Peds Flashcards
1
Q
Multiple clinical studies have been performed to assess the effectiveness of LGG in acute gastroenteritis in children. These studies have consistently shown LGG to be effective at reducing both duration and frequency in infectious ___
A
diarrhea
2
Q
Chylothorax is the accumulation of chyle in the pleural space due to thoracic duct damage and is most frequently associated with ___ surgery
A
cardiac
3
Q
American Academy of Pediatrics recommends osmolality of less than ___ mOsm/kg.
A
450
4
Q
The osmolality of standard infant formulas at a caloric density of 20 kcal/oz generally falls below this limit with a range of ___-___ mOsm/kg
A
200-380
5
Q
Preterm and term infants require ___ mcg/kg/day of selenium
A
2
6
Q
Early initiation of minimum enteral feeds does NOT increase the risk of NEC and has shown benefits such as a shorter time to full enteral feeds, faster weight gain, improved feeding tolerance, decreased length of hospitalization and reduced incidence of serious infections in low birth weight and very low birth weight infants.
A
7
Q
When can minimum enteral feeds begin? The preferred feeding is human milk.
A
On the day of birth
8
Q
Regurgitation is very common in infants and may occur daily. It does not necessarily signify the presence of a serious health problem. Common causes of regurgitation in preterm infants include lower esophageal sphincter immaturity and slower gastric emptying. In term infants, regurgitation may not present until the second or third week of life as oral intake increases and usually peaks at around 4 months old. It may seem more pronounced after a larger volume feeding or if the infant is fed in a recumbent position. Regurgitation tends to resolve with time on its own around 7-12 months of age.
A
9
Q
Cysteine is a conditionally essential amino acid (AA) in neonates and infants. It is not included in standard AA solutions because of solubility concerns. However, it can be added as cysteine HCl at a dose of ___ to ___ mg per gram of AAs which also increases the solubility of calcium and phosphate by lowering the pH of the solution.
A
30-40
10
Q
The suggested daily amount of potassium is ___-___ mEq/kg for preterm infants, term infants, and children. In newborns, potassium is generally not added to the PN solution until kidney function is established.
A
2-4
11
Q
GER is a frequently encountered problem in infancy and it commonly resolves spontaneously. GER is not associated with significant complications and many times these infants are referred to as “happy spitters”.
GERD on the other hand is associated with significant complications including weight loss or failure to thrive, feeding difficulties, arching of the back, or irritability. Surgical intervention with fundoplication for treatment of GERD is considered only after other therapies have failed.
A
12
Q
The goal of the ___ Equation is to estimate energy expenditure in the critically ill child by including age, weight, and body temperature of the patient to account for their inflammatory response, but it is not widely used by pediatric practitioners.
A
White
13
Q
If IC is not available or is not feasible for an individual patient, the ___ or ____ equations may be used to estimate a critically ill infant or child’s energy expenditure with close monitoring for signs of overfeeding or underfeeding.
A
WHO or Schofield
14
Q
The 1989 Recommended Daily Allowance (RDA) for energy also accounts for age and sex but is based on the median intakes for groups of healthy infants and children that were observed during longitudinal studies. The RDA has been shown to usually ___ a critically ill infant or child’s energy requirement.
A
overpredict
15
Q
The Schofield Equations and the WHO Equations estimate either basal metabolic rate or resting energy expenditure, respectively, with adjustments (for an individual’s sex, weight, and age and also for height using Schofield) but were developed for use in ___children.
A
healthy
16
Q
Taurine and tyrosine are considered ___ amino acids in neonates because of their enzyme immaturity. The contents of phenylalanine, methionine, and glycine is lower in neonatal parenteral AA solutions when compared to adult and pediatric parenteral AA solutions.
A
essential
17
Q
BMI is a screening tool used to identify children over ___ years of age and adolescents who are outside of their healthy weight ranges.
A
2
18
Q
Children with age and sex specific BMIs less than the ___th percentile are classified as underweight
A
5th
19
Q
Children with age and sex specific BMIs between the 5th and 85th percentile are classified as ___
A
Healthy weight
20
Q
Children with age and sex specific BMIs between the ___th and ___th percentiles are classified as overweight
A
85-94
21
Q
Children with age and sex specific BMIs greater than or equal to ___th percentile are classified as having obesity.
A
95
22
Q
When indirect calorimetry is not available, the ___ or ___ equation may be used.
