Monday, May 28, 2012

Doctorese babble -- Failure To Thrive


   1.     Definition
a.     Crossing two percentile lines vertically or horizontally – 5th and 95th are 2 STDs
b.     Weight drops first, then height follows – if HC drops  pathological
c.     Also if Consistently below 3rd percentile or 80th percentile on weight vs. height
d.     Premies should be age-corrected up to two years
   2.     Causes
a.     Achondroplasia
b.     Trisomy 21
c.     GH deficiency
                                               i.     Williams’
                                             ii.     Turner’s
d.     Nutrition
                                               i.     1 oz = 30mL
                                             ii.     Should be getting 100ml/kg/day
                                            iii.     4 kg = 400mL/8 = 50mL = 1.5 oz q8hr
                                            iv.     Normal 60-80 kcal/day – Enfamil = 20kcal/oz
                                             v.     Premies/FTT/SGA/Withdrawal/Heart defects /Fast metabolism/ short bowel/ malabsorption all require increased energy needs -- 24 kcal/oz – can sometimes result in diarrhea -- discharge with Enfacare = 22kcal/oz
   3.     Inorganic
a.     Non-pathological – zero nutrition
b.     Observe a feeding
c.     15/min breast
d.     MCC of non-accidental abuse -- neglect
   4.     Organic
a.     Decreased food
                                               i.     TEF
                                             ii.     Pyloric stenosis
                                            iii.     Cleft palate/lip – special nipple
                                            iv.     Pierre Robin’s Sydrome
                                             v.     Oral-motor dysfunctions
b.     Increased metabolism
                                               i.     CHD
                                             ii.     Malabsorption syndrome
1.     Celic
2.     CF
                                            iii.     Short-bowel
                                            iv.     Small L-colon
                                             v.     Lactose intolerance
1.     Soy milk
2.     Galactosemia -- increased bilirubin
                                            vi.     Milk protein allergy – Neosure and Neoko? – rash/hives/diarrhea/melena
                                          vii.     Milk protein intolerance – only bloating and discomfort
c.     Increased excretion
d.     blaj
   5.     Infection
a.     IUGR – ToRCH -- symmetrical SGA
b.     Candida
c.     HIV ***
d.     Any other infection
   6.     Metabolic conditions
a.     Anion gap metabolic acidosis
b.     Neurological symptoms 
   7.     Neurological disorder
   8.     Lead toxicity – testing at 9 months
a.     Anemia
b.     Basophilic stippling
c.     Constipation
d.     Dust is MC source
e.     Screaming is capillary stick
   9.     Hg poisoning à fish 
   10.  Renal tubule acidosis
a.     Distil tubule
b.     Proximal tubule -- lost water and proteins – do UA  
   11.  ARPKD
   12.  Renal agensis
   13.  Reflux à hydronephrosis -- especially boys
   14.  Endocrine
a.     Hypothyroidism
                                               i.     Macrogloassia impedes swallowing
                                             ii.     Impacts metabolism
b.     Hypothalamus
   15.  Evaluation
a.     Watch a feeding
b.     Newborn screen
c.     Growth chart
d.     CMP/BMP – CBC (Infection) – glucose
e.     UA
f.      Pb
g.     HIV
h.     ToRCH titers
i.      Pre-ablumin – good indicator of feeding
   16.  Treatment
a.     Normal food à catch-up 100-120 kcal/kg -- 120ml/kg replacement – replace slowly
                                               i.     Refeeding syndrome – decreases PO4
                                             ii.     < 6 mo à increase 10-20g/day weight – weigh without diapers on the same scale at the same time

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