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NUTR 620 Exam 2
| Question | Answer |
|---|---|
| Preterm | <37 weeks gestation |
| Extremely Preterm | <28 weeks gestation |
| Very Preterm | 28 to 32 weeks gestation |
| Moderate Preterm | 32 to 34 weeks gestation |
| Late Preterm: | 34 to 36 weeks gestation |
| Full Term | 37 to 40 weeks gestation |
| Low Birth Weight | <2500 g |
| Very Low Birth Weight | <1500 g |
| Extremely Low Birth Weight | <1000 g |
| What growth charts are appropriate for term infants? | WHO or CDC weight for age, length for age, weight for length, head circumference for age |
| What growth charts are appropriate for very preterm infants? | low birthweight chart by Fenton |
| What growth charts are appropriate for preterm infants? | use preterm chart by Fenton until 2 weeks after estimated due date, then use regular charts with corrected gestational age |
| Describe how to properly prepare infant formula | see notes |
| Define the recommendations for breastfeeding in the US | Breastfeeding should be initiated within 1 hour of birth Babies should be exclusively breastfed for the first 6 months. Mothers should continue to breastfeed baby alongside introduction of complementary foods at 6 months until 1 year and beyond |
| Define the recommendations for breastfeeding globally | Breastfeeding should be initiated within 1 hour of birth Babies should be exclusively breastfed for the first 6 months. Mothers should continue to breastfeed baby alongside introduction of complementary foods at 6 months until 2 years and beyond |
| Describe importance of breastfeeding for the parent | Decreased risk of breast cancer, T2DM, CVD, Ovarian Cancer, Decreased potential of unwanted pregnancy, Increased bonding with infant, Potential for weight loss, Reduced postpartum bleeding, Faster shrinkage of uterus, Helps save money, buy less formula |
| Describe importance of breastfeeding for the infant | Decreases risk of diarrhea, T1DM, T2DM, Pneumonia, UTIs, Heart Disease, Ear Infections, leukemia, and Obesity, Decreases risk of SIDS & child under 5 mortality, Offers numerous immunological, anti-microbial, hormonal, and enzymatic components |
| What nutrients are independent of maternal diet? | calories, protein, vitamin E, trace minerals |
| What nutrients are altered by maternal diet? | fatty acids Vitamins A, B12, C, D, thiamine, riboflavin, niacin, folate, pyridoxine Minerals Zinc, Selenium, and Iodine |
| True or False: When malnourished, mother will produce subpar milk | False, mother will produce less milk |
| Why are folate, calcium, and Vitamin E nutrients of concern when breastfeeding? | They are included in breastmilk at the expense of maternal tissue |
| Describe ethe role of fortifiers in supporting nutrition in preterm infants | Most preterm infants won't have nutritional needs met from breastmilk alone. Fortifying infant milk allows us to add the additional calories and nutrients that preterm infants need to grow and develop |
| Describe optimal health at discharge from NICU | can feed orally a minimum 160 mL/kg/day or growing well on exclusive BF at breast, In-hospital growth is normal or improving, head circumference gain appropriate, Biochemical measures of nutritional status are normal |
| Describe suboptimal health at discharge from NICU | • Infant Intake <160 ml/kg/day • Growth less than adequate • Biochemical measures of nutritional status abnormal, not normalizing and indicative of ongoing protein or mineral insufficiency |
| Feeding plan for breastfeeding dyad being discharged from NICU with optimal health | ○ Option 1: Change diet to unfortified breast milk & monitor growth and milk intake for 1 week before discharging ○ Option 2: Change diet to unfortified breast milk at any time as long as follow can be arranged with 1 to 2 days and repeatedly |
| Feeding plan for breastfeeding dyad being discharged from NICU with suboptimal health | 1: unfortified BM for most feedings & add either 3 feedings a day of PT formula / 1 feeding of 30 kcal/30ml formula/day. 2: add powder PT DC formula to HM to increase kcal/ounce to 22. 3: BF at breast & 15 mL of PT formula for all feeds with supplementer |
| Describe the role of donor human milk in sustaining an exclusively human milk diet | allows for infants with parents unable to BF/produce enough BM to keep feeding their baby via EBF; lower risk of NEC, retinopathy, sepsis, &patient re-admittance; reducing patient care costs, patient stay, & higher human milk consumption post-discharge |
| List community services available for families with young children that need additional nutrition support. | SNAP, WIC, CACFP, NSLP, SBP |
| SNAP | Designed to improve the nutrition of low-income individuals by offering monetary support for purchasing food |
| WIC | Provides vouchers for food to pregnant women or families with children under age 5 to redeem for healthy foods in the store |
| CACFP | Provides reimbursement to the participating program for 2 meals and 1 snack OR 1 meal and 2 snacks per day AND nutrition education for childcare providers |