A
Schofield or World Health Organization
23
Q
A Z-score of below -3 is consistent with ___malnutrition
A
severe (undernutrition)
24
Q
A Z-score below -2 indicates ___malnutrition.
A
moderate
25
A Z-score above 2 is consistent with ___
Overweight
26
A Z-score above 3 is consistent with ___
Obesity
27
Non-nutritive sucking is thought to stimulate the secretion of lingual lipase, gastrin, insulin and motilin through vagal innervation in the oral mucosa
28
20mg of zinc per day for 10-14 days for children with acute diarrhea and 10mg per day for infants under six months of age to curtail the severity of the episode and prevent further occurrences in the ensuing 2-3 months.
29
Symptoms of cow's milk protein allergy typically develop by 1 month of age and the majority present with 2 or more symptoms. These symptoms may manifest as:
-Gastrointestinal (blood, diarrhea)
-Cutaneous (rash, eczema)
-Respiratory (wheezing)
30
Infants with a Cow's milk allergy need what kind of formula?
Most of these infants will do well on an extensively hydrolyzed protein formula though some may require a free amino acid formula.
Though soy protein based formulas can be used, studies have demonstrated cross-reactivity of up to 10-15% in infants with cow's milk protein allergy.
31
The Fenton growth chart is best used to assess growth over time. A major advantage is that it allows for tracking of growth from ___ weeks gestational age up through 10 weeks post term age
22, 10
32
Iron is critical for neurodevelopment during the neonatal period. Both iron deficiency and iron overload may cause adverse outcomes to neurodevelopment. Thus, iron supplementation should be individualized based on risk stratification.
VLBW infants receiving human milk should receive elemental iron supplementation of ___-___ mg/kg/day beginning at 2 weeks and continuing until 6 months of age.
2-4
33
Human milk fortifiers should be added to human milk to meet the protein, calcium, phosphorous and sodium needs of the rapidly growing premature infant
34
Preterm formulas contain 40-50% of the carbohydrate calories as lactose (50-60% as glucose polymers), which is a lower load of lactose to the premature infant compared to standard term infant formulas (100% lactose).
Term formulas contain only long chain fatty acids. Preterm formulas contain 40-50% of fat calories as medium chain triglycerides, which are easier to absorb than long chain fatty acids as they do not require pancreatic lipase or bile salts for digestion or absorption.
35
Preterm formula and human milk often contain a ___ concentration of protein. However, the protein concentration decreases by 28 days of lactation.
higher
36
The ebb response initially follows burn injury and lasts 3-5 days and includes depressed resting energy expenditure, hyperglycemia, low plasma insulin, loss of plasma volume, decreased oxygen consumption, decreased blood pressure, reduced cardiac output, and decreased body temperature.
After the ebb phase, the acute phase of the flow response occurs and is represented by elevated catecholamines and elevated or normal plasma insulin along with hyperglycemia, elevated glucagon and glucocorticoids, high glucagon-to-insulin ratio, catabolism, increased body temperature, increased cardiac output, redistribution of polyvalent cations such as zinc and iron, mobilization of metabolic reserves, increased urinary excretion of nitrogen, sulphur, magnesium, phosphorus and potassium, and accelerated gluconeogenesis.
These metabolic alterations occur quickly, and the acute phase peaks between the 6th and 10th day following burn injury. The transition from acute to adaptive phase of the flow response is gradual.
37
Anabolism is not established until the ___ phase of the flow response.
adaptive
38
The deficiency of phenylalanine hydroxylase in classic PKU prevents the hydroxylation of phenylalanine to tyrosine which causes a build up of phenylalanine in the blood and a subsequent deficiency of tyrosine.
39
If the mother has had sufficient supply while in utero, the infant's vitamin D status can remain sufficient for a couple weeks after birth.
Human milk is insufficient in providing adequate levels of vitamin D intake. Therefore, it is recommended that all infants exclusively breastfed receive 400 IU (10 mcg) daily of vitamin D beginning soon after birth.
40
Infants with acute diarrhea, usually associated with gastroenteritis, can develop secondary lactase deficiency, but a soy protein- based formula is not recommended in those instances. A percentage (10-14%) of children who are allergic to cow's milk protein may also be allergic to soy protein. The American Academy of Pediatrics now recommends a trial use of either a hydrolyzed or free amino acid-containing formula.
