Mid Year exam

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What is the primary focus of the 2022 ESPGHAN position paper?

Breastfeeding guidelines for hospitalised preterm infants
Enteral nutritional requirements for hospitalised preterm infants (correct)
Parenteral nutritional requirements for hospitalised preterm infants
Enteral nutritional requirements for hospitalised term infants

What is the specific population of interest in the 2022 ESPGHAN position paper?

Neonates with a gestational age of 37 weeks
Infants with a diagnosis of Intrauterine Growth Restriction
Hospitalised term infants with a birth weight of 2.5 kg
Hospitalised preterm infants with a birth weight of <1.8kg (correct)

What is the purpose of the ESPGHAN position paper?

To compare the efficacy of different enteral nutrition formulas
To provide a comprehensive review of breastfeeding techniques
To discuss the role of probiotics in neonatal nutrition
To establish guidelines for enteral nutritional requirements in hospitalised preterm infants (correct)

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 (C) Signup and view all the answers

What is the purpose of using the enzyme trypsin in SMA Nutrition products?

To break down proteins into smaller pieces Signup and view all the answers

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 Signup and view all the answers

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. Signup and view all the answers

Why is the SMA High Energy product not suitable for vegetarians?

Because it contains DHA from a fish source Signup and view all the answers

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 Signup and view all the answers

Why is the 200ml SMA High Energy product not Halal certified?

Because it is produced on different production lines than the 90ml product Signup and view all the answers

What is the purpose of having SMA Nutrition products tested by EUROFINS?

To detect any residual porcine DNA Signup and view all the answers

What will be provided to HCPs regarding the SMA High Energy product?

A letter explaining its status Signup and view all the answers

Which independent laboratory is used to test SMA Nutrition products for residual porcine DNA?

EUROFINS Signup and view all the answers

The Rome IV criteria defines specifics for diagnosing infant colic. List the 3 main defining criteria

<ol> <li>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</li> </ol> Signup and view all the answers

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 Signup and view all the answers

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 Signup and view all the answers

What is the main cause of functional constipation in young babies?

Insufficient fluid intake Signup and view all the answers

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 Signup and view all the answers

What are the 3 main NICE recommendations for managing infant colic?

<ol> <li>Provide info/support to parents 2. Infant soothing techniques to help calm baby and minimise GI discomfort 3. Encourage parental wellbeing</li> </ol> Signup and view all the answers

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 Signup and view all the answers

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 Signup and view all the answers

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 Signup and view all the answers

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) Signup and view all the answers

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 Signup and view all the answers

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 Signup and view all the answers

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 (A) Signup and view all the answers

What is the purpose of the WHO Code for Marketing of Breastmilk substitutes?

To regulate the marketing of breast-milk substitutes (B) Signup and view all the answers

What is the age range of children covered by the Code?

0-3 years (A) Signup and view all the answers

What is the current status of national implementation of the Code?

Few countries have implemented the Code (B) Signup and view all the answers

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. Signup and view all the answers