Jawaban Kuis Pediatric Nutrition

  1. b. The American Academy of Pediatrics (AAP) recommends that the introduction of solids be delayed until 4 to 6 months of age. The reason for that is to allow infants to develop the motor skills necessary to clearly indicate hunger or satiety. There is some evidence that spooning food into infants who lacks the skills to show if he or she is no longer hungry may increase the likelihood that the child will learn to overeat. This becomes more important issue in light of theincreasing prevalence of obesity in childhood.

  2. e. A relatively high fat intake should continue throughout infancy to ensure adequate caloric intake and to provide substrate for central nervous system growth. Because of its low caloric density and high protein and electrolyte load, low- fat milk is not recommended by the AAP until age 2 years.

  3. a. Most of food aspiration occurs in children 3 years of age and younger. Two-thirds of the recovered food items are clearly inappropriate food for infants and young children (such as nuts, popcorn, and candy), but one fourth of the items are vegetables and fruits, suggesting a continued need for supervision to prevent choking.

  4. d. The AAP recommends delaying the introduction of fresh milk until 12 months of age. Early use of cow’s milk increase the risk of iron deficiency because of the low concentration and bio-availability of iron in milk, and because fresh cow’s milk induces occult fecal blood loss in young infants.

  5. c. Breast milk is low in vitamin K. Prior to the widespread use of vitamin K prophylaxis in hospitals, classic hemorrhagic disease of the newborn affected 0.25% to 1.7% of term infants. This has been almost eliminated by parenteral administration of vitamin K at birth. This form of hemorrhagic disease most often presents with intra-cranial bleeding and causes severe morbidity and mortality. Factors contributing to the development of the late bleeding include diarrhea and antibiotic administration. Breast fed infants are at risk for iron deficiency anemia because the iron in breast milk, although well absorbed, is inadequate. Some breast- fed infants deplete their iron stores by 4 to 6 months of age and could develop biochemical evidence of iron deficiency anemia by 9 months of age. Iron fortification of formulas has resulted in significant decrease in the prevalence of childhood anemia.

  6. c. Please refer to table 1. The explanation for this question: 1000cc (for the first 10 Kg) + 50cc x 2= 1100 cc. For IVF calculation you can use the rule 4, 2, 1 which is 4cc/Kg/ Hour for the first 10 kg, 2 cc/Kg /Hour for (11-20 kg) and 1 cc/Kg /Hour for (21 kg and above). Therefore, the IVF rate for this 12 Kg infant is (4ccx10 Kg) + (2ccx 2 Kg)= 44cc/hour.

Table 1

Maintenance Fluid Requirements for Children

Weight (kg)

Volume (per day)

Preterm

(<1,000)140-150 cc/kg

1-10

100 cc/kg

11-20

1,000 cc + 50 cc/kg for each kg above 10 kg

20-50

1,500 cc + 20 cc/kg for each kg above 20 kg

>50

3,000 cc

  1. For infants younger than 1 year of age, special elemental formulas are available in which the source of protein is a hydrolyzed casein or amino acids. The fat blend is a mixture of medium-chain and long-chain triglycerides, whereas the carbohydrate content is mostly corn syrup solids. These formulas are commonly used in situations where the gastrointestinal tract is compromised, as in the case of postgastroenteritis malabsorption syndrome (partial villus atrophy causing decrease in the ability to digest and absorb nutrients). On the other hand, patients with fat malabsorption and cholestatic liver disease require formula, which contains high amount of medium-chain triglycerides.

  2. c. Portagen is a formula that contains the highest amount of medium-chain triglyceride oil (85%), and is most commonly used for patients with fat malabsorption and cholestatic liver disease (see table 2. composition of special infant formulas).

Table 2

Composition of Special Infant Formulas

Formula

Protein

Fat

Alimentum

Casein hydrolysate

MCT (50%)/LCFA

Pregestimil

Casein hydrolysate

MCT (55%)/LCFA

Portagen

Na+ hydrolysafe

MCT (8%)/LCFA

Neocate Infant

Amino acids

LCFA/MCT

MCT = medium-chain triglyceride; LCF = long-chain fatty acid; SHS = Scientific Hospital, Inc.

  1. d. The best indicator for appropriate feeding is adequate weight gain. Infants typically gain 1 oz per day for the first few months of life (this is after the first 10days of life when they could loose up to 10% of their birth weight). Urine output (about 6-7 wet diapers per day) is a good measurement of adequate fluid intake. Calories count could be used to assure adequate nutrition by comparing the calories required versus the calories taken by the infant (see table 3.)

Table 3

Caloric Requirements for Parenteral Nutrition for Children

Age

(yrs) kcal/kg/d

Preterm neonate

85-150

Term neonate

100-120

Infants

80-100

1-3

75-90

4-6

65-75

7-10

55-75

10-18

40-60

Clinical Tip: Quick assessment of appropriate amount of formula for an infant:

The number of oz given every 4 hours = Weight in KG
Example: A 3 Kg baby should be given 3 oz of formula every 4 hours.
Calories count=3 Kgx 120 cal per day=360 calories
360 calories/20 cal per oz=18 oz
18 oz/6 (feeding every 4 hours)=3 oz

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