nenonatal nutrition support

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nenonatal nutrition support
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2012-02-29 21:50:26
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nenonatal nutrition support
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  1. The expected initial wt loss of a PRETERM infant is
    A – 5 – 7.5%
    B – 7.5 – 10%
    C – 10-15%
    D – 15%
    C – 10-15% (expect to be regained within 2 weeks)
  2. The expected initial weight loss of a TERM infant is:
    A - <= 5%
    B - <=10%
    C - <=15%
    D – <=20%
    C - <=15% expected to be regained within 1-2 weeks
  3. For a TERM infant who has regained weight lost initially after birth, a weight gain of ____ g/kg is desired
    A – 7-10
    B – 10-15
    C – 15-20
    D – 20-25
    C – 15-20 (plus length gain of 0.8-1.1 cm/wk for first 3 months)
  4. For a PRETERM infant who has regained weight lost initially after birth, a weight gain of ____ g/kg is desired
    A – 7-10
    B – 10-15
    C – 15-20
    D – 20-25
    A – 7-10 (plus length gain of 0.69-0.75 cm/wk for first 3 months)
  5. Parental nutrition is indicated in infants in the following conditions
    A – necrotizing enterocolitis
    B – GI tract abnormalities
    C – bowel rest for surgical correction of intestinal anomalies
    D – all of the above
    D – all of the above
  6. Some of the documented benefits to early initiation ( within first 24 hr) of PN in infants include all of the following EXCEPT:
    A – a decreased incidence of hypoglycemia via promotion of glc homeostasis, (truth - nitrogen balance and inc pro synthesis are also benefits of early PN)
    B – an increased serum [] of glutathione d/t free gln administration in PN
    C – prevention of EFA deficiency
    D – a possible decreased risk of bronchopulmonary dysplasia (r/t the antioxidant effects of early PN on lipids)
    B – an increased serum [] of glutathione d/t free gln administration in PN
  7. When assessing the adequacy of AA provision in infants, insufficient amounts of AA may be indicated by
    A – lack of wt gain despite insufficient calorie provision
    B – low albumin and/or prealbumin
    C – rapid wt gain w/ edema
    D – all of the above
    D – all of the above
  8. When assessing the adequacy of AA provision in infants, excessive amounts of AA may be indicated by
    A – elevated BUN and/or serum ammonia
    B – albumin and/or prealbumin that exceeds the ULN
    C – hyperphosphatameia
    D – hypertriglyceridemia
    A – elevated BUN and/or serum ammonia
  9. In a preterm infant, EFAD may develop within ___ days after birth in the absence of exogenous lipid provision
    A – 1
    B – 4
    C – 10
    D – 14
    B – 4 (it is recommended to start IV fat supplementation on day #1 of life)
  10. Manifestations of EFAD can include all the following except:
    A – scaly dermatitis, poor hair growth
    B – thrombocytopenia
    C – increased susceptibility to infection and impaired wound healing
    D – triene:tetraene ratio of >= 1.2
    D – triene:tetraene ratio of >= 1.2 ( a ratio of 0.4 is reflective of EFA, FTT is also a common s/s of EFAD)
  11. It is recommended to provide ___ g/kg/d of IV lipids to prevent EFAS, with an upper limit of ____g/kg/d
    A – 1;4
    B – 2;5
    C – 2.5;6
    D – 3;8
    A – 1;4 (intralipid should be limited to a range of 0.5-0.3 g/kg/d with an upper limit of 4g/kg/d)
  12. Manifestations of EFAD can include all the following except:
    A – scaly dermatitis, poor hair growth
    B – thrombocytopenia
    C – increased susceptibility to infection and impaired wound healing
    D – triene:tetraene ratio of >= 1.2
    D – triene:tetraene ratio of >= 1.2 ( a ratio of 0.4 is reflective of EFA, FTT is also a common s/s of EFAD)
  13. It is recommended to provide ___ g/kg/d of IV lipids to prevent EFAS, with an upper limit of ____g/kg/d
    A – 1;4
    B – 2;5
    C – 2.5;6
    D – 3;8
    A – 1;4 (intralipid should be limited to a range of 0.5-0.3 g/kg/d with an upper limit of 4g/kg/d)
