annexure 1 -...

274

Annexure 1

277

Annexure 2

278

SAMPLE SIZE CALCULATION

Single Mean - Hypothesis testing - one population mean Standard Deviation = 4 Sample mean = 3.8 Population mean = 4.5 Alpha Error(%) = 5 Power (%) = 80 sided = 2 Effect Size = .175 Number needed (n)= 256 Alpha Error(%) Power(%) Sample Size(n) 70 315 1 80 382 90 487 70 201 5 80 256 90 343 70 153 10 80 201 90 279

279

Annexure 3

280

Paediatric Nutritional Assessment Data Sheet

Name Photo Date of Admission I.P. No. Date of Surgery Age/sex Date of Discharge Date of Birth Total no. of NSD: Address: Phone No. Contact I.D Informant : Reliability: Family History

Marriage of parents: Consanguineous / Non- Consanguineous

Family tree:

Mother‘s name : Period of gestation:

Date of delivery : Birth weight:

Type of delivery : Normal/ Instrumental/ Operation

Place of delivery: Hospital/ Home

Any problems during birth: Yes/ No

If Yes explain:

281

Antenatal history:

Mother‘s age: Height : Weight:

Nutritional status of mother:

Socio-economic background:

Literacy level:

Medical History

Presenting Problems:

Milestones:

Past Medical History:

Diagnosis:

Ventilation: Yes/ No Total no. of days:

Subjective data:

Appetite: Bowel:

Hunger: Micturition:

Thirst: Sleep:

Menstrual History ( > 12 yr and ≤ 18 yr girls) :

Anthropometric Data

Weight _______kg ______expected ______percentile (Chart enclosed)

Height _______cm ______ expected ______percentile (Chart enclosed)

Weight/height __________percentile

BMI _____percentile (Chart enclosed)

Head circumference______cm ______percentile

Chest circumference______cm ______percentile

282

Skinfold thickness _______mm ______percentile

Arm circumference_______cm ______percentile

Biochemical Data

Data

Normal value

Current Value

Interpretation

HAEMOGLOBIN 12-15gm/dl

WBC 4500-1100m3

RBS 80-120mg/dl

UREA 7-18mg/dl

CREATININE 0.6-1.2mg/dl

SODIUM 134-144mmol/dl

POTASSIUM 3.5-5mmol/dl

BILIRUBIN.T 0.2-1mg/dl

BILIRUBIN.D <0.4mg/dl

SGPT 40 I.U

SGOT 40 I.U

T.PROTEIN 6-7.8g/dl

ALBUMIN 3.2-5.6g/dl

GLOBULIN 2.3-3.5g/dl

ALK PO4 50-115I . U

Calcium 7.5-9.5mg/dl

Any other

283

Clinical Data

Signs or symptoms of nutrient deficiencies or excess:

Dietary Data

Colostrum given: Yes/No

Any problems observed during weaning:

Food allergies, intolerances, or special dietary concerns? Yes/ No

Explain:

Meal pattern at home:

Vegetarian/ Non vegetarian

Wake up Time/Bed Time

Diet (at hospital) Food frequency

284

Subjective Global Assessment A.1 – Weight change over past six month A: Weight gain or No change or Mild weight loss B: Moderate weight loss C: Severe weight loss

A.2 – Weight change in past 2 weeks A: Weight is increasing B: No change in weight C: Weight is decreasing

A.3 – Change in dietary intake A: No change or slight change for short duration B: Intake borderline and decreasing; Intake poor and increasing; Intake poor, no change based on prior intake C: Intake poor and decreasing A.4 – Duration and degree of change A: Less than 2 weeks, little or no change B: More than 2 weeks, mild to moderate suboptimal diet C: Unable to eat or starvation A.5 – Presence of GI symptoms A: Few or no symptoms intermittently B: Some symptoms for >2 weeks; severe symptoms that are improving C: Symptoms daily or frequently >2 weeks A.6 –Functional status A: No impairment in strength, stamina and full functional capacity; mild-moderate loss and improving B: Mild to moderate loss of strength, stamina / some loss of daily activity or severe loss but now improving C: Severe loss of function, stamina and strength A.7 – Disease state and co-morbidity A: No stress B: Low or moderate stress C: High stress B.1 – Subcutaneous loss of fat A: Little or no loss B: Mild-moderate in all areas; severe loss in some areas C: Severe loss in most areas

285

B.2 – Muscle wasting A: Little or no loss B: Mild to moderate in all areas; severe loss in some areas C: Severe loss in most areas B.3 – Edema A: Little or no edema B: Mild to moderate edema C: Severe edema

B.4 – Ascites A: No ascites or only on imaging B: Mild to moderate ascites or improving clinically C: Severe ascites or progressive ascites

Categories Nutritional Status Scores

A Well Nourished 0-11

B Moderately Undernourished 12-22

C Severely Undernourished 23-33

Estimated calorie intake from 24- hr recall

____________kcal/day ________________kcal/kg

___________g protein _____________protein/kg _____% kcals

_______________g fat _____________% calories

______g carbohydrate _____________% calories

286

Rx:

Energy:

Protein:

Carbohydrate:

Fat:

Fluid:

Salt:

Fibre:

Oil:

Plan (Oral/ EN) as indicated:

Follow up:

287

Annexure 4

288

FLUID CALCULATION AND MICRONUTRIENT RDA

Holiday and Segar formula for fluid calculation

Upto 10 kg 100ml/kg

10- 20 kg 1000 ml + 50 ml/kg above 10 kg

Above 20 kg 1500 ml + 20 ml/kg above 20 kg

Micronutrient RDA

Vitamin A

Vitamin D

Vitamin E

Vitamin C

1500 IU/day

400 IU/day

5-15 IU/day

40mg/day

Vitamin B complex

Thiamine (B1)

Riboflavin (B2)

Pyridoxine (B6 )

Niacin (B3 )

Folic Acid (B11)

Cyanocobalamine (B12)

0.5- 1.5 mg/day

0.5- 1.5 mg/day

0.5- 1.5 mg/day

5.0- 15 mg/day

50- 150 µg/day

0.5- 1.5 µcg/day

Calcium

Phosphorous

Magnesium

500- 1000 mg/day

800- 1000 mg/day

200- 300 mg/day

289

Iron

Iodine

Copper

Zinc

Fluoride

Manganese

Selenium

Molybdenum

Chromium

10- 20 mg/day

50- 150 µg/day

1-2 mg/day

5-15 mg/day

1-5 mg/day

1-5 mg/day

100 µg/day

200-500 µg/day

10 µg/day

290

Annexure 5

291

Type of Formula Quantity Energy (kcal)

Protein (g)

Infant formula (1) I, II,III

(1 scoop in 30 ml water)

30 ml 23 kcal 0.6


(1 scoop in 30 ml water + ½ tsp sugar)

30 ml

33 kcal

0.6

Infant formula (1) I,II,III

(1 scoop in 30 ml water + ½ tsp sugar + ½ tsp oil)

30 ml

55 kcal

0.6



30 ml

23 kcal

0.65



30 ml

33 kcal

0.65



30 ml

55 kcal

0.65

Infant formula (3)


30ml

21 kcal

0.72

Infant formula (3)


30ml

31 kcal

0.72

Infant formula (3)


30ml

53.5 kcal

0.72

292

Infant formula (3)


30ml

23 kcal

0.5

Infant formula (3)


30ml

33 kcal

0.5

Infant formula (3)


30ml

55.5kcal

0.5

Infant formula (3)


30ml

23.5 kcal

0.55

Infant formula (3)


30ml

33.5 kcal

0.55

Infant formula (3)


30ml

56Kcal

0.55

Infant formula (3)


30ml

23 kcal

0.7

Infant formula (3)


30ml

33 kcal

0.7

Infant formula (3)


30ml

55.5kcal

0.7

293

Infant formula (3)

Special Care for Lbwt child


30ml

23 kcal

0.56

Infant formula (3)



30ml

33 kcal

0.56

Infant formula (3)



30ml

55.5kcal

0.56


(1 scoop in 30 ml milk)

30 ml 43 kcal 1.6


(1 scoop in 30 ml milk + ½ tsp sugar)

30 ml

53 kcal

1.6


(1 scoop in 30 ml milk + ½ tsp sugar + ½ tsp oil)

30 ml

75 kcal

1.6



30 ml

43 kcal

1.65



30 ml

53 kcal

1.65


(1 scoop in 30 ml milk + ½

30 ml

75.5kcal

1.65

294

tsp sugar + ½ tsp oil)

Infant formula (3)


30ml

40.5 kcal

1.7

Infant formula (3)


30ml

50.5 kcal

1.7

Infant formula (3)


30ml

73 kcal

1.7

Infant formula (3)


30ml

42.5 kcal

1.5

Infant formula (3)


30ml

53.5 kcal

1.5

Infant formula (3)


30ml

76 kcal

1.5

Infant formula (3) Premium


30ml

43 kcal

1.5



30ml

53 kcal

1.5



30ml

75.5Kcal

1.5

295



30ml

43 kcal

1.7



30ml

53 kcal

1.7



30ml

75kcal

1.7

Infant formula (3) Special Care for Lbwt child


30ml

43 kcal

1.5



30ml

53 kcal

1.5



30ml

75kcal

1.5

Milk 100ml 75 3.2

Milk (100ml +

1tsp Sugar)

100ml 120 3.2

Milk ( 100ml +2tsp Sugar) 100ml 140 3.2

Egg Flip ( 2 eggs + 200ml Milk + 4tsp sugar)

300ml

340

19.5

296

Buttermilk

100ml

15

0.8

Clear Soup

150ml

85

1.2

Rice Kanjee

150ml

85

0.8

Dal water

150ml

85

2.8

Fruit juice

200ml

100

0

Fruit juice

( 200ml + 2tsp sugar)

200ml

140

0

Tender coconut water

100ml

30

0

Standard Pediatric Formula (>2year)

(5 scoops in 190 ml water)

225 ml

210

6.3

Soy protein isolate 1

( 1scoop in 60 ml water)

60 ml

65

1.74

297

Soy protein isolate 2

(1 scoop in 30ml)

30ml

21

0.7

Soy protein isolate 3 (>2year)

( 10gm in 100ml water)

100ml 38 8.4

MCT formula 1 scoop in 30 ml water

23 0.67

annexure 1 -...

Documents