41
Galactosemia is an inborn error of metabolism that affects the body's ability to metabolize galactose. Currently, the only way to treat galactosemia is to eliminate galactose from the diet. Soy-based infant formulas are used as substitutes for milk in galactosemia. The galactose content (approximately 20 mg/L) of lactose-free cow's milk infant formula is considerably higher than soy and hypoallergenic formulas. Therefore, lactose-free cow's milk formula is not recommended for treatment of galactosemia. Soy protein-based formulas have no role in preventing allergy or in management of non-specific gastrointestinal symptoms, e.g., infantile colic and regurgitation.
42
An infant who is mildly dehydrated from diarrhea is likely suffering from a viral gastroenteritis that will commonly resolve in 72-96 hours.
An otherwise healthy infant with acute dehydration can receive adequate fluid and electrolyte replacement with oral rehydration solutions. A short course of oral rehydration therapy is the preferred treatment. Starting parenteral nutrition is not an appropriate treatment option. Return to an age-appropriate diet early in the course of diarrheal illness is superior to providing diluted formula or full strength elemental formula. Infants provided human milk ad lib should continue to be fed the human milk.
Infants should be monitored for clinical indications that dehydration is worsening including sunken eyes, sunken fontanel, loss of skin turgor and dry mucous membranes.
43
Iron is the world's most common single-nutrient deficiency and may impact long-term neurodevelopment. The AAP guidelines, last revised in 2010, recommend universal screening for all infants at ___ months of age to determine iron status.
Selective screening can be performed at any age for infants with known risk factors such as prematurity, low socioeconomic status, poor growth and exclusive breastfeeding without supplementation. Healthy, term infants have sufficient iron stores until approximately 6 months of age making screening before this unnecessary.
Formula-fed infants are typically able to meet iron needs throughout infancy due to iron fortification of infant formula. Human milk, however, contains insufficient levels of iron to meet the needs of the older infant.
Breastfed infants should receive additional iron from complementary foods starting at approximately 4 months of age. For those unable to take complementary foods, iron supplementation should be considered.
12
44
MBD is a multifactorial condition characterized by osteopenia and osteomalacia. Studies have shown that MBD is most often seen in very low birth weight infants, particularly those weighing <___ grams. Antenatal risk factors include placental insufficiency, intrauterine growth deficiency, maternal preeclampsia, chorioamnionitis, intraventricular hemorrhage, genetic polymorphisms that affect bone generation, and male gender. Postnatal risk factors include PN for greater than four weeks, bronchopulmonary dysplasia, necrotizing enterocolitis, immobilization, and cholestasis. Medications that increase the risk of MBD include diuretics, methylxanthines (theophylline or aminophylline), or glucocorticoids.
1500
45
Precocious puberty is usually associated with an advanced bone age, while children with genetic short stature typically have a bone age similar to their chronological age. Hypothyroidism, growth hormone deficiency and Cushing syndrome all are associated with a delayed bone age.
46
How is bone age evaluated?
The bone age is evaluated by a radiography of the patient's knees or left wrist.
47
ILE provides a concentrated source of calories, helps maintain the integrity of peripheral lines, and supplies essential fatty acids for brain development.
In order to prevent EFAD, it is imperative to provide soybean oil-based ILE at ___-___ g/kg/day. For patients where prolonged PN dependence (> 1 month) is anticipated, soybean oil-based lipid restriction to 1 g/kg/day may be instituted to help prevent PN-associated liver disease.
If an alternative ILE is used, consult the manufacturer's product information for essential fatty acid composition to assess dosing needs. If an alternative ILE is used, consult the manufacturer's product information for essential fatty acid composition to assess dosing needs.
0.5-1
48
When is fluid restriction indicated?
Fluid restriction is indicated to prevent fluid build up around the heart and lungs
49
Conversion of a PEG to a gastrojejunostomy tube could also be considered as an alternative to fundoplication
50
Iron deficiency anemia is the most common nutritional deficiency in childhood.
Term infants usually have adequate iron stores up to 6 months of age. Infant formulas are fortified with sufficient iron to meet the needs of growing infants. The iron content of breast milk, though efficiently absorbed, is much lower compared to infant formula.
Exclusively breastfed infants require additional iron starting at ___-___ months of age. This can be provided by complementary foods or iron supplementation. The iron content of cow's milk is similar to human breast milk but the bioavailability is very low due to inhibitory effect of calcium on iron absorption.
Due to the inadequate nutritional composition, cow's milk should not be introduced before ___ months of age. A child with picky eating habits may or may not be at increased risk of iron deficiency anemia depending on which foods they are willing to consume. Diet assessment should be done to determine if iron supplementation is warranted.
