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Recent Advances in Pediatrics—Special Volume 20: Nutrition, Growth and Development
Suraj Gupte
CHAPTER 1:
Maternal Nutrition and Fetal Health and Outcome
INTRODUCTION
PREPREGNANCY STATUS AND FETAL OUTCOME
MATERIAL DIET AND FETAL OUTCOME
NUTRITIONAL REQUIREMENTS DURING PREGNANCY
Calories
Proteins
Iron
Folic Acid
Calcium
Zinc
EFFECT OF FOOD SUPPLEMENTATION DURING PREGNANCY
RECOMMENDATIONS FOR WEIGHT GAIN IN PREGNANCY
EFFECTS OF VEGETARIAN DIET
Carbohydrates
Fats
Proteins
Micronutrients
Iron Deficiency in Vegetarian Diets
IS NONVEGETARIAN DIET ESSENTIAL?
LACTATION AND MATERNAL NUTRITION
Barker's (FOAD) Hypothesis
SPECIAL SITUATIONS
Anemia in Pregnancy
Dietary Intake, Physical Work and Nutritional Status
Lactation and Second Pregnancy
Nutritional Status and Reproductive Performance of Working Women
Nutrition and HIV Interactions
MISCONCEPTION ABOUT NUTRITION DURING PREGNANCY/LACTATION
STRATEGIES AND INTERVENTIONS FOR IMPROVING MATERNAL NUTRITION
CHAPTER 2:
Immunobiology of Human Milk
INTRODUCTION
ANTIBODIES
LACTOFERRIN
LYSOZYME
CASEIN
α-LACTALBUMIN
GLYCOCONJUGATES AND OLIGOSACCHARIDES
LIPIDS AND MILK FAT GLOBULES
ANTI-INFLAMMATORY COMPONENTS
CELLS
Soluble CD-14 and Soluble Toll-like Receptor
Leucocytes in Milk
Neutrophils
Macrophages
Lymphocytes
HORMONES AND GROWTH FACTORS
ENZYMES
LEPTIN, ERYTHROPOIETIN AND MELATONIN
NUCLEOTIDES
ANTISECRETORY FACTOR
CHAPTER 3:
Human Milk Fortification
INTRODUCTION
NUTRITIONAL NEEDS OF PRETERM INFANTS
Why Neonates are at Risk of Malnutrition?
Recommended Dietary Intake
Energy
Recommended Energy Intake for Enterally-fed Growing VLBW Infants20
Energy Intake for Parenterally-fed Infants
Recommended Energy Intake of SGA Infants
Macronutrient Requirements
Protein
Carbohydrate
Fat
Calcium and Phosphorus
HUMAN MILK FOR PREMATURE INFANTS
DOES HUMAN MILK MEET THE REQUIREMENTS OF PRETERM INFANTS?
EFFECTS OF FEEDING UNFORTIFIED HUMAN MILK ON GROWTH AND METABOLIC DISEASES
BENEFICIAL EFFECTS OF HUMAN MILK FORTIFICATION
FORTIFICATION AND LONG-TERM GROWTH AND NEURODEVELOPMENT
FORTIFICATION OF VARIOUS COMPONENTS
Protein
Fat
Carbohydrate
Minerals
COMMERCIAL MULTI-COMPONENT FORTIFIER
WHEN TO INITIATE HMF?
HOW LONG TO CONTINUE HMF?
