Immunoglobulin that is high in breastmilk?
IgA
The whey-to-casein ratio in mature human milk
3:2
Breastmilk is initiated within ____
1-4 hours after birth
____ mL intake in the first week of life
60-90 mL/feeding
6-9 feedings/24 hours
[Type of Breastmilk]
High lactose, high protein, watery
Foremilk
[Type of Breastmilk]
High fat, creamy
Hindmilk
Colostrum is secreted within ___ days
0 to 7 days
What are the IgG/protective factors that are high in breastmilk
- Lactoferrin
2. Lysozyme
Colostrum has low ___
- Fat
2. Carbohydrates
Mature milk will be produced at ___ DOL
10-14
[Casein to whey ratio]
Early milk
10:90
[Casein to whey ratio]
mature milk
40:60
[Casein to whey ratio]
late lactation
50:50
Fat globules bound by membranes are rich in ____
- Phospholipids
2. Cholesterol
Formula milk has a higher ____ compared to breastmilk
- Iron
- Vitamin D
- Vitamin K
What is the definitive test to diagnose pediatric GERD?
esophageal pH probe
Esophageal pH monitoring of __ which part of the esophagus
distal esophagus
NV: <5-8% of total monitored time
Patients with GERD, patient shall be position ____ carried position
prone or upright
What are the symptoms of GERD in infants
- Regurgitation
- Excessive crying
- Irritability
What are the symptoms of GERD in children
- Vomiting
- Food refusal/feeding disturbances/anorexia
- Persisting hiccups
- Sandifer syndrome
What are the contraindications to breastfeeding?
- Galactosemia
- Septicemia
- Active TB
- Breast CA
- Malaria
- Substance abuse
- Severe neurosis or psychosis
- HIV
Mother is no longer infectious after ____ of TB treatment
2 weeks after
HIV mother can breastfeed in times where no safer alternative is available provided that
- Shortest possible duration
2. Exclusive breastfeeding
[Micronutrient deficiency]
Excematous, dry, scaly or psoriasiform, perioral, sacral, perianal areas
Zinc
[Micronutrient deficiency]
generalized scaly dermatitis
alopecia
Essential fatty acids
[Micronutrient deficiency]
edema, erythema, burning of sun exposed skin on the face, neck, hands
diarrhea, dementia
Pellagra/Niacin
[Micronutrient deficiency]
alopecia with neurological symptoms
Biotin / Vit B7
[Micronutrient deficiency]
Night blindness, xerosis
Vit A
[Micronutrient deficiency]
perifollicular erythema and hemorrhage; bleeding swollen gums
Vit C
What is the bioavailability of vitamin A in breastmilk?
> 90%
Bone changes in pediatric patients with Vitamin A deficiency
Faulty epiphyseal bone formation, defective tooth enamel
Vitamin ____ in human milk that depends on maternal sunlight exposure
Vitamin D
Facial exposure to sunlight of ____ hours for at least once a week is is sufficient for Vit D
2 hours
30 mins with bare arms and legs
Rickets appear in children only before ___
fusion of the epiphyses
increase in the circumference of the growth plate and metaphysis
___ is a horizontal depression along the lower anterior chest due to pulling of softened ribs by the diaphragm during inspiration due to Vit D deficiency
Harrison groove
___ is a result of widening of costochondral junctions due to Vit D deficiency
Rachitic Rosary
___ deformity
valgus deformity of 1 leg with varus deformity of the other leg
Windswept deformity
What comprise Stoss Therapy?
Vitamin D 300,000-600,000 IU IM or OD 2-4 doses over 1 day
Vitamin that has a constant value in mature milk
Vitamin E
0.32 mg tocopherol equivalents/100mL
Deficiency in Vitamin E can lead to
- RBC hemolysis in premature infacnts
- Loss of neural integrity
- Posterior column and cerebellar dysfunction
- Pigment retinopathy
What is the vitamin K content of breast milk
0.1-0.4 ug/100mL
What are the possible causes of early vitamin K deficiency of the newborn?