  14. To reduce the risk of hyperlipidemia in preterm infants weighting less than 1500g, intralipid infusion should not exceed rates of ___ g/kg/d
    A – 0.15
    B – 0.25
    C – 0.5
    D – 0.75
    A – 0.15
  15. Tolerance of IV lipids should be assessed by
    A – visual inspection of serum for fat globules
    B – daily cholesterol monitoring
    C – checking TAG [] prior to initiation of IV lipids
    D – monitoring serial LFT, amylase and lipase
    C – checking TAG [] prior to initiation of IV lipids if TAG>= 150 mg/dL, dec lipids by 0.5 g/kg/d; advance IV lipids back to goal as TG levels allow
  16. The addition of __ may optimize fatty acid oxidation
    A – chromium
    B – L-carnitine
    C – enteral pancreatic enzymes
    D – L-choline
    B – L-carnitine
  17. As a parenteral MVI for preterm infants in unavailable, the nutrition advisory group of the AMA and the ASCN recommend providing 40% of the pediatric MVI per kg body wt until this threshold has been reached, allowing the provision of 100% of the MVI
    A - >1500g
    B - >2000g
    C - >2500g
    D - >3000g
    C - >2500g (for mvi-pediatric, the AAP recommends dosing of 2mL/kg; once >3kg dose at 5mL
  18. A serious and commonly observed complication of LT PN in both term and preterm infants is
    A – Rickets + severe bone demineralization
    B – ‘lyte destabilization
    C – frequent UTI
    D – acaculous cholcystitis
    A – Rickets + severe bone demineralization
  19. This AA sol’n is designed for infants to allow for the maximum Ca++ and phos [] w/o precipitations:
    A – tryptophan
    B – aminosyn
    C – trophamine
    D – procalamine
    C – trophamine
  20. The goal ca++ provision for preterm infants on PN is: (in mg Ca++/kg)
    A – 20-30
    B – 30-50
    C – 50-80
    D – 80-100
    C – 50-80
  21. The goal phosphorus provision for preterm infants on PN is: (in mg PO4/kg)
    A – 15-30
    B – 35-60
    C – 65-80
    D – 85-100
    B – 35-60 )because Ca2+ and phos retention has been reported to be up to 90% among preterm infants receiving PN w/ goal amounts of Ca2+ and phos, Ca2+ and phos should be initiated @ 70% of the guidelines and advanced in increments of 10% daily while closely monitoring for hyper/hypocalcemia and hypo/hyperphosphatameia)
  22. Zc should be supplemented with an PN rx, as it is essential for growth; requirements for zc increase w/ all of the following conditions except:
    A – increased urinary output
    B – increased GI losses
    C – goal PN provision of AA
    D – elevated cysteine and histidine levels
    C – goal PN provision of AA
  23. When providing PN to a pt w/ impaired liver fxn/cholestasis as indicated by a direct bilirubin of >2.0; the following trace elements should be withheld from the PN rx:
    A – carnitine
    B – cu
    C – manganese
    D – cu and manganese
    D – cu and manganese, for cu, in pts w/ inc biliary losses, an additional 10-15 mcg/kg/d of cu should be provided
  24. The following trace elements should be provided when PN is long term (>4 wk), but should be withheld w/ renal dysfxn
    A - selenium
    B – chromium
    C - zc
    D – selenium and chromium
    D – selenium and chromium
  25. To promote desired growth in the TERM infant, the following caloric (kcal/kg/d) and protein (g/kg/d) goal rangers are recommended for enteral or oral intake:
    A – 85 ; 1.5
    B – 108; 2.2
    C – 115; 2.5
    D – 125; 2.8
    B – 108; 2.2
  26. To promote desired growth in the PRETERM infant, the following caloric (kcal/kg/d) and protein (g/kg/d) goal rangers are recommended for enteral or oral intake:
    A – 85 ; 1.5
    B – 120 - 130; 3-4
    C – 130-140; 2.5-3.5
    D – 140-150; 3.5-4.5
    B – 120 - 130; 3-4
  27. Maternal breast milk is considered the “gold standard” for a healthy newborn for all of the following reasons except for:
    A – breast milk contains enzymes to aid digestion and bioactive chemicals for growth/maturation of the GI tract
    B – breast milk contains immunological protection from viruses and bacteria