| National School Lunch Program | Provides free and reduced-price lunch based on family income with the goal of improving school nutrition environments |
| School Breakfast Program | Provides free and reduced priced breakfast based on family income |
| SNAP stands for: | Supplemental nutrition assistance program |
| WIC stands for: | women, infant, children |
| CACFP stands for: | Child and Adult Care Food Program |
| How does MRSA impact breast feeding? | If parent has MRSA, breastmilk has to be pumped & dumped for first 24 hours while antibiotic therapy is initiated |
| How does Ebola impact breastfeeding? | breastfeeding must be discontinued |
| How does tuberculosis impact breastfeeding? | see notes |
| How does HIV/AIDS impacts breastfeeding? | developed nations: breastfeeding should be avoided if parent has HIV/AIDS developing nations: exclusive breastfeeding is recommended for 6 months followed by introduction of complementary foods. ART should be administered to parent and child |
| How does diabetes impact breastfeeding? | • T1DM and GDM can possibly delay lactogenesis. Early/frequent skin to skin and breastfeeding is encouraged • T2DM: potential for low milk production. Encourage early/frequent skin to skin and breastfeeding |
| How does hypothyroidism impact breastfeeding? | Hypothyroidism can lead to low milk production safe to breastfeed during treatment |
| How does cystic fibrosis impact breastfeeding? | Cystic Fibrosis can make breastfeeding difficult. Lactation support is needed |
| How does PCOS impact breastfeeding? | PCOS might make breastfeeding difficult: Lactation support is needed |
| How does cancer impact breastfeeding? | Should not breastfeed if parent has cancer and is on chemo or radiation treatment |
| List the signs that indicate an infant is developmentally ready for solid foods. | Baby is six months or older, has doubled birth weight , no longer satisfied with only breast milk or formula, wants to eat more frequently, sits up and holds head up, no longer exhibiting tongue thrust reflex,takes interest in what caregivers are eating |
| Describe the process of introducing solid foods to an infant | see notes |
| List the nutrients that need to be prioritized during complementary feeding | • Vitamin A rich fruits and vegetables • Protein: meat, fish, eggs • Fat: DHA/ARA adequate fat content |
| List the steps involved in safe preparation and storage of complementary foods | Wash hands before preparation and eating, Serve food immediately after preparation of store food safely at proper temperatures, Use clean utensils to prepare/serve food, Use clean cups and bowls when feeding children, Avoid use of feeding bottles |
| Describe characteristics of a toddler | 1 to 3 years of age, rapid increase in gross and fine motor skills, increasing mobility |
| Describe characteristics of a preschool age child | 3 to 5 years of age, increasing autonomy and language skills, broader social circumstances |
| How to measure growth of children? | Use appropriate growth charts If younger than 2, use recumbent length If 2 or older, use standing height |
| Describe changes in toddler behavior | Orbiting around parents, go from self centered to interactive, expanded vocabulary, increase in temper tantrums |
| What milestone occurs at 15 months? | crawl up stairs |
| What milestone occurs at 18 months? | running stiffly |
| What milestone occurs at 24 months? | walk up stairs one foot at a time |
| What milestone occurs at 30 months? | alternate feet going up stairs |
| What milestone occurs at 36 months? | ride a tricycle |
| Describe developmental milestones during transition from bottle feeding to complimentary feeding | 9 to 10 months: bottle weaning, 12 to 14 months: completely bottle weaned; 12 months: refined pincer grasp, 18 to 24 months: able to use tongue to clean lips and rotary chewing |
| What are the most common allergens? | milk, fish, soybeans, tree nuts, peanuts, eggs, shellfish, wheat |
| List the four parent feeding styles? | Authoritative, Authoritarian (Restrictive), Permissive, Uninvolved |
| What are some feeding behaviors of toddlers | rituals in feeding, strong preferences and dislikes, food jags common, imitating behavior of others, serve new foods with familiar foods |
| Explain Satter's Division of Responsibility in Feeding | The child controls how much food and whether to eat it, the parent controls what, where, and when |
| How much complementary food should be fed? | One tablespoon per year of age for each type of food offered |
| How many calories per day for 6 to 8 month olds? | Developing countries: 200 kcal/day Developed Countries: 120 kcal/day |
| How many calories per day for 9 to 11 month olds? | Developing countries: 300 kcal/day Developed countries: 310 kcal/day |
| How many calories per day for 12 to 23 month olds? | Developing countries: 500 kcal/day Developed countries: 510 kcal/day |
| What chronic conditions increase energy needs? | cystic fibrosis, renal disease, ambulatory children with diplegia, pediatric AIDs, bronchopulmonary dysplasia (BPD) |