ADVERSE EFFECTS OF FORTIFICATION
Tolerance
Infection
Risk of NEC
Reduced Fat Absorption
Preterm Formula
NUTRITIONAL ASSESSMENT
Biochemical
SPECIAL CONSIDERATIONS FOR ELBW BABIES
POST-DISCHARGE FEEDING
RESEARCH QUESTIONS
SUMMARY AND CONCLUSION
ACKNOWLEDGEMENT
CHAPTER 4:
Micronutrients and their Deficiency States
INTRODUCTION
MICRONUTRIENTS IN HUMAN HEALTH
MICRONUTRIENT MALNUTRITION
Iron
Vitamin A
Iodine
Folic Acid/Folate (Vitamin B11)
Other B Complex Factors
Vitamin B1 (Thiamine)
Vitamin B2 (Riboflavin)
Vitamin B3 (Niacin and niacinamide)
Vitamin B5 (Pantothenic acid)
Vitamin B6 (Pyridoxine)
Vitamin B12 (Cyanocobalamin)
Biotin
Inositol
Pyrroloquinoline quinine (PQQ)
Vitamin C (Ascorbic Acid)
Bioflavanoids
Vitamin K
Vitamin E
Vitamin D
Other Microminerals (Trace Elements)
Zinc
Copper
Cobalt
Selenium
Chromium
Manganese
Fluorine
Molybdenum
Nickel
Vanadium
Silicon
Arsenic
INTERACTION OF MICRONUTRIENTS AND DEVELOPMENTAL BIOLOGY
ANTIOXIDANTS
MICRONUTRIENTS INTERACTIONS: IMPLICATIONS ON PREVENTIVE AND THERAPEUTIC PRESCRIPTIONS
CHAPTER 5:
Nutrition in Pediatric Intensive Care Unit (PICU)
INTRODUCTION
METABOLIC STORES
METABOLIC RESPONSE TO ACUTE INJURY
Protein Metabolism
Energy Metabolism
Carbohydrates
Lipid Metabolism
TOTAL PARENTERAL NUTRITION (TPN) IN PICU
Fluid Requirements
Protein Requirements
Carbohydrates
Lipid
Electrolytes
ENTERAL VS PARENTERAL NUTRITION – WHICH IS BETTER?
NEWER CONCEPTS
CONCLUSION
CHAPTER 6:
Protein-energy Malnutrition: Changing Trends in Management
INTRODUCTION
MANAGEMENT OF MILD-MODERATE PEM
A. Mild to Moderate Malnutrition
B. Uncomplicated Severe Malnutrition
Management in Nutrition Rehabilitation Center (NRC)
CLINICAL WORK-UP IN SEVERE/COMPLICATED PEM10–16
THREE MAJOR PHASES OF TREATMENT OF SEVERE MALNUTRITION IN HOSPITAL
TEN ESSENTIAL STEPS OF TREATMENT OF SEVERE MALNUTRITION
STEP 1: TREATMENT/PREVENTION OF HYPOGLYCEMIA
Diagnosis
Treatment
A. Asymptomatic Hypoglycemia (Consciousness Retained)
B. Symptomatic Hypoglycemia
Monitoring
Prevention
STEP 2: TREATMENT/PREVENTION OF HYPOTHERMIA
Diagnosis
Treatment
Monitoring
Prevention
STEP 3: TREATMENT/PREVENTION OF DEHYDRATION
A. Dehydration without Shock
Diagnosis
Treatment
Monitoring
Prevention
B. Severe Dehydration with Shock
STEP 4: TREATMENT/PREVENTION OF ELECTROLYTE IMBALANCE
STEP 5: TREATMENT/PREVENTION OF INFECTION
Monitoring
Prevention of Infection
STEP 6: CORRECTION OF MICRONUTRIENT DEFICIENCIES
STEP 7: INITIATION OF REFEEDING
Start Cautious Feeding
STEP 9: PROVISION OF SENSORY STIMULATION AND EMOTIONAL SUPPORT
STEP 10: FOLLOW-UP AFTER RECOVERY
RESULTS OF EFFECTIVE NUTRITIONAL REHABILITATION
POOR RESPONSE TO NUTRITIONAL REHABILITATION
ADVERSE PHENOMENA OCCURRING DURING NUTRITIONAL REHABILITATION18
Refeeding Edema
Refeeding Syndrome
Pseudotumor Cerebri
Nutritional Recovery Syndrome
Encephalitis-like Syndrome
Nutritional Rickets
Anemia and Micronutrient Deficiencies
DISCHARGE
Acknowledgements
APPENDIX 6.1
APPENDIX 6.2
APPENDIX 6.3
CHAPTER 7:
Nutritional Support in the Hospitalized Children
INTRODUCTION
PATHOGENESIS
GENERAL PRINCIPLES