    C – breast milk contains FA and bile salt stimulated lipase that enhance absorption
    D – breast milk contains more casein than whey pro, which is easier to digest, preventing colic
    D – breast milk contains more casein than whey pro, which is easier to digest, preventing colic (whey is easier to digest than casein, no definitive cause of colic
  28. Contraindications for breast feeding include all of the following except for:
    A – inborn errors of metabolism (galactosemia,propionic academia)
    B – maternal drug/etOH usage (including radioactive compounds, illicit drugs, chemo-rad, lithium, nicotine, CNS acting drug
    C – maternal HIV/AIDS, TB, CMV, certain lymphomas (or herpes lesions on breasts)
    D – previous breast augmentation surgery
    D – previous breast augmentation surgery
  29. Banked donor milk (which pasteurized) has been associated w/ healing, growth, maturation of tissues/organ systems as well as a decreased risk of:
    A – necrotizing enterocolitis
    B – rotovirus
    C – bronchopulmonary dysplasia
    D – middle ear infections
    A – necrotizing enterocolitis
  30. Daily supplementation of 200IU of vit D is now recommended for :
    A – exclusively breastfed infants
    B – infants ingesting 500 mL/d of fortified fortified milk or formula
    C – children and adolescents who do not get regular sunlight exposure and/or do not ingest <500 mL/d of fortified milk
    D - exclusively breastfed infants AND children and adolescents who do not get regular sunlight exposure and/or do not ingest <500 mL/d of fortified milk
    D - exclusively breastfed infants AND children and adolescents who do not get regular sunlight exposure and/or do not ingest <500 mL/d of fortified milk
  31. The following are true comparisons between preterm and term human breast milk
    A - preterm milk has more energy, pro and fat than term milk
    B - preterm milk has less lactose, ca2+, and phos than term milk
    C – term milk has more energy, pro and fat than preterm milk
    D - preterm milk has more energy, pro and fat than term milk AND preterm milk has less lactose, ca2+, and phos than term milk
    D - preterm milk has more energy, pro and fat than term milk AND preterm milk has less lactose, ca2+, and phos than term milk
  32. Human milk fortifier (HMF) is added to breast milk for infants <34 weeks gestation and
    A – birth wt of <1500 g
    B – requirement of PN for >2 wks
    C - >1500g w/ suboptimal growth or volume restriction unnecissated
    D – all of the above (HMF provides the advantages of breast milk w/ the additional nutrients needed, increasing kcal, pro, ca2+, phos and mag)
    D – all of the above (HMF provides the advantages of breast milk w/ the additional nutrients needed, increasing kcal, pro, ca2+, phos and mag)
  33. Provided that sufficient weight gain has been achieved (>2500g) and adequate nutrition is acquired via suckling (as indicated by sufficient growth) HMF is usually d/c’s upon d/c from the hospital d/t:
    A – expense
    B – sterile environment is necessary for the mixing
    C – lack of breast pumps in the home environment
    D – concern for the vitamin toxicity (vit A and D)
    D – concern for the vitamin toxicity (vit A and D)
  34. The following statements are true regarding the supplementation of arachodonic H+ (AHA) and DHA in infant formula:
    A – AHA and DHA are derived from the EFA
    B – the supplementation of ARA and DHA is believed to possible improve visual acuity and enhance cognitive development
    C – the AAP recommends the addition of DHA and ARA to all infant formulas
    D – AHA and DHA are derived from the EFA AND the supplementation of ARA and DHA is believed to possible improve visual acuity and enhance cognitive development
    D – AHA and DHA are derived from the EFA AND the supplementation of ARA and DHA is believed to most companies have formulas that contain both ARA and DHA, making them 15% more $$. The AAP d/n currently have position on ARA and DHA)
