Nutrition

Question 0

Breast Milk Advantages

Answer 0

Dynamic composition: changes over time during the day, during the feed
Colostrum: more protein, Ig’s, carotene, enzymes to stimulate gut maturation
Mature Milk: more fat, lactose
Unique Protein Content: more whey (easily digested, rapid gastric emptying), more lactoferrin/Ig’s (prevent infection)
Unique FA Pattern: visual function, neuro development
More Lipase: fat absorption
Unabsorbed Lactose: softer stool, better fecal flora, better mineral absorption
Oligosaccharides: prevent bacterial attachment to mucosa
Minerals: more bio-available
*enhanced bonding
*mom’s lose weight faster
*natural contraception
*decreased risk breast/ovarian cancer

Question 1

Consequences of feeding solid food <6mos

Answer 1

• Increased GI illness (diarrhea)
• If formula-fed might not decrease formula intake so overall calories increase&raquo_space; weight gain
• No clear increase in allergies/atopy
• Extrusion reflex usually until 4mos
• thickening feeds doesn’t decrease reflux episodes but can reduce frequency/severity of SYMPTOMATIC episodes

Question 2

Breast-Feeding Contraindications

Answer 2

Galactosemia
Maternal HIV
Herpes, chicken pox or syphilis on breast
Maternal TB (until 2+ wks tx)
Maternal chemotherapy
Maternal drug use

Question 3

Infant Vitamin Supplementation

Answer 3

Vitamin K: at birth to prevent bleeding in BF infants
Vitamin D: 400 IU/d in ANY infant who is BF or is taking 6mos
Fluoride (prevent dental caries): 0.25mg/d if no supplemented water (exclusively BF or pre-mixed formula) when >6mos

Question 4

Infant Nutrition Requirements

Answer 4

100-120 kcal/kg/day

150-180 mL/kg/day

Question 5

Why avoid cow’s milk in infants

Answer 5

Inadequate iron
Excess protein
Excess electrolytes
 >> excess renal load
 >> high Phos >> low Ca
 >> GI bleeding

Question 6

Goat milk only

Answer 6

Folate deficiency

Question 7

Semi-vegetarian (no red meat) or lacto-ovo vegetarian (no meat)

Answer 7

Iron deficiency

Question 8

Vegan (no meat or dairy- no animal products)

Answer 8

Iron deficiency + Vit B12, Vit D, Calcium, Zinc deficiency

Question 9

Refeeding Syndrome

Answer 9

Reintroduction of carbohydrate&raquo_space;

• insulin&raquo_space; K (Phos, Mg, Ca) shift into depleted cells
• ATP production&raquo_space; use up Phos
• tissue anabolism&raquo_space; uses ATP, K, gluc, H2O
• Na, H2O retention&raquo_space; edema

Complications: rhabdomyolysis, respiratory failure, arrhythmia, seizure, delirium/coma, death

*Main Concern low Phos
also watch low K, Mg

Question 10

Marasmus

Answer 10

Infant w/severe caloric deficiency
Significant weight loss, emaciated/weak, thin skin/hair
Constipation, ravenous hunger
Slow vertical growth
Low prealbumin (albumin may be nl)

Question 11

Kwashiorkor

Answer 11

Toddler w/protein deficiency
Minimal weight loss, muscle wasting masked by edema
Hyperkeratotic depigmented peeling skin 
Diarrhea, irritability
Slow vertical growth
High Na, Cl
Low albumin, prealbumin, BUN

Question 12

Enteral Nutrition

Answer 12

Can include glutamine, long-chain polyunsaturated fatty acids, short-chain fatty acids, fiber (not in parenteral)

Question 13

Parenteral Nutrition

Answer 13

Hepatic Disease: cholestasis in infants, steatohepatitis in kids
Reversible intestinal mucosal atrophy
Risk of bacteremia

Question 14

Obesity Complications

Answer 14

HTN, hyperlipidemia, DM-II
NASH, OSA, PCOS
constipation
SCFE
pseudotumor cerebri

Question 15

Caloric Requirements

Answer 15

Like 4/2/1 rule for fluids except
“100/50/20 rule”

100 kcal/kg 0-10kg
50 kcal/kg 11-20kg
20 kcal/kg >20kg

Question 16

Protein Requirements

Answer 16

3.5 g/kg daily for preterm

2-2.5 g/kg daily for full term

Question 17

Infant Weight Loss

Answer 17

Can be due to renal fluid loss (during stress) b/c can’t handle high solute load (Na, K, Cl, Phos)— weight loss/lack of gain not necessarily lack of protein

Question 18

Iron Requirements

Answer 18

12mg/L in formula
Supplement even if BF if:
- LBW
- preterm
All need supplementation (from food) at 4-6mos

Question 19

Essential FA Deficiency

Answer 19

Most important Linoleic Acid

• alopecia
• thrombocytopenia
• scaly dermatitis

Question 20

TPN

Answer 20

Peripheral 7d
Glucose: 20% central, 10% peripheral
    10-20 g/kg/d = 30-75 kcal/kg/d
    *1500mL of 10% glucose = 150g
Amino Acid: 1.5%
    1-2 g/kg/d
    *err on low side to prevent hyperammonemia
Lipid: 
     1-3 g/kg/d
     *start 0.5g/kg/d and gradually increase to avoid high TG