ASSESSMENT OF NUTRITIONAL STATUS
Route of Nutrient Delivery
Enteral
Parenteral Nutrition
NUTRITION IN SPECIFIC SITUATIONS
CHAPTER 8:
Nutritional Support in the Critically Ill Children
INTRODUCTION
REQUIREMENTS
INTRAVENOUS FLUIDS AND ELECTROLYTES
ENTERAL FEEDING
Routes of Feeding
Continuous and Intermittent Feeding
BREASTFEEDING
PARENTERAL FEEDING
COMBINATION OF ENTERAL AND PARENTERAL NUTRITION
NUTRITIONAL SUPPORT IN COMMON DISEASES
Diet in Liver Diseases
Diet in Heart Diseases with CCF
Diet in Renal Diseases
Diet in HIV
Diet in Neurological Disorders
Diet in Respiratory Disorders
Diet in Acute Pancreatitis
Diet in Diabetes Mellitus
CONCLUSION
CHAPTER 9:
Nutritional Support in Diarrheal Diseases
INTRODUCTION
PATHOPHYSIOLOGICAL CHANGES IN ACUTE DIARRHEA
PATHOPHYSIOLOGICAL CHANGES IN PERSISTENT DIARRHEA
Digestion of Carbohydrates
Digestion of Fats
Intolerance to Cow's Milk
Role of Bile Acids
Bacterial Colonization
Local and Systemic Immunoincompetence
GENERAL PRINCIPLES OF DIETARY MANAGEMENT
Osmolality of the Food
Dietary Fat
Intolerance of Lactose
Intolerance to Animal Milk Protein
Clinical Presentation of the Patient
SPECIFIC DIETARY RECOMMENDATIONS IN ACUTE DIARRHEA
Breastfed Infants
Milk or Formula-fed Infants
Older Infants and Young Children
SPECIFIC DIETARY RECOMMENDATION IN PERSISTENT DIARRHEA
Dietary Management of Persistent Diarrhea at Home
Dietary Management of Severe Persistent Diarrhea in a Hospital
Feeding of an Anorexic Child
Feeding During Convalescence
CHAPTER 10:
Nutrition in Celiac Disease
INTRODUCTION
PATHOGENESIS
CLINICAL PROFILE
DIAGNOSIS
TREATMENT
NEW THERAPIES
CHAPTER 11:
Cystic Fibrosis and Nutrition
INTRODUCTION
MEDICAL NUTRITION THERAPY IS PROACTIVE
GROWTH AND BODY COMPOSITION
ENERGY REQUIREMENTS AND DIET
Diet
Anticipatory Guidance
Special Diet Considerations
EFAD and DHA
Gastrostomy Tube Feedings
Diabetes
Vitamins and Minerals
Fat Soluble Vitamins
Vitamin D
Vitamin K
Vitamin A
Vitamin E
Zinc
Calcium
Iron
Sodium
CHAPTER 12:
Childhood Obesity
INTRODUCTION
INCIDENCE
RISK FACTORS
REGULATION OF APPETITE AND ENERGY BALANCE
ETIOLOGICAL CLASSIFICATION10
Simple/Primary/Endogenous Obesity
Organic/Secondary/Exogenous Obesity
Genetic syndromes
Hypothalamic causes
Endocrine causes
Drug induced
Handicapped Children due to Sedentary Lifestyle
Psychological Factors
BODY FAT COMPOSITION DURING GROWTH AND DEVELOPMENT
BARKER'S HYPOTHESIS
ASSESSMENT OF BODY FAT MASS
CONSEQUENCES OF OBESITY
APPROACH TO A CASE OF OBESITY
TREATMENT
PREVENTION
CHAPTER 13:
Growth and Development from Birth to Puberty
INTRODUCTION
Determinants of Growth and Development1–4
PERIODS OF GROWTH1–4
Patterns of Growth and Development1–4
Types of Body Build1,3
Statistics Used in Describing Growth and Development3–5
GROWTH
Normal Growth1–6
Assessment of Growth1–12
Nutritional Anthropometry
Body Measurements
1. Weight
2. Length/Height
3. Head Circumference
3. Chest circumference
Velocity of Physical Growth
1. Growth Velocity
2. Linear Catch-up Growth
Growth Chart
1. The WHO Growth Chart (Fig. 13.10)
2. Growth Charts used in India