- Poor transfer of vitamin K across the placenta
- Inadequate intake during first few days of life
- No intestinal synthesis of vitamin K2
[Micronutrient deficiency]
angular cheilosis (perleche), glossitis (magenta tongue)
riboflavin (vitamin B2)
Vitamin deficiency associated with long term use of high estrogen OCP by mothers
Vitamin B6
___ mg/day of B6 supplementation is needed by mothers taking high estrogen OCPs to prevent neonatal deficieny
20 mgday
___ is a water soluble vitamin bound to protiens in the whey fraction of breastmilk
Vitamin B12 and B9
___ mg of Vitamin C is requried to prevent scurvy
8 mg
____ rosary
seen in Vitamin C at the costochondral junction and depression of the sternum; sharper beads compared to rachitic
Scorbutic rosary
[Micronutrient deficiency]
perifollicular hemorrhages, hyperkeratosis of hari follicles, corkscrew hair
XRAY: distal ends of long bones with ground grass appearance
Vitamin C deficieny
____ mg of vitamin C supplemented OD/IV are preferable to ensure more rapid and complete cure of deficiency
100 to 200mg
Iron in breastmilk is sufficient to meet infants iron needs to how many months
6-12 months
Iron is lesser in milk but is more bioavailable
The fetal stores of Zinc that can supply for 6 months are accumulated in the ___ trimester of pregnancy
Third trimester
Iodine accumulates in what part of the mother
Mammary gland
What vitamins and minerals are significantly affected by maternal status?
- Vitamin D
2. Iodine
[Micronutrient deficiency]
Perleche
Vitamin B2
[Micronutrient deficiency]
White line on end of shaft
Vit C
[Micronutrient deficiency]
Absence of metaphyseal changes
Vit A toxicity
[Micronutrient deficiency]
Casal necklace, gloves and boots
Vit B3
[Micronutrient deficiency]
brawny swelling, dry skin, seborrhea, pruritus, painful extremities
Hypervitaminosis A
[Micronutrient deficiency]
corn as staple
Niacin
[Growth Chart]
Height for age measures ___
Linear growth
Cumulative impact
[Growth Chart]
Weight-for-height measures
Wasting
Acute malnutrition
[Growth Chart]
MUAC cut off for wasting
11.5-12.5
[Growth Chart]
MUAC cut off for severe wasting
<11.5
What are the parameters that can assess acute malnutrition
- WFL or WFH
- MUAC
- BMI
[Diagnose]
Growth failure edema hair changes mental changes flaky pain fatty liver
Kwashiorkor
[Diagnose]
Growth failure Wasting no edema no mental changes no dermatosis good appetite Monkey-like face no hepatomegaly
Marasmus
Severe acute malnutrition is diagnosed by ____
WFL or height below -3SD
based on CGS
In children ages 6-59 months, a MUAC of ____ mm denotes extreme thinness
<115mm
What are the immediate goals in treating malnourished children?
Prevent hypoglycemia, hypothermia, dehydration
What are the criteria for inpatient care of patients with SAM?
- Severe edema
- MUAC <115 mm
- Anorexia
- Clinically unwell
- Not alert
What is the electrolyte abnormality in patients with refeeding syndrome?
1 Hypokalemia
- Hypophosphatemia
- Hypomagnesemia
What is the hallmark of refeeding syndrome?
Severe hypophosphatemia
PO4 /< 0.5mmol/L
Overweight children belongs to what BMI percentile for age?
> / 95th
At >85th percentile, what are the possible associated diseases of the child
- Hypercholesterolemia
- Hypertriglyceridemia
- Low HDL
- Abdominal central obesity
___ syndrome
Extreme exogenous obesity leading to severe cardiorespiratory distress with alveolar hypoventialtion
Pickwickian syndrome