  35. Preterm infant formulas, intended for infants <1800g, differ from standard formulas intended for term infants as follows:
    A – term infant formulas contain a higher lactose load
    B – preterm infant formulas contain a higher [] of whey pro and ‘lytes/minerals
    C – preterm infant formulas contain a higher [] of whey pro and ‘lytes/minerals AND the RDA for vitamins/minerals will be satisfied by a preterm formula if intake is => 120 kcal/d
    D - preterm infant formulas contain a higher [] of whey pro and ‘lytes/minerals AND term infant formulas contain a higher lactose load
    D - preterm infant formulas contain a higher [] of whey pro and ‘lytes/minerals AND term infant formulas contain a higher lactose load
  36. Calculate the adjusted gestational age for an infant that was born 6 weeks ago after spending 30 weeks in the womb
    A – 36
    B – 42
    C – 24
    D – 33
    A – 36
  37. When a preterm infant is being transitioned to home, the following is recommended:
    A – a post-d/c formula should be utilized until a weight of 3500g is achieved or until adjusted age is 9 months (post d/c formulas are used to reduce risk of vit toxicity)
    B – human milk fortifier should continue for the duration of breastfeeding
    C – the supplementation of ARA and SHA have shown to be beneficial in this populations
    D – human milk fortifier should continue for the duration of breastfeeding AND the supplementation of ARA and SHA have shown to be beneficial in this populations
    A – a post-d/c formula should be utilized until a weight of 3500g is achieved or until adjusted age is 9 months (post d/c formulas are used to reduce risk of vit toxicity)
  38. The following are true regarding term infant formulas
    A – term formulas are cow milk based formulas containing nonfat protein extracted from cow’s milk plus additional whey (CHO = lactose)
    B – caloric dis’n is similar to breast milk
    C – fat is derived via soy, sunflower, or coconut oil
    D – all of the above
    D – all of the above
  39. In addition to being utilized for suspected lactose intolerance, lactose free infant formulas may be used in all of the following situatuations except for:
    A – vegetarian families
    B – galactosemia
    C – prematurity
    D – cow’s milk protein allergy
    C – prematurity d/t lower ca2+:phos
  40. Protein hydrolysate formulase used for moderate cases of intolerance or malabsorption contain
    A – “predigested casein in peptide form
    B – no lactose
    C – free AA
    D – all of the above
    D – all of the above. Pro hydrolysate formulas are not indicated in preterm infants d/t low ca2+:phos
  41. The following statement is true re: elemental infant formulas
    A – sucrose, lactose and milk free
    B – reserved for severe malabsoprtion, as in short bowel syndrome
    C - contains free essential AA and non-essential AA
    D – all of the above
    D – all of the above
  42. When providing modular supplements, its important to remember that:
    A – a sterile environment is necessary for mixing
    B – no more than 2 doses of a modular can be provided per 500 mL of formulas
    C – pro powders typically only provide non-essential AA
    D – MCT d/n provide EFA
    D – MCT d/n provide EFA
  43. Trophic feeds, also referred to as minimal enteral nutrition or priming are provided to:
    A – stimulate gut hormones and promote GI tract maturation
    B – preventing necrotizing enterocolitis
    C – prevent infections
    D – all of the above
    A – stimulate gut hormones and promote GI tract maturation
  44. Some of the demonstrated benefits of trophic feeds ( 1-2 cc/kg/hr) include
    A – improved wt gain and feeding tolerance
    B – faster attainment of full enteral feeds
    C – decline in serum bilirubin/less phototherapy
    D – all of the above
    D – all of the above – a lower serum alk phos, inc serum gastrin, more rapid functional maturation of the intestines have also been observed w/ trophic feeds. When advancing trophic feeds the goal volume should be reached first, the [] to desired [].