4-6
12
51
Though growth is often the primary goal in neonatal and infant nutrition, growth cannot occur until recovery from the stress response has begun. Critically ill and postoperative neonates and infants usually have significantly ___ energy needs compared with healthy neonates due to absence of growth, decreased activity, and reduction in insensible losses during stress states.
Indirect calorimetry (IC) is recommended when possible but, if IC is not available, the estimated basal energy or resting energy expenditure should be used for nutrition support provision for the first few days after cardiac surgery. When the patient's metabolic response is thought to have shifted from a primarily catabolic to an anabolic state, the total calories may be gradually increased to meet post-op needs for healing and growth. Energy requirements for growth for patients with complex congenital heart disease (CHD) are often found to be higher as compared to those without CHD.
lower
52
Infantile anorexia is characterized by a child's refusal to eat adequate amounts of food for at least 1 month. Children with infantile anorexia generally do not communicate that they are hungry, have an interest in food and eating, and exhibit growth deficiency. This disorder is not due to an associated gastrointestinal disorder or other medical condition and does not follow a traumatic event. Onset typically occurs between 6 months to 3 years of age and often occurs during the transition to spoon- and self-feeding. Treatment includes understanding the child's temperament and level of arousal, establishing a regular feeding schedule and incorporation of behavioral techniques and feeding guidelines.
53
The Holliday-Segar method estimates caloric expenditure in fixed weight categories; it assumes that for each 100 calories metabolized, 100 mL of H2O will be required. Fluid rates can be adjusted based on clinical state (e.g., fever, tachypnea). This method is not suitable for neonates <14 days old. Fluids are calculated in the following way:
first 10 kg - 100 mL/kg/d; second 10 kg - 50 mL/kg/d; each additional kg - 20 mL/kg/d (≤ 50 kg.) or 15 mL/kg (> 50 kg.).
Another method of calculating fluid needs is by way of calculating Body Surface Area (BSA) however, BSA should not be used in infants less than 10 kg.
54
What should the MAXIMUM glucose infusion rate (GIR) be for a term infant receiving parenteral nutrition (PN)?
14-18 mg/kg/min
55
Intestinal adaptation is a complex process that occurs following a massive loss of intestinal surface area. ___ is necessary for the adaptation process to occur. For infants, ___ milk is the preferred source of EN and has been associated with decreased PN duration
EN
Human
56
Pancreatic enzymes are used to increase nutrient absorption and decrease the presence of steatorrhea. High dose enzyme usage may result in strictures of the ascending colon, also known as fibrosing colonopathy.
Enzymes should be used at less than ___ units of lipase/kg/day.
Cystic fibrosis related diabetes is secondary to mucus obstruction of pancreatic beta cells, which prevents insulin secretion and may lead to beta cell destruction.
10,000
57
Meconium ileus has similar symptoms as fibrosing colonopathy, including intestinal obstruction, mass in the right lower quadrant, and abdominal pain that most often occurs in neonates. Meconium ileus is a bowel obstruction that occurs only in infants with signs of abdominal distension, bilious emesis, and no passage of meconium.
58
The expected initial weight loss of a PRETERM infant is: ___-___% (expect to be regained within 2 weeks)
10 to 15%
59
The expected initial weight loss of TERM infant is: <___% (expect to be regained within 1-2 weeks)
10
60
For a PRETERM infant who has regained weight lost initially after birth, a weight gain of ___-___ g/kg/d plus length gain of ___-___ cm/wk for first
3 months is desired
15-20
0.8-1.1
61
For a TERM infant who has regained weight lost initially after birth, a weight gain of ___-___ g/kg/d plus length gain of ___-___ cm/wk for first 3
months is desired
7-10
0.69-0.75
62
Parenteral nutrition is appropriate for NEC, GI tract abnormalities, bowel rest for surgical correction of intestinal anomalies, OR when infant
received inadequate nutritional provision for >___d (PRETERM) or >___d (TERM)
1, 3
63
To prevent the endogenous production of glucose, a glucose infusion rate of ___-___ mg/kg/min is required, up to ___ mg/kg/min is generally tolerated
4-8
14
64
AAP recommends initiating glucose at a rate of ___ mg/kg/min and advancing to a goal of ___ mg/kg/min over several days
5, 15
65