Age Independent Anthropometry
1. Weight for Height
2. Midarm Circumference
3. Quac Stick
4. Midarm/Head Circumference Ratio
5. Mid Upper Arm/Height Ratio
6. Quetlet's Index
7. Body Mass Index (BMI)
8. Ponderal Index
Body proportions
1. Upper/lower Segments Ratio
2. Stem Stature Index
3. Span
Tissue Growth
1. Triceps Skinfold Thickness
2. Subscapular Skinfold Thickness
3. Biceps Skinfold Thickness
Skeletal Age
Dentition
Physiologic and structural Growth
DEVELOPMENT 1,3,6,14,15
Normal Development1,3,6,13,14
Assessment of Behavioral Development1,3,6,13,14
Gesell Developmental Schedule
Denver Development Screening Test (DDST)
Denver II (Modified DDST)
Bayley's Scale of Infant Development
Phatak Vadodra Screening Test
Trivandrum DST
Other Developmental Screening Tests
ANNEXURE
CHAPTER 14:
Short Stature Revisited
INTRODUCTION
PATHOPHYSIOLOGY
ETIOLOGIC CONSIDERATIONS
SALIENT FEATURES OF IMPORTANT TYPES OF SHORT STATURE
Genetic (Familial) Short Stature
Constitutional Short Stature
Primordial Dwarfism
Nutritional Dwarfing/Dwarfism
Emotional Deprivation
Chronic Systemic/Visceral Diseases
Endocrinopathies
Skeletal Disorders
Chromosomal Disorders
Genetic Disorders
EVALUATION PROTOCOL 4–8
Appearance
Anthropometry
Growth Velocity (GV)
Body Proportions
Midparental (Target Height)
Pubertal Staging
Bone Age
Interpretation of Clinical Information
Investigations
MANAGEMENT 4,12–15
COMPLICATIONS
PROGNOSIS
ACKNOWLEDGEMENTS
CHAPTER 15:
High-risk Neonate: Neurodevelopment Follow-up
INTRODUCTION
WHO ARE HIGH-RISK INFANTS?
IMPORTANCE OF FOLLOW-UP
WHO SHOULD DO FOLLOW-UP?
FOLLOW-UP SCHEDULE
COMPONENTS OF FOLLOW-UP
Assessment of Growth
Nutritional Assessment
Vitamins and Minerals
Immunization
Developmental Screening
Neurological Assessment
Cognitive Assessment
ROP Screening
Screening Protocol
When to Screen?
Review
Hearing Screening
History suggestive of a hearing loss
Screening Tests
Follow-up
Behavioral Problems
EARLY INTERVENTION AND PHYSICAL THERAPY
IMPORTANCE OF EARLY INTERVENTION
SUMMARY AND CONCLUSION
CHAPTER 16:
Neurodevelopmental Delay
INTRODUCTION
DESCRIPTION
NEURODEVELOPMENTAL EVALUATION
DEVELOPMENTAL DOMAINS
GLOBAL DEVELOPMENTAL DELAY
SPEECH AND LANGUAGE DELAY
EXPRESSIVE LANGUAGE DELAY
HEARING LOSS
DYSARTHRIA
VERBAL LEARNING DISABILITY
AUTISM
DEVELOPMENTAL LANGUAGE DISORDER
LANDAU-KLEFFNER SYNDROME
MOTOR DELAY
HYPOTONIA
Fine-motor Adaptive Delay
PERSONAL AND SOCIAL DELAY
Personal Social Delay
SCREENING TOOLS
HISTORY AND PHYSICAL EXAMINATION
INTERVENTIONS
CHAPTER 17:
Learning Disabilities
INTRODUCTION
DEFINITION
CLASSIFICATION OF LD
PREVALENCE
ETIOLOGICAL THEORIES OF DYSLEXIA
The Phonologic-deficit Hypothesis
Magnocellular Theory
NEUROBIOLOGICAL BASIS OF LEARNING DISABILITIES
THE GENETICS OF LEARNING DISABILITIES
BRAIN MEASUREMENTS
SIGNS OF LEARNING DISABILITY
ASSESSMENT
Neuropsychological Testing
NEUROPSYCHIATRIC COMORBIDITY
Neuropsychiatric Disturbances in LD
MANAGEMENT
AVAILABLE FACILITIES FOR LEARNING DISABILITIES
CHAPTER 18:
Developmental Disabilities: Comorbidity
INTRODUCTION
WHY COMORBIDITY?
