FTT
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
iii.
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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