  45. Enteral feeding is commonly utilized in premature infants given that a coordinated suck-swallow d/n usually develop until ___ weeks gestational age.
    A – 28-30
    B – 32-34
    C – 36-38
    D - >39
    B – 32-34
  46. Non-nutritive sucking (i.e. using pacifiers during gavage feeding) may
    A – improve wt gain (and result in earlier hospital d/c)
    B – lead to tooth decay
    C – delay transition to bottle
    D – lead to tooth decay AND delay transition to bottle
    A – improve wt gain (and result in earlier hospital d/c)
  47. Vitamin and mineral supplementation guidelines for TERM hospitalized newborns include
    A – if formula-fed, provide an iron fortified formula by 4 months of age
    B – if breast-fed, provide a dietary source of fe by 6 mos
    C – if breast-fed, provide 400 IU vit D
    D - if breast-fed, provide 400 IU vit D AND a dietary source of fe by 6 mos
    D - if breast-fed, provide 400 IU vit D AND a dietary source of fe by 6 mos
  48. Vitamin and mineral supplementation guidelines for PRETERM hospitalized newborns include
    A – if formula fed, provide a preterm infant formula or MVI if not on preterm formula
    B – if formula-fed or breast-fed, provide dietary source of fe by 2 mos of age
    C – if breast fed, provide human milk fortifier or an MVI if on unfortified breast milk
    D – all of the above
    D – all of the above
  49. In premature infants, when the exogenous provision of mineral substrates are inadequate to maintain the normal remodeling, mineralization and growth of bone, this condition develops
    A – osteopenia of prematurity
    B – osteomyelitis
    C – Gamma-1-hydroxylase osteomalacia
    D – aluminum toxicity
    A – osteopenia of prematurity
  50. All of the following are risk factors for osteopenia of prematurity except for:
    A - <34 wks gestational age at birth or <1500 g
    B – provision of enteral feeds with low mineral content/availability e.g. soy formulas, unsupplemented human milk, standard term milk based formula
    C – family hx of osteopenia
    D – chronic use of meds that alter bone mineralization, e.g. diuretics, dexamethasone)
    C – family hx of osteopenia
  51. The prevention and tx of osteopenia of prematurity consists of all of the following except:
    A – maximizing ca2+ and phos in PN
    B – use of HMF or preterm formula
    C – at least 2 hr/d of sunlight exposure
    D – ensure sufficient vit d provision (160-400 IU/d)
    C – at least 2 hr/d of sunlight exposure
  52. Bronchopulmonary dysplasia, defined as the need for assisted ventilation for >3d during the first 2 wks of life w/ radiological evidence of pulmonary changes lasting beyond the 1st month of life has been associated with poor growth as well as:
    A – feeding difficulties
    B – pancreatic insufficiency
    C – fluid, ‘lyte, and mineral imbalances
    D - fluid, ‘lyte, and mineral imbalances AND feeding difficulties
    D - fluid, ‘lyte, and mineral imbalances (ca2+ and phos abn d/t fluid restriction, lyte imbalances d/t pulmonary HTN, left ventrical hypertrophy) AND feeding difficulties (d/t dec suck/swallow, gastro esophageal reflux, and recurrent vomiting)
  53. Goals for enteral nutrition in the patient with Bronchopulmonary dysplasia include ___ kcal/kg/d and ___ g pro/kg
    A – 100-110; 2-3
    B – 120-130; 2.5-3.5
    C – 140-150; 3-4
    D - >150; >4
    B – 120-130; 2.5-3.5. if catch up growth is needed, up to 180 kcal g/d may be required. These pts require standard vitamin supplementation based on age/wt, but may require additional supplementation (i.e. folic H+ if on chronic abx or additional ca2+ and phos if on prolonged PN and/or unable to provide sufficient amts d/t fluid restriction

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