Pediatric/Neonatal

Question 1

Fluid Management in Neonates

Answer 1

Consider rapid fluid changes. Assess I&O every 6 hours. Tend to have variable period of post-birth Liguria (12-36 hours). Very pre-term may have polyuria (hours to several days)

Question 2

The premature neonate is predisposed to hypoglycemia due to

Answer 2

Limited glycogen stores.

Question 3

Minimal Enteral Feedings (MEF) in preterm neonate do not

Answer 3

Increase incidence of necrotizing enterocolitis. MEF can produce both direct and indirect trophic stimulation of the gut

Question 4

Excessive IV lipid administration

Answer 4

May result in impaired pulmonary function and displacement of bilirubin from albumin binding sites

Question 5

Low birthweight

Answer 5

<2500 g

Question 6

Very Low Birth Weight

Answer 6

<1500 g

Question 7

Extremely Low Birth Weight

Answer 7

<1000 g

Question 8

Micropremie

Answer 8

<750 g

Question 9

AGA

Answer 9

Appropriate for gestational age

Question 10

SGA

Answer 10

Small for gestational age

Question 11

LGA

Answer 11

Large for gestational age

Question 12

Current standard for postnatal growth in the premature infant

Answer 12

Duplicates normal in utero growth ~ 1.5% (15 g/kg) increase in weight per day

Question 13

Adverse outcomes hypoglycemia in premature infants

Answer 13

Reduced head circumference, performance in perceptive and motor capacity, and intelligence quotient

Question 14

DHA important for development of

Answer 14

Lipid rich neuronal membranes (retina and brain). Provided from maternal-fetal transfer in the last trimester

Question 15

The smaller and more premature infant (<26 weeks and <750 g) may require

Answer 15

Up to 2-3 weeks to regain birthweight

Question 16

Neonates protein requirement

Answer 16

3-3.5 g/kg/day for appropriate growth and nitrogen retention

Question 17

Conditionally essential AA in infants

Answer 17

Cysteine, taurine, tyrosine, and histidine - due to immature transsulferation pathway

Question 18

Cysteine impacts PN by

Answer 18

Reducing PH of PN admixture - increased calcium and phosphorous stability

Question 19

Infant hypoglycemia

Answer 19

BG<40 mg/dL (should be treated in infants of any age)

Question 20

Preferred IVLE for infants

Answer 20

20% is preferred over 10% due to lower phospholipid content per fat gram (in 20%)

Question 21

Lipid infusion rate (infant)

Answer 21

Not exceeding 0.15 g/kg/hour

Question 22

The recommended daily intakes (per kg) of Ca, Mg, Phos are much _____ in the preterm infant compared to the term infant

Answer 22

Higher (may need fortifier for breast milk for rapidly growing premature infant)

Question 23

AAP recommends iron supplementation to begin in

Answer 23

The first 2 months of life and continue through first year

Question 24

NEC is primarily in the premature infant and usually involves the

Answer 24

Distal small intestine

Question 25

Coordination of sucking, swallowing, and breathing do not occur for premature infants until approximately _______ gestation

Answer 25

34 weeks

Question 26

Infants requiring > 2 weeks of PN should receive lab surveillance for

Answer 26

Liver dysfunction and metabolic bone disease

Question 27

Amino acids should be initiated (PN) on

Answer 27

First day of life to avoid catabolic state. Start 1-2 g/kg/ day and advance by 0.5-1.0 g/kg/day up to 3-3.5 g/kg/day goal

Question 28

IV glucose infusion rates

Answer 28

Start at 5-6 mg/kg/day Advance by 2-4 mg/kg/day Up to 10-12 mg/kg/day

Question 29

Osmolarity of enteral feeding for infants should be

Answer 29

<400 mOsm/L (<450 mOsm/kg liquid)

Question 30

Most sensitive indication of acute malnutrition in a child

Answer 30

Weight-for-length percentile

Question 31

Brain metabolism accounts for >_____% of REE in an infant

Answer 31

50

Question 32

Infants require ____ kilocalories for growth than do older children

Answer 32

More

Question 33

_______ (PN complication) occurs more frequently on infants than adults

Answer 33

Cholestatic Liver Disease (CLD)

Question 34

Bone age test is done by

Answer 34

Radiograph of child’s knees or left wrist. Children with growth that has been affected would be expected to have delay in bone age

Question 35

REE for children increases by ____ for each degree of fever

Answer 35

13%

Question 36

Breast milk and infant formulas _____ kcal/oz Enteral Formulas for children ____ kcal/oz

Answer 36

20 kcal/oz (breast milk/infants) 30 kcal/oz (children)

Question 37

Initial rate of _____ mL/kg/hr of formula via continuous infusion is usually successful

Answer 37

1-2 mL/kg/hr - increased every 6-8 hours

Question 38

Major difference for prescribing protein, lipids, electrolytes for pediatric PN

Answer 38

Prescribed on a per kg body weight per day basis (kg/day)

Question 39

If PN >1 month, which trace element will need to be added that is not in standard pediatric trace elements

Answer 39

Selenium

Question 40

Pediatric IV MVI include what vitamin not typically in adult preparations?

Answer 40

Vitamin K

Question 41

Children with cystic fibrosis may require greater than _____ of the RDA for calories

Answer 41

120-150% - diet planned to exceed the RDA/DRI for kcal and all other nutrients. Also recommend to have liberal use of table salt (increased sweat losses)

Question 42

Early presentation of celiac disease occurs during the 1st 2 years and manifests as

Answer 42

Diarrhea and failure to thrive

Question 43

Secondary lactose deficiency in children with celiac disease resolves ______ after starting a gluten-free diet

Answer 43

Usually within 2-4 weeks

Question 44

Phenytoin is recognized to have absorption impacted by tube feeding, recommended to be given

Answer 44

In between bolus feeds

Question 45

Risk factors for PN-associated cholestasis include

Answer 45

Low birth weight Prematurity Length of time on PN Occurrence of sepsis