Genetic Factors
Anatomic Factors
Neurochemistry
Social Factors
MENTAL RETARDATION AND COMORBIDITY
Associated Psychiatric Disabilities
Affective Disorder
Conduct Disorder
ADHD
Autism and Pervasive Developmental Disorders
Stereotypy and Self-injurious behavior
LEARNING DISABILITY AND COMORBIDITY
PERVASIVE DEVELOPMENTAL DISORDERS (PDD) AND COMORBIDITY
Associated Deficits
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) AND COMORBIDITY
Comorbidity
CEREBRAL PALSY AND COMORBIDITY
CHAPTER 19:
Children and Adolescents with Poor Scholastic Performance
INTRODUCTION
PREVALENCE
CAUSES OF SCHOLASTIC BACKWARDNESS
In the Home Environment
In the School Environment
In the child
SPECIFIC LEARNING DISABILITY
Definition of Specific Learning Disability (SLD) by the National Joint Committee on LD25
What are the Underlying Deficits?
Clues to Dyslexia in Early Childhood
Indicators of Learning Disability in school going child
Reading and Language Disability
Problems with Reading
Problems with Reading comprehension
Problems with Writing
Mathematics learning disability
Problem with Mathematics
Other difficulties noted in children with SLD
DIAGNOSIS OF SLD
INTERVENTIONS AND THEIR IMPLICATIONS ON PROGNOSIS
OUTCOMES
CHAPTER 20:
Picky Eating and Anorexia in Children
INTRODUCTION
LEPTIN AND GHRELIN – THE SATIETY AND HUNGER SIGNALS
DEFINITIONS
EPIDEMIOLOGY
DEVELOPMENTAL STAGE OF FEEDING DISORDERS
PATHOGENESIS
Supertaster Theory
Slower Growth Rate
Emotional State and Mood Swings
Parental Influence
Neophobia and Slow Adaptation
Genetic and Environmental influences
Picky Eating
PICKY EATING AND ASSOCIATED CONDITIONS
Low birthweight and BMI
Future Eating Disorders
Other Associations
COMPLICATIONS/CONSEQUENCES
Nutritional Deficiencies
Infantile Anorexia
Anorexia Nervosa
DIFFERENTIAL DIAGNOSIS
MANAGEMENT
NEAT PROGRAM
PROGNOSIS
CHAPTER 21:
Integrated Management of Neonatal and Childhood Illnesses
INTRODUCTION
RATIONALE FOR AN EVIDENCE-BASED SYNDROMIC APPROACH TO CASE MANAGEMENT
BACKGROUND
EVIDENCE-BASED SYNDROMIC APPROACH
GOALS OF IMNCI3
THE PRINCIPLES OF INTEGRATED CARE
THE CASE MANAGEMENT PROCESS
THE IMNCI-PLUS APPROACH
STATUS OF IMPLEMENTATION AND CHALLENGES 3–7,12–14
CHAPTER 22:
National Nutrition Programs for Children in India
INTRODUCTION
CHANGING NUTRITION SCENARIO
PRESENT SCENARIO2–4
STRATEGIES TO COMBAT PUBLIC NUTRITION PROBLEMS5
NATIONAL NUTRITION PROGRAMS FOR CHILDREN6
NUTRIENT BASED PROGRAMS DIRECTED AGAINST SPECIFIC NUTRITIONAL DEFICIENCIES6–10
National Nutritional Anemia Prophylaxis Program
National Program for Prophylaxis against Blindness in Children
Infancy
Childhood
National Iodine Deficiency Disorders Control Program
SUPPLEMENTARY FEEDING PROGRAMS DIRECTED AGAINST GENERAL MALNUTRITION6–12
Special Nutrition Program
Balwadi Nutrition Program
Midday Meal Program
Applied Nutrition Program
Integrated Child Development Services Scheme
Pradhan Mantri's Gramodaya Yojana
Tamil Nadu Integrated Nutrition Program
Wheat-based Supplementary Nutrition Program
ADMINISTRATION AND POLICIES TO COMBAT THE PROBLEM OF MALNUTRITION1,6,9,13–15
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