30 Questions
What is the primary focus of the 2022 ESPGHAN position paper?
Enteral nutritional requirements for hospitalised preterm infants
What is the specific population of interest in the 2022 ESPGHAN position paper?
Hospitalised preterm infants with a birth weight of <1.8kg
What is the purpose of the ESPGHAN position paper?
To establish guidelines for enteral nutritional requirements in hospitalised preterm infants
At what volume of enteral intake does the ESPGHAN 2022 position paper recommend that a breast milk fortifier be started?
40 - 100 ml/kg/day
What is the purpose of using the enzyme trypsin in SMA Nutrition products?
To break down proteins into smaller pieces
Which SMA Nutrition products have been partially broken down into smaller pieces using trypsin?
Comfort, AR, Gold Prem 1, Gold Prem 2, Advanced IF, FoF, and GUM
What is the difference between the technology used in SMA High Energy and other SMA Nutrition products?
The enzyme used in SMA High Energy is of microbial origin, whereas in other products, they are from animal sources.
Why is the SMA High Energy product not suitable for vegetarians?
Because it contains DHA from a fish source
What is the purpose of heat treating the whey protein hydrolysate in SMA High Energy?
To ensure there is no carryover of microbial material into the final product
Why is the 200ml SMA High Energy product not Halal certified?
Because it is produced on different production lines than the 90ml product
What is the purpose of having SMA Nutrition products tested by EUROFINS?
To detect any residual porcine DNA
What will be provided to HCPs regarding the SMA High Energy product?
A letter explaining its status
Which independent laboratory is used to test SMA Nutrition products for residual porcine DNA?
EUROFINS
The Rome IV criteria defines specifics for diagnosing infant colic. List the 3 main defining criteria
- Infant below 5 months of age, 2. Recurrent and prolonged periods of crying/fussing/irritability that occur without obvious cause and which cannot be prevented/resolved, 3. No evidence of failure to thrive (faltering growth)/fever/illness
The Rome IV criteria defines constipation in children <1 year of age by having 2 or more of a number of signs. List 3 of the signs included in this definition.
Any 3 of: less than 3 complete stools/week (type 3 or 4, Bristol Stool type), Hard large stool, Rabbit droppings (type 1 Bristol Stool type), Distress on stooling, bleeding associated with hard stool, straining, previous episode of constipation, previous/current anal fissure
Colic has many proposed causes. What are 3 factors thought to contribute?
Any 3 from: GI: immature & imbalanced gut microbiota, CMPA, excess gas, Lactose intolerance, GOR(D), gut hormones. Neurodevelopmental-caused by inability of baby to regulate crying. Psychosocial-parental perception of crying, stress/anxiety, inadequate infant-parent interaction. Infant feeding issues-e.g. swallowing air during feeding
What is the main cause of functional constipation in young babies?
Insufficient fluid intake
Up to 1 in 6 families with babies showing colic symptoms consult a HCP. List 3 potential effects of colic on parents.
Any 3 of: Stress, sleep deprivation, tiredness/fatigue, clinical depression, breastfeeding cessation, loss of working days, anxiety, infant maltreatment, loss of confidence in parenting skills
What are the 3 main NICE recommendations for managing infant colic?
- Provide info/support to parents 2. Infant soothing techniques to help calm baby and minimise GI discomfort 3. Encourage parental wellbeing
Specify 4 ways that SMA Comfort differs to a standard First Infant Milk, in order to help in the dietary management of colic and constipation
Any 4 of: 1. 100% whey PHP 2. Reduced lactose 3. Starch thickener 4. Increased Mg content 5. Prebiotics GOS/FOS
Explain how a higher magnesium content in a Comfort formula may help with constipation (2 marks)
Mg can increase the water content and volume of stools, significantly improve stool consistency and frequency
The NHS, NICE and Bladder and Bowel UK all recommend management strategies for infant functional constipation. Please list 3 of these strategies.
3 of: Sufficient fluid intake, cycling baby's legs, abdominal baby massage, warm bath, giving a formula-fed baby a little extra cool boiled water between feeds
Summarise topline the evidence for the use of probiotics in infant constipation (2 marks)
Overall insufficient evidence to conclude whether they can successfully manage functional constipation-data from systematic reviews. (1 mark) or Outcomes are strain dependent (1 mark) or More research is needed (1 mark)
Constipation is rare in exclusively Breast fed babies. However, at what age do babies start to pass stools less often (and hence when might some parents mistake this for constipation)?
6 weeks old
Why do Comfort formulas have a lower lactose level than standard first infant milks? (1 mark)
Temporary lactose intolerance may be a cause of colic in SOME babies
What type of products are covered by the WHO Code for marketing of breastmilk substitutes?
Breast-milk substitutes and other foods suitable for infants under 6 months
What is the purpose of the WHO Code for Marketing of Breastmilk substitutes?
To regulate the marketing of breast-milk substitutes
What is the age range of children covered by the Code?
0-3 years
What is the current status of national implementation of the Code?
Few countries have implemented the Code
What does the ESPGHAN 2022 paper say about hydrolysed protein use in preterm infants?
In Preterm infants , hydrolysed protein formula accelerates gatro-intestinal transit and enteral feeding advancement and may be used for early enteral feeding if human milk is not available.
Assess your knowledge on the 2022 ESPGHAN position paper on enteral nutritional requirements for hospitalised preterm infants with a specific birth weight. Test your understanding of this important guideline.
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