Flashcards in Nutrition: Parenteral & Enteral Deck (81)
How should nutrition be initiated in the neonate?
early & consistently to maintain the rate of intrauterine growth for term and preterm babies
What is adequate nutrition linked with?
brain growth, health status and repair; ex: repair of damaged tissues with chronic lung dz
How do you know when nutrition status is optimal?
allows for maximum growth without adverse effects
What infants have the best neurocognitive outcomes?
infants who grow at the highest quartile ; IUGR and related comorbidites have inadequate nutrition and can lead to poor outcomes
What is the goal of neonatal nutritional care?
to facilitate a rate of growth that approximates the rate of intrauterine growth of a normal fetus at the same post conceptual age (approximately 15-30g/kg/d)
What is the typical kcal requirement for a preterm infant?
120kcal/kg/d for LBW, could be more for an infant with high metabolic needs or catch up growth needs
What population of infants has higher caloric intake requirements?
chronic lung dz, NEC, sepsis, cardiac anomalies- have been shown to have higher metabolic needs and to gain wt more slowly than their peers (may need 140kcal/kg/d); 25-45% more energy
What are the benefits of TPN?
promote overall nutritional health of the infant, decreases the magnitude of the nadir of postnatal weight loss- supporting an earlier return to BW, decreases our dependence on the baby's tolerance of enteral feeding (especially important in babes c h/o GI surgery or EPTL
What is the recommended caloric intake for TPN?
80-100kcal/kg/d; parenteral needs are less r/t negligible fetal loss and increase absorption with parenteral nutrition
What is the composition of calories in TPN?
CHO should not exceed 50%, protein should not exceed 12% and IL should not exceed 40%
As it r/t enteral nutrition, to approximate the equivalent of 3rd trimester intrauterine weight gain, what should caloric intake be?
a minimum of 120kcal
What is the goal of protein administration?
to prevent negative energy balance, negative nitrogen balance and catabolism
What is the clinician hoping to achieve by beginning AA early in neonatal life?
by beginning AA administration in the first neonatal hours, we are avoiding a period of early malnutrition; first strategy to prevent critical growth failure and promote and enhance neurodevelopment outcome and glucose tolerance
What are the benefits of early AA infusion?
stimulates the endogenous release of insulin and prevents nonoliguric hyperK; prevent metabolic shock
How does early AA infusion promote glucose tolerance?
may stimulate endogenous insulin secretion consistent with the concept that forestalling the starvation response improves glucose tolerance
How does early AA infusion prevent nonoliguric hyperK?
when the plasma levels of argentine and luciene decrease, secretions of insulin also decreases. this contributes to the leakage of intracellular K
Where should AA infusion begin?
with 1g/kg/d and increase by 1g/kg/d until the goal is reached (3-4g/kg/d); 1.5-2g/kg/d is sufficient to avoid catabolism in all groups
What is catabolism?
the break down of muscle
What is anabolism?
the gain of muscle
In what conditions are most neonates anabolic?
at 2/g/kg/d of AA and 50kcal/kg/d
Protein deposits or the gain of muscle is directly correlated to what?
with protein intake if superimposed catabolic conditions are not present
What occurs when an infant only receives supplemental glucose?
loose 1% of protein stores each day, a negative nitrogen balance and catabolic state
In VLBW infants, what is the progression of metabolic shock?
some key AA can decline from the time the cord is cut, this shock may trigger a starvation response for which endogenous glucose production is a prominent feature.
What is the etiology of glucose intolerance in the VLBW baby?
Irrepresible glucose production may be the cause of this so called glucose intolerance that often limits the amount of energy that can be given; glucose tolerance improves substantially by the introduction of early AA
How many calories are in each gram of protein?
How much nitrogen is in each gram of protein?
1g protein= 1g AA= 0.16g nitrogen
What is the effect of increasing glucose concentration?
What is the glucose utilization rate of a preterm baby compared with term?
preterm>term; the increased brain to body weight ration , decrease fat stores and increased energy expenditures
What is the glucose utilization rate for a preterm infant?