Importance of LCPUFAs
Long-chain polyunsaturated fatty acids are important for the development and function of the nervous system. Tissues that contain a large amount of this type of fatty acid include the brain, the retina, and other neural tissues
Feeding coordination
Term newborns have 10 to 30 sucks per burst. Preterm newborns born at 32-weeks gestational age have 3 to 5 sucks per burst. The period of maximum vacuum occurs when the newborn’s tongue is lowered, allowing milk to enter the mouth. Thereafter, when the tongue is raised, the vaccum decreases and the flow of milk stops
Manganese
trace element in pn. activates specific enzymes (superoxide dismutase), plays a role in bone structure, and assists with carbohydrate metabolism. A neonate who is deficient in manganese can develop dermatitis, hair depigmentation, growth failure, and GI symptoms. Excessive amounts can lead to basal ganglia injury as a result of manganese deposition
Cysteine
Required for the synthesis of antioxidant glutathione, helps to maintain redox potential, and assists with calcium production. poor solubility so often added last to the amino acid solution
Estimated survival time with no food for 2kg baby
10 days. 4 days for 1kg baby. 2 days for 500g
Reasons for decreased milk supply in pump-dependent preterm mothers
Infrequent or ineffective pumping, breast shield with a tight fit, initiation of progestin-based contraception
Donor milk banks test for…
HIV, HTLV, Hep B, Hep C, syphillis
How much copper should be in diet
120 mcg/kg/d of copper
Generally Recognized as Safe
refers to an ingredient in food that is considered safe
How much zinc should be in diet
350 mcg/kg/d
when can you thicken feeds
beyond 40 weeks corrected
Prevalence of severe cholestasis
The incidence of cholestasis increases with increasing parenteral nutrition duration so that prevalence is 14% in neonates who received parenteral nutrition for 14 to 28 days, with severe cholestasis occurring in 42%, 72%, 85% of neonates who received parenteral nutrition for 29 to 56 days, 57 to 100 days, and more than 100 days respectively
Hypertryglyceridemia
> 150 mg/dl
starter PN requirements
3.5 to 4 g/kg/day protein
5 to 6 mg/kg/min glucose
also want 3g/kg/day lipids
intralipid
soy-bean based oil with omega 6 fatty acids (linoleic) and phytoserols
Omegaven
fish oil. omega 3 fatty acids (docosahexaenoic)
Crematocrit
estimates the amount of lipids and calories in human milk
Platelet activating factor acetylhydrolase
Anti-inflammatory component found in human milk that degrades platelet activating factor, which is thought to be involved in the development of NEC
sucking to swallowing ratios
The typical ratio of sucking to swallowing during nonnutritive sucking is 6:1 to 8:1. This is in comparison with nutritive suckign in young neonates and older infnats who have ratios of 1:1 and 2:1 to 3:1
Lactoferrin
Most common whey protein in human milk. In the stomach pepsin assists with the proteolysis fo lactoferrin, which produces lactoferricin, a microbicide. Lactoferricin assits with the direct destruction of bacteria, viruses, fungi and parasites. Antacids could negatively effect this. Colostrum contains the greatest amount of lactoferrin compared with formula, hind breast milk, or mature breast milk
Zinc deficiency
FTT, alopecia, diarrhea, perianal dermatitis, crusted erythematous rash involving the face, extremities, and anogenital regions, nail hypoplasia and dysplasia
___ increases zinc intestinal absroption
protein and amino acids
Signs of copper deficiency
hypochromic anemia (not responsive to iron), neutropenia, osteoporosis, in preterm- seborrheic dermatitis-like rash, ftt, diarrhea, hepatosplenomegally, hypotonia, apnea
Docosahexaenoic acid
DHA (22:6, n-3) major long-chain polyunsaturated fatty acid in the retina is DHA, which is important for photo transduction. The newly identifeid anti-inflammatory mediators resolivn D1 and protectin D1 are most likely derived from DHA