Crystalline amino acids (AA) should be initiated at ___-___ g/kg/d (Without AA provision, in the first days of life >1 gm/kg/day of AA is lost)
1 to 1.5
66
To match intrauterine growth rate, goal AA provision should be ___-___ g/kg/d (with 100-120 total kcal/kg/day or 80-90 non-protein
kcal/kg/day)
2.5 to 3
67
To avoid using AA for energy, a non-protein calorie:nitrogen (NPC:N2) ratio of ___-___: 1 should be achieved
Exceeding >200:1 may result in fatty liver infiltration
150 - 200 : 1
68
Insufficient amounts of AA may be indicated by low albumin /prealbumin, lack of weight gain despite sufficient calorie provision, rapid weight
gain with edema
69
Excessive amounts of AA may be indicated by elevated BUN and/or serum ammonia
70
In a preterm infant, essential fatty acid deficiency (EFAD) may develop within ___ days after birth in the absence of exogenous lipid provision
(start iv lipid at DOL 1)
4
71
Signs of EFAD: scaly dermatitis, poor hair growth, thrombocytopenia, increased susceptibility to infection & impaired wound healing, FTT, >0.4 Triene:
Tetraene ratio
72
It is recommended to provide ___g/kg/d of intravenous (IV) lipids to prevent EFAD, with an upper limit of ___g/kg/d
1, 4
73
To reduce the risk of hyperlipemia in preterm infants weighing less than 1500g, intralipid infusion should not exceed a rate of ___ g/kg/hr
0.15
74
Tolerance of IV lipids should be assessed by:
checking triglyceride (TG) level
75
L-Carnitine (upper limited 20-50 mg/kg/d) may optimize fatty acid oxidation
76
As a parenteral multivitamin (MVI) for preterm infants is unavailable, the Nutrition Advisory Group of the American Medical Association (AMANAG) and American Society for Clinical Nutrition recommend providing ___% of the pediatric MVI per kg of body weight until >2500g weight reached, allowing the provision of 100% of the MVI
40
77
Rickets (& severe bone demineralization) is a serious and commonly observed complication of long-term PN in both term and pre-term infants
78
Trophamine (AA solution) is designed for infants to allow for the maximum calcium and phosphorus concentrations without precipitation:
79
The goal calcium provision for preterm infants on PN is 50-80 mg Ca+ /kg (___-___ mEq/g)
2-4
80
The goal phosphorus provision for preterm infants on PN is 35-60 mg PO4/kg (___-___ mmol/kg)
1-2
81
Because calcium & phosphorus retention has been reported to be up to 90% among preterm infants receiving PN w/ goal amounts of calcium and phosphorus, calcium & phosphorus should be initiated @ 70% of the guidelines and advanced in increments of 10% daily while closely monitoring for hyper/hypocalcemia and hyper/hypophosphatemia
82
____ should be supplemented with any PN prescription, as it is essential for growth; requirements for ___increase with increased urinary output,
increased GI losses, elevated cysteine & histidine levels
Zinc, zinc
83
To promote desired growth (with EN/oral intake) in a TERM infant: ___ kcal/kg/day + ___ g/kg/day
108
2.2
84
Selenium and chromium should be withheld with ___dysfunction
Renal
85
To promote desired growth (with EN/oral intake) in a PRETERM infant: ___ kcal/kg/day + ___ g/kg/day
120-130
3-4
86
Critically ill and postoperative neonates have significantly lower energy needs compared with healthy neonates due to absence of growth, decreased activity, and reduction in insensible losses during stress states. ___-___ kcal/kg/day
55-60
87
Banked donor milk has been associated with healing, growth, maturation of tissues/organ systems as well as a decreased risk Necrotizing
Enterocolitis
88
Daily supplementation of 400 IU of vitamin D is now recommended for exclusively breastfed infants AND children and adolescents who do not get
regular sunlight exposure and/or do not ingest at least 500 mL/day of fortified milk
89
Preterm milk has more energy, protein, & fat BUT less lactose, calcium, and phosphorus than term milk
90
HMF provides the advantages of breast milk with the additional nutrients needed, increasing calories, protein, calcium, phosphorus,
and magnesium
91
Added to breast milk for infants <34 weeks gestation and birth weight of <1500g, requirement of PN for > 2 weeks, >1500 g with suboptimal
growth or volume restriction necessitated
92
Preterm infant formulas vs term (intended for <1800 g) have a reduced lactose load, a higher concentration of whey protein and
electrolytes/minerals, RDA for vitamins/minerals will be satisfied by a preterm formula if intake is > 120 kcal/kg/d
93
When a preterm infant is being transitioned to home, post-discharge formula should be utilized until weight of 3500 g is achieved or
until adjusted age is >9 months (Post-discharge formulas are used to reduce the risk of vitamin toxicity).
