal dosing
Zinc 350mcg/kg/d Copper 120mcg/kg/d
60
Donor milk versus formula
Lower incidence of nec and sepsis Better lipoproteins and lower blood pressure during adolescence Delayed early weight gain
61
Stocked TPN should have one amount of amino acids
3.5g/80ml or 4/100
62
Pasteurization of donor milk reduces
IgA, lactoferrin and lyozymes Olligosaccharides are not changed
63
The factor in human milk that has been most attributed to decreasing nec
 Platelet activating factor acetylhydrolase
64
Nutritive sucking versus non-nutritious sucking ratios
A lower ratio is more indicative of nutritive, sucking as opposed to higher ratios 2:1 vs 8:1
65
Most common whey protein in human milk
Lactoferrin, which produces lactoferrocin which aids in direct destruction of bacteria and fungus
66
IUGR infants are at increased risk of what?
Increased carotid blood flow (assym) increased MCA Dopplers (assym) increased catecholamines increased risk of meconium increased risk of renal failure Decreased immunoglobulins Decreased calcium Polycythemia Increased perinatal, depression
67
Glucogenic amino acids
Alanine glycine glutamate
68
If you resect terminal ileum what may you lack
B12 Bile salts Zinc
69
Refeeding syndrome
Can happen in premies with high aa early. Low k and phos You need a low cal:phos ratio You can reduce the amount of aa to help with severity of low phos
70
Who do premies not tolerate intralipids well
Decreased lipoprotein lipase which helps clear triglycerides from the blood stream
71
Cow milk has more - compared to human milk
Protein and electrolytes
72
Fridge storage of milk
Lacks bacteriosidal activity after 3 days
73
Freezing milk
Decreased lactoperoxidase, cellular activity and lipase
74
Heating milk
Loss of enzymes Antioxidants Increased bacterial growth
75
Holder pastuization
Decreased lactoferin, lysozyme, IgA, protein denatured Loss of all IgM but lipids are kept
76
Additional essential aa for premies
Cysteine Tyrosine Arginine Taurine
77
TPN cholestasis
Duct proliferation leads to fibrosis Switch to omegaven and drop aa down to 2
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