CLIPP 26 - CF

Question 1

FTT criteria (3)

Answer 1

Any of:

• weight below 3rd percentile
• weight for height/length less than 3rd percentile
• downward crossing of two or more major percentiles

Question 2

FTT causes (8)

Answer 2

• chronic diarrhea/vomiting
• CHF
• formula allergy
• improperly prepared formula
• inadequate formula volume
• malabsorption
• parental neglect
• severe gastroesophageal reflux

Question 3

CF genetics

Answer 3

autosomal recessive

Question 4

Average daily weight gain up to 4 months

Answer 4

20-30g/day (~1oz/day)

Question 5

When should birth weight be doubled?

Answer 5

By 4 months

Question 6

Organic FTT causes (underlying pathology)

Answer 6

• congenital heart defects
• CF
• developmental delay with poor suck/swallow
• renal tubular acidosis
• milk protein allergy
• HIV
• vomiting d/t reflux or bowel obstruction

Question 7

Non-Organic FTT Causes (inadequate caloric intake)

Answer 7

• poverty
• poor feeding technique
• improperly prepared formula
• inadequate supply of breast milk

Question 8

Daily caloric intake for first 4 months

Answer 8

100-110cal/kg/day

Question 9

Normal infant RBC values (birth and 2 months)

Answer 9

Birth: 16.5 g/dL

2 months: 11.2 g/dL (physiologic anemia)

Question 10

CF treatment plan

Answer 10

• nutritional management (enzymes, vitamins, calories)
• airway clearance
• treatment of airway infections

Question 11

Labs for FTT evaluation

Answer 11

• CBC (anemia, infection)
• Urinalysis (renal dysfunction, infection)
• BUN/Cr (renal function)
• Others: electrolytes (hydration, renal function, acid/base status), sweat test (CF), occult blood (milk protein intolerance), xray (cardiomegaly/pulmonary infilatrates), fecal fat analysis (malabsorption), fecal elastase (pancreatic insufficiency), LFTs (infection, biliary obstruction), neonatal screen, O&P (parasite), stool culture (salmonella, campylobacter), TSH (hypothyroid)

Question 12

DDX FTT

Answer 12

• CHF (difficulty feeding, respiratory distress)
• Formula allergy (intestinal blood loss, fussiness, vomiting)
• gastroenteritis (vomiting, diarrhea, fever, bloody stool)
• hypothyroidism (poor feeding, constipation)
• malabsorption (loose stools, good caloric intake)