94
Term formulas are cow milk based formulas containing nonfat protein extracted from cow’s milk plus additional whey (the carbohydrate
source is lactose), caloric distribution is similar to breast milk, and fat is provided via soy, sunflower, or coconut oil (to provide the needed
long chain fatty acids)
95
In addition to being utilized for suspected lactose intolerance, lactose-free infant formulas may be used for chronic diarrhea, galactosemia,
damaged GI tract (NOT prematurity)
96
Soy-based infant formulas, also used when a lactase deficiency is suspected, can be provided for vegetarian families, galactosemia, cow’s milk
protein allergy (NOT prematurity)
97
Enteral feeding is commonly utilized in premature infants given that a coordinated suck-swallow does not usually develop until 32-34 weeks
gestational age
98
Non-nutritive sucking (using pacifiers for infants to suckle during gavage feeding) may Promote oral feeding when developmentally appropriate
99
Term infants usually have sufficient iron stores up until ___ months of age
6
100
Vitamin and mineral supplementation guideline for PRETERM and FORMULA FED hospitalized newborn
provide a preterm infant formula or MVI if not on preterm formula
If formula-fed or breast-fed, provide dietary source of iron by 1 month of age (2-4 mg/kg/d enteral)
101
Vitamin and mineral supplementation guideline for PRETERM and BREAST-FED hospitalized newborn
Provide human milk fortifier or an MVI if on unfortified breastmilk
If formula-fed or breast-fed, provide dietary source of iron by 1 month of age (2-4 mg/kg/d enteral)
102
Vitamin and mineral supplementation guideline for TERM and BREAST-FED hospitalized newborn
provide a dietary source of iron by 4-6 months of age
If breast-fed, provide 400 IU vitamin D
103
Vitamin and mineral supplementation guideline for TERM and FORMULA FED hospitalized newborn
If formula-fed, provide an iron-fortified formula by 4 months of age
104
Minimum soy-based ILE = ___-___ g/kg/d
0.5-1
105
VLBW infants receiving human milk should receive elemental iron supplementation of 2-4 mg/kg/day beginning at ___ weeks and continuing
until ___ months of age.
2
6
106
In premature infants, when the exogenous provision of mineral substrates are inadequate to maintain the normal remodeling, mineralization, and
growth of bone, osteopenia of prematurity develops.
Prevention and treatment of osteopenia of prematurity consists of all maximizing calcium & phosphorus in PN, use of human milk fortifier or
preterm formula, sufficient vitamin D provision (160-400 IU/day)
107
Bronchopulmonary dysplasia (BPD), defined as the need for assisted ventilation for >3 days during the first 2 weeks of life with radiological
evidence of pulmonary changes lasting beyond the first month of life has been associated with poor growth, feeding difficulties, and fluid, lyte, and
mineral imbalances (Ca and phos)
Goals for EN in the patient with BPD: ___-___ kcal/kg/d; ___-___ g pro/kg; If catch-up growth is needed, up to 180 kcal/kg/d may be required; may need additional vitamin supplementation
120 - 130
2.5 - 3.5
108
Cystic Fibrosis:
-Increased WOB, increasing needs
-PERT/Creon needed. MAX: 10,000 IU lipase/kg/d OR ___ units of lipase/kg/meal
2500
109
How do high doses of PERT lead to fibrosing colonopathy?
Pancreatic enzymes are used to increase nutrient absorption and decrease the presence of steatorrhea. High dose enzyme usage
may result in strictures of the ascending colon, also known as fibrosing colonopathy
110
Corrected age
Weeks preterm = 40 weeks (full term) - age in weeks at birth
○ Chronological age – how many weeks premature = Corrected age
○ 16 weeks old – 8 weeks premature = 8 weeks corrected age
111
Infant formulas:
Preterm: ___ kcal/oz
Standard: ___kcal/oz
Breast milk ___ kcal/oz
Soy based (galactosemia): ___ kcal/oz
24
20
20
20
112
Pregnancy deficiencies
1. Folic acid (neural tube defect)
2. Iron deficiency (hx of bariatric, IBD, celiac)
3. Zinc (may lead to preterm birth and may prolong labor. May also lead to CNS problems and growth restriction)
4. Iodine (is crucial for brain development)
