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What is the dose of MVI for pediatrics?
- <2.5 kg = 2mL/kg
- >2.5 kg = 5 mL
- > or = to 11 yrs = 10 mL
How does pediatric MVI differ from adult?
- No propylene glycol
- More fat soluble vitamins = ADEK
If a patient over = to or > 11 years is receive TPN for > 2 weeks, what supplementation is required in addition to MVI?
What is the significance of adding additional Cysteine to pediatric TPNs?
- Conditionally essential AA
- Acidifies the bag, increasing the amount of Ca and phosphorus that can be dissolved
What are the common complications of TPN in pediatrics?
- Line complications
When is Cholestasis expected to arise after commencement of TPN?
2 weeks to 2 months
What lab values indicate Cholestasis?
Gtt and direct bilirubin increases, followed by Increased AST and ALT
What are the treatments for pediatric TPN induced Cholestasis?
- Cycling of TPN
- Withdrawal of TPN
- Enteral feeding
- Ursodial (Actigall)
- Cholestyramine (Questran)
What is the brand name for Ursodial?
What is the generic name for Actigall?
What is the generic name for Questran?
What is the brand name for Cholestyramine?
How is TPN induced osteopenia treated in pediatrics?
Give as much Ca, Phosphorus and Vitamin D as possible
Why is enteral nutrition better than parenteral?
- Maintains GI functional and structural integrity
- Decreased bacterial translocation
- Enhanced utilization of nutrients
- Ease and safety of administration
- Decreased hepatobilirary complications
- Less expensive
What are the contracindications to enteral feeding?
- Necrotizing enterocolitis (infected bowel)
- GI obstruction
- Intestinal atresia
- Severe inflammatory bowel disease
- Acute pancreatitis
What diseases are reduced when infants are breastfed?
- Crohn’s disease
- Diabetes mellitus
- Allergic gastroenteritis
- (all autoimmune diseases)
What are the CI to breastfeeding?
- Herpes or Syphilitic lesions
- Chicken pox
- Hep B
- Some meds
- Prematurity (< or = to 34 weeks)
What are the preterm formulas and how do they differ from normal formulas?
- Similac Special care and Enfamil premature formula
- More protein, more calorically dense (20-24 kcal/oz) and more Ca and Phosphorus
What are the transitional formulas?
- Help transition preterm babies to term milk:
- Neosure and Enfacare
What must a preterm infant receive if they are getting formula?
What formulas are partially hydrolyzed?
- Similac Sensitive
- Enfamil Gentlease
- Similac Total comfort
What formulas are soy based?
Prosobee and Isomil
What are the indications for Soy based formulas?
- Lactose intolerance
- Cow’s milk allergy
- Lactase deficiency
When would a partially hydrolyzed formula be indicated?
- Lots of spit up = potential protein allergy
What are the Casein hydrosylate based formulas used?
- When all other formulas are not tolerated
- Severe persistant GI disruption or diarrhea
What are the Casein hydrosylate formulas?
What are the elemental formulas?
What are Advance or Lipil formulas?
Contain extra FFAs associated with increased visual acuity (DHA and ARA)
What formulas are available for older children (for ages 1-10 years)?
Kindercal and Pediasure
What are the complications of formulas?
What are the daily caloric need of an infant?
What are the daily fluid needs of an infant?