Transcript Maternal chapter9

Chapter 9
Infant Nutrition:
Conditions and Interventions
Nutrition Through the Life Cycle
Judith E. Brown
Key Terms
• Children with Special Health Care Needs
Infants, children or adolescents with, or at risk for,
a physical or developmental disability, or with a
chronic medical condition
• Low-Birthweight (LBW) Weighing <2500 g
• Very Low Birthweight (VLBW) <1500 g
• Extremely Low Birthweight (ELBW) <1000 g
Infants at Risk
• Key questions regarding infants:
– How is the baby growing?
– Is the diet providing all required nutrients?
– How is the infant being fed?
Infants at Risk
• Families of infants with special health care
needs should be considered
– Emotional impact of having sick newborn may
be overwhelming to parents
– Healthcare providers must be sensitive to
parents’ emotional needs
Energy and Nutrient Needs
• Energy Needs
– May be the same, more or less depending on
the special needs
– Increased calories required for
• Difficulty breathing
•Infections
• Temperature regulation •Fever
• Recovery from surgery
– Decreased calories recommended for spina
bifida or Down syndrome
Energy and Nutrient Needs
• Energy Needs
– AAP suggests 120 cal/kg for preterm infants
– The European Society for Gastoenterology and
Nutrition gives a caloric range of 95-165 cal/kg
– Recovering infants may need as much as 180
cal/kg
Energy and Nutrient Needs
• Protein Requirements
– 2.2 g/kg adequate if growth or digestion are not
affected
– 3.0-3.5 g/kg required for preterm or recovery from
illness
– 4 g/kg may be needed for ELBW
• Form of protein
– Hydrolyzed protein or single amino acid formulas
– Specific amino acid formulas such as for PKU
Energy and Nutrient Needs
• Fats
– Provide up to 55% calories from fat
– Low-fat diet rarely required
– Medium-chain triglycerides (MCT) beneficial
to VLBW and ELBW infants because of low
pancreatic and liver enzymes
– Essential fatty acids and DHA and AA
important
Energy and Nutrient Needs
• Vitamins and Minerals
– May need additional vitamins and minerals to
support “catch-up” growth or during recovering
from illness
– Human-milk fortifiers provide additional
calories and nutrients
– Preterm infant formulas may have higher
amounts of vitamins and minerals
Growth
• Tracking growth reflects nutritional status for
most infants
• Additional methods to use if underlining
conditions exist include:
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Growth charts for specific conditions
Biochemical indicators
Body composition
Head circumference
Medications that impact growth
Growth
• Growth in Preterm Infants
– “Neonatal Research Network Growth Observational
Study Research Network” tracks infant BW between
501 and 1501 g
– Infant Health and Development Growth Charts:
• For LBW Premature
• For VLBW Premature
• Correction for Gestational Age
– Gestation-adjusted age calculated by subtracting GA at
birth from 40 weeks
Growth
• Does Intrauterine Growth Predict Outside
Growth?
– Depends on:
• Intrauterine environment
• Fetal origins theory
• Other factors like air pollution
• Interpretation of growth
– Based on a pattern of weight gain
Growth
• Interpretation of Growth
– Rate of growth frequently used to measure
improvement in preterm or sick infants
– Microcephaly or macrocephaly may affect body
composition and growth
– Great variability in growth of infants
Nutrition for Infants with Special
Health Care Needs
• Health conditions in infants interfere with
growth and development
• Nutrition plays an important role in:
– Preventing illness
– Maintaining health
– Treating conditions in infancy
Nutrition for Infants with Special
Health Care Needs
Common Nutritional Problems
• Nutrition Risks to Development
• Developmental delays—range of symptoms
reflecting slow development such as:
– Slow growth and/or
– Feeding problem
Common Nutritional Problems
• Down syndrome–
– Incidence is 13 per 10,000 live births
– Developmental delays seen in infancy
• Nutrition concerns include:
– Weak facial muscles cause feeding difficulty
– Overweight common—close monitoring of
growth
– Low amount of movement resulting in reduced
caloric needs
Severe Preterm Birth
and Nutrition
• Incidence and prognosis
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About 60,000 VLBW born in U.S. each year
Survival rate ~ 90%
Nutrition support generally required
High metabolic rates
• Preterm infants fed by nutrition support
– Parenteral—nutrients delivered directly to the
bloodstream
– Enteral—nutrients delivered directly to GI tract
Severe Preterm Birth
and Nutrition
• How sick babies are fed
• Conditions that require parenteral feeding
– Gastrointestinal problems may interfere with
oral feeding
– Damage or inflammation to GI tract from
necrotizing enterocolitis (NEC)
Severe Preterm Birth
and Nutrition
• How sick babies are fed
• Conditions that require enteral feeding
– Gastrointestinal reflux, constipation, spitting
up, vomiting, etc.
• Types of enteral tube feeding
– Oral-gastric (OG)
– Transpyloric
– Gastrostomy
– Jejunostomy
Severe Preterm Birth
and Nutrition
• Food Safety
– Vital for preterm infants with immature
immune systems
Severe Preterm Birth
and Nutrition
• What to feed preterm infants
– Breastmilk
– Human-milk fortifier
– Preterm infant formulas
• Vary in caloric content
• MCT oil
• Whey protein
Severe Preterm Birth
and Nutrition
Severe