| What chronic conditions decrease energy needs? | down syndrome, spina bifida, nonambulatory children with diplegia, prader-willi syndrome, nonambulatory children with short stature |
| How many times per day should a 6 to 8 month old eat? | 2 to 3 meals per day |
| How many times per day should a 9 to 11 month old eat? | 3 to 4 meals and 1 to 2 snacks |
| How many times should a 12 to 23 month old eat? | 3 to 4 meals and 1 to 2 snacks |
| Which foods may cause choking hazards | nuts, grapes, raw carrots, hot dogs |
| What age range is female puberty? | 10.5 to 14 years |
| What age range is male puberty? | 12 to 16.5 years |
| What age range cognitive maturation? | 12 to 16 years |
| What age range is psychosocial maturation? | early: 12 to 14 years middle: 14 to 17 years late: 17 to 21 years |
| what age range is finale female height spurt? | 9.5 to 14.5 years |
| What age range is menarche? | 10.5 to 16.5 yeaers |
| What age is finale male height spurt? | Peak velocity around 14.4 years and finale height at 21 years |
| Describe teen developmental changes that affect nutrition | Dramatic growth increases micro and macro needs Increased autonomy means adoption of health-compromising eating behaviors |
| Describe energy needs of teens | depends on activity level, BMR, puberty, males have higher needs, overall energy need reduced due to less physical activity |
| Describe protein needs of teens | 0.85 g/kg body weight daily needed to support growth of new lean body mass |
| Describe carbohydrate needs for teens | primary source of energy, 130 g/day or 45-65% of calories |
| Describe fat needs for teens | 25-35% of calories with no more than 10% from saturated fat needed for growth and development |
| How does dietary intake change for athletes? | possible increase in calories, eat two to three hours prior to exercise and eat 400 to 600 highcarb foods post-event, consume adequate calcium, |
| What is the recommended fluid intake during physical activity? | 12-22 oz cool water 1-2 hrs before event 10 to 20 oz cool water 10-15 minutes before event 4 to 6 oz cool water every 15 to 20 minutes during event 2 to 3 cups of cool fluid for every pound of body weight loss |
| What is the female athlete triad? | combination of low energy availability, menstrual disturbance, and low bone mineral density commonly found in female athletes or teens with low energy intake |
| What are the goals of eating disorder treatment programs? | restore body weight, improve social and emotional well-being, normalize eating behaviors |
| How does lactation happen? | Milk ejection reflex from suckling stimulates hypothalamus, a positive regular of paraventricular nucleus and negative regulator of dopamine, which signal anterior pituitary to release prolactin and posterior pituitary to release oxytocin |
| What are the roles of prolactin and oxytocin? | prolactin promotes milk synthesis by signaling mammary cells to produce milk oxytocin promotes milk secretion via muscle contraction |
| What effect does the presence of the placenta have on milk production? | Placenta contains progesterone, which inhibits milk synthesis |
| What hormones inhibit milk production? | cortisol, t3, t4, insulin, growth hormone |
| What occurs during lactogenesis I & II? | Endocrine control: For the first 2 weeks of age post delivery, there is a drop in progesterone, increase in prolactin, resulting in increased milk supply |
| What occurs during lactogenesis III? | Autocrine Control: 2 weeks and beyond, suckling stimulates prolactin, stimulates let down, stimulates milk removal, stimulates alterations in milk, stimulating more suckling |
| How much does a baby drink? | An average of 750 to 800 mL/day but can range from 450 to 1200 mL/day |
| What are the stages of human milk? | Colostrum: first milk, 3 to 4 days postpartum Transitional milk: first 2 weeks Mature milk: 2 weeks and beyond |
| What are the differences between foremilk and hindmilk? | foremilk - lactose rich and watery hindmilk - fatty |
| What are characteristics of preterm human milk? | higher levels of IgA, lactoferrin, lysozyme, LC-PUFAs (for first 6 months), trophic effect on gut, stimulates cell proliferation, enhanced motility maturation, decreases permeability, probiotic effects, decrease risk of NEC |
| How many calories in preterm human milk per ounces? | 24 calories per ounce |
| How many calories in mature milk? | 20 calories per ounce |
| How does mature milk change over time? | as baby grows, protein decreases, water increase, LC-PUFAs decline during first 6 to 12 months |
| What is the process for donor human milk? | incentive to donate, physician approval, screening, serologic testing, maternal education on handling, milk pooled from 4 to 5 donors and pasteurized, bacterial screening, frozen and shipped overnight on dry ice |
| What supplementation recommended alongside breastfeeding? | Either vitamin D supplementation for mother up to 6400 IU/day or a supplement for baby, Vitamin K shot for baby |
