Paediatric seminar: Failure to thrive Flashcards
(40 cards)
What is the medical viewpoint for calorie?
The small calorie approx the energy needed to increase temp of 1g of water by 1C
The large calorie (Cal) approx the energy needed to increase temp of 1kg of water by 1C (4.2kJ) food calorie
What is excessive Cal leading to obesity?
Excessive 3500 Cal ~ 1 pound weight
Positive balance of 200 Cal per day for 5 weeks = 200 x 35 = 7000 Cal, leading to a gain of 2 pounds
What are the essential nutrients in food and milk?
- Protein
- Fat
- Carbohydrates
- Minerals
- Vitamins
- Water
Is protein sufficient in breast milk?
Protein in human breast milk is adeqauate for normal term infants (2-2.5g/kg/day)
Essential amino acids (human milk: in whey component)
Compare whey vs casein proteins
Whey proteins: 60-80% of proteins in human breast milk, its ratio changes with stage of lactateion
Portion that remains soluble on acidification: alpha-lactalbumin, lactoferrin, binding proteins, immunoproteins, enzymes (lipase, lyzozyme)
Casein michelles: complexes of proteins and salts, 20-40% of proteins in human milk; 80% of bovine milk. Acidification –> precipitates (producing cheese)
Which milk is casein dominant vs whey dominant?
Cows milk is casein dominant
Humans breast milk is whey dominant
* Colostrum- whey:casein = 90:10
* Mature milk- whey:casein = 60:40
What is the energy and protein intake in breast milk vs formula?
Breast milk: protein concentration (g/100cal) with age
Formula: designed to meet highest possible needs i.e. youngest of infants
Excess nutrients and increase metabolic stress
What are the fats in diet?
- Dietary fat consists of provision of 40-50% of total caloric intake with at least 3% of total calories as linoleic acid
- MCT can boost calories
- LC- PUFA (polyunsaturated fatty acid) is important for growth and development of retina and brain: n-3, n-6 essential fatty acid (LA, DHA, ARA)
What is the glucose utilization rate in term infant?
What is the physiology of energy storage in infants?
4-6mg/kg/min (6-10g/kg/day)
- Glycogen stored from the start of 2nd trimester
- Storage can be exhausted within 12 hours
- Lactose –> glucose (usage) and galactose (storage)
What are the constituents during fasting?
- Glucose – 4-6mg/kg/min
- Fluid - ~ 100-120 ml/kg/day depends on the age and status of baby
- Other supplements e.g. Ca
A newborn weighing 3kg required fasting for a day procedure: what kind of fluid and how much would you give to the baby?
- Body weight 3kg
- Glucose req = 4-6mg/kg/min =26 gram glucose per day
- Fluid req 100ml/kg/day = 300ml/day
- Selection of fluid: D10 (10 gram/100ml)
What are the nutritional comparisons of milk: energy, protein, whey: casein, fat, carb, ironm vit D, renal solute load
What are benefits to baby for breastfeeding?
What immunologic protection?
- Nutritional value: best composition with high bioavailablity
- Reduced obesity and overfeeding
- Protect against infection & allergy
- Less contamination, readily available
- Enzymes, hormones and immune factors
- matches with the sequence of postnatal development of the immune system
- help adaptation of the gastrointestinal tract in the switch from fetal to postnatal life
What are the protective properties of breastfeeding?
3 overlapping groups of bioactive agents
* Direct acting antimicrobial agents
* Antiinflammatory agents
* Immunomodulating agents
Protections against infections and atopy
What are the increased health risks of not breastfeeding (baby)?
- Diabetes 40%
- Obesity 25%
- Recurrent ear infection 60%
- Hospitalization for asthma or pneumonia 250%
- Death in first year 27%
What are the benefits to mother for breastfeeding?
- Involution of uterus
- Better physical shape
- Reduce neoplasm
- Improves psychological well being
- Less postnatal depression
What are increased health risks of not breastfeeding (mother)
- Maternal Breast cancer 39%
- Maternal Type 2 diabetes 14%/yr
What are benefits to family for breastfeeding?
- Maternal-infant bonding (attachment)
(less school withdrawal, behavioral problem and abuse of child) - Contraceptive effect (for birth control)
- Most economic & effective way of feeding
What are the benefits to society for breastfeeding?
- Less medical consultations
- Less hospitalizations
- Less medical expense related to infections
What is breastfeeding disadv?
- Physical exhaustion of mother (frequent, on demand feed)
- Emotional stress on mother
- Sleeping quality (mother) impaired
- Infections – virus e.g. HIV, CMV, HTLV
- Transmission of undesirable drugs e.g.Chemo-, radiotherapy, psychiatric drugs
- Inborn error of metabolism – special diet
Can a mom be too thin to breastfeed?
- Previous study on breast milk from malnourished mothers in Gambia showed that the nutritional value of their milk is same as that of women in UK
What are the contraindications of breastfeeding?
- Chemotherapeutic agents
- Drugs of abuse - e.g. marijuana, heroin, PCP/Amphetamines, nicotine
- Radioactive compounds- require interruption of nursing
- Anxiolytics,antidepressants,andantipsychotic medications effects are not known but are of concern
- Contraindicated-
Lithium, Tetracycline, Cyclosporine, Ergotamines, Bromocroptine (suppresses lactation)
What are maternal illnesses that contraindicate breastfeeding?
- Toxemia: drugs used to treat toxemia are contraindicated for nursing mothers and milks discarded until the medicatiosn are stopped
- TB: +ve skin test and -ve chest radiographs may continue nursing while taking INH. If mother has active TB there should be no contact between the mother and the infant until mother is successfully treated.
- HIV: HIV +ve mother should not breastfeed because virus is transmitted through the milk to the infant. In areas where substitutes for breast milk are not available, nursing should be done by HIV+ve mothers (3rd world countries risk of diarrheal illnesses in attempts to prepare formula with unclean water supplies.
- Mastitis and breast abscess: infection caused by staphylococcus; may come from plugged duct. Should use antibiotic, heat and acetaminophen. Should not stop nursing.
- Candida infection of the breast: topical antifungals like nystsatin and lotrimin should be used and the breast should be wiped off before feeds; check the infant for thrush and treat with mycostatin accordingly. Breastfeeding may continue.
- UTI: may use penicillins, cephalosporins, gentamicin and ampicillin. Tetracyclines and chloramphenicol are C/I.
- Hep A: may nurse if she feels well. If she develops hep A 2 weeks prior to delivery or within 1 week of infants birth, infant should recieve Ig
- Hep B: infant should recieve HBIG and HBV vaccine after birth and mother may nurse. Although hep B has been isolated from human milk, predominant mode of transmission is vertical at the time of delivery,
- Hep C: nursing not contraindicated
- Varicella: if both infant and mother have varicella at birth, they should both be isolated and nursing may continue.
- Herpes: infant should avoid contact with herpes lesions and if there are no vesicles on the breast, the mother may breastfeed.
- CMV: breastmilk may contain viruses, it also contains antibodies that are protective against CMV. Therefore, breastfeeding should not be stopped in CMV infeted mothers
- Syphilis: only contraindication if there are syphilitic lesions on the breast. After mother is treated and sores are healed, nursing may resume
What is the WHO recommendation for when to breastfeed?
- Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to 2 years of age of beyond
