Flashcards in Nutrition: Parenteral & Enteral Deck (81)
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61
What can the deprivation of enteral feeds lead to?
atrophic ∆ in the gut and may render the gut vulnerable to pathologic organisms and NEC
62
What is the estimated caloric expenditure a/w resting metabolic rate?
50kcl/kg/d
63
What is the estimated caloric expenditure a/w activity?
15kcl/kg/d
64
What is the estimated caloric expenditure a/w cold stress?
10kcl/kg/d
65
What is the estimated caloric expenditure a/w nutritional processing?
45kcl/kg/d
66
What is included in the recommended administration of 120-150kcal/kg/d of enteral nutrition?
resting metabolic rate, activity, cold stress and nutritional processing
67
What conditions necessitate a delay to the introduction of enteral feeds?
any situation a/w GI hypoxia or decreased intestinal blood flow, including: mechanical ventilation (high settings, acute stage of illness), asphyxia, hypoxemia, hypotension, indomethacin and blood product transfusion
68
Some evidence suggests that feeds are better tolerated and better absorbed if given via which route?
transpyloric
69
What are the benefits of gut stimulating feeds?
stimulates normal postnatal gut hormone surges even at low rates, insulin is released helping glucose tolerance, significant increase in plasma concentrations of enteroglucagon, gastrin and gastro inhibiting polypeptide in preterm infants after feeding
70
What can be expected with the residuals of an infant receiving gtt feeds?
not necessary to check residuals, not unusual to have 30-50% residuals
71
What is the gastrocolic reflex?
5x baby's wt in kg= volume necessary to stimulate this emptying reflex
72
What protein is found in EBM?
whey; more easily digestible and is a/w more rapid emptying time, better absorption of nutrition, lower renal solute load and higher quality protein
73
What are contraindications for breast feeding?
illicit drugs- heroine, cocaine, meth, HIV, HSV lesion on breast, symptomatic with pos PPD or pos CXR, active breast abcesses, galactosemia, lithium, cyclosproine, methotrexate, radioactive agents and some chemo agents
74
When is portagen the formula of choice?
fat is derived from MCT oil and used in patient with bile obstruction, severe cholestasis or fat malabsoprtion
75
What is galactosemia?
a condition of primary lactase deficiency; temporary lactase deficiency often occurs with gastroenteritis
76
What formula should be prescribed to a patient with a documented cow's milk allergy?
protein hydrazaline formula, not soy
77
When is the use of soy based formula indicated?
glactosemia, lactase deficiency and parents wanting a vegetarian diet
78
For what populations is the use of soy base formula not recommended?
babes with BW <1800g, known osteopenia; may over time have decreased wt gain and poor phosphorus absorption
79
What clinical finding indicates that protein intake is inadequate?
BUN <4
80
In what values is EBM inadequate?
zinc, calcium, phosphorus, protein and sodium
81