| How many extra calories are needed for milk production? | For first 6 months: 650 kcal/day of which 150 are from fat stores After 6 months: 400 kcal/day |
| Overall, what are the caloric needs for a lactating parent, including macro breakdown? | 1800 to 2500 kcal/day 45 to 65% CHO 10 to 35% PRO 20 to 35% FAT |
| What is the RDA for CHO for non-pregnant women? What is it for nursing women? | 130 g/d ; 210 g/d |
| What is the estimated average requirement for nursing women? | 160 g/d |
| What is the RDA for PRO for non-pregnant women? Nursing women? | 0.8/kg/d ; 1.1 g/kg/d |
| What effects fat content of breastmilk? | increases over course of feeding, increases with shorter time between feedings, decreases with smoking |
| What is AI for Omega 3 fatty acids (EPA, DHA, ALA) for nursing mothers? | 1.3 g/day |
| What should breastfeeding women avoid in diet? | limit caffeine mercury containing fish, avoid shark, swordfish, king mackerel, tilefish; alcohol, recreational drugs, restrictive diets, weight loss medications |
| General diet recommendations when breastfeeding | avoid weight loss diets, eat variety of grains, fruits, vegetables, dairy, meats/alternatives, eat 3 or more servings of milk daily, increase vitamin A rich veggies and fruits, drink when thirsty, 2 or less servings of caffeine |
| True of false: Bone loss occurs even with adequate calcium intake | True, reversal of bone density losses happens within 3 to 6 months of weaning from breast milk, breastfeeding will reduce risk of osteoporosis |
| What is RDA for iodine for non pregnant and nursing woman? | 150 ug/day; 290 ug/day |
| Who is at risk of iodine deficiency? | vegans, smokers |
| Why is iodine important? | Important for neonatal thyroid hormone stores & neurological development |
| What are sources of iodine? | iodized salt, seafood, dairy products |
| What is RDA for iron for non pregnant women? | Age 14 to 18: 15 mg/d Age: 19 to 50: 18 mg/d |
| Whata is RDA for iron for nursing women? | Age 14 to 18: 10 mg/d Age 19 to 50: 9 mg/d |
| What nutrient is most likely to be low in milk if diet inadequate? | pyridoxine (B6) |
| What is the RDA for pyridoxine-B6 in non pregnant women? | Age 14 to 18: 1.3 mg/d Age 19 to 15: 1.2 mg/d |
| What is the RDA pyridoxine-B6 in nursing women? | 2.0 mg/d |
| True or False: You should avoid mega doses of pyridoxine because it may decrease milk production | True: best way to increase is through dietary intake |
| What are sources of pyridoxine (B6) | meat, shellfish, poultry, eggs, beans, bananas, whole grains |
| What is RDA for folate for non pregnant women? Nursing women? | 400 mcg/d; 500 mcg/d |
| What are sources of folate? | green leafy vegetables, beans, seeds, eggs, wheat germ, fortified cereals and grains |
| How long does it take alcohol to clear from breastmilk? | 2 to 3 hours in 120# woman, can take longer when heavier |
| True or false: pumping clears breastmilk | false |
| Caffeine intake while nursing | <300mg/day |
| What are nutrient concerns related to vegetarianism when nursing for mom and baby | mom: D, B12, Zinc, Iron, Calcium, DHA, Iodine baby: B12, D, Zinc |
| Explain APGAR Scores | APGAR used to screen the growth of infants immediately after birth. They look at heart rate, respiratory effort, muscle tone, reflex irritability, and color. Conducted at 1 and 5 minutes after birth. If score less than 7, check is repeated every 3 minutes |
| What does an APGAR score of less than 3 indicate? | viability of infant is threatened |
| What issue can arise from SGA? | poor suck and swallow coordination |
| Another name for SGA | IUGR |
| What issues are associated with LGA? | birth injuries, hypoglycemia, polycythemia, hyperbilirubinemia |
| What risk associated with late preterm infants? | poor feeding, needs careful follow up |
| How to do growth correction for gestational age on growth charts? | Current age - weeks premature = corrected age |
| What weight gain occurs between 0 to 6 months? | 5 to 7 oz/week, birth weight doubles |
| What weight gain occurs from 6 to 12 months? | 3 to 5 oz/week |
| What weight occurs during first year? | birth weight triples |
| True or false: breastfed infants lose up to 10% of weight during first 72 hours | True: weight is gained at 1 oz/day afterward |
| Review infant developmental milestones | see slide 30 on infant and development ppt |
| Indications for standard cow milk based formula | healthy term infants |
| Indications for partially hydrolyzed protein formula | spitting up/ fussiness |
| Indications for soy based formula | vegetarian diet, galactosemia, hereditary lactase deficiency contraindication: preterm infants |
| Indications for premature post discharge formula | preterm infants transitioning home |
| Indications for extensively hydrolyzed protein formula | hypoallergenic, intolerance to cow milk protein or soy protein, malabsorption issues |
| Indications for amino acid based formula | extreme protein hypersensitivity |
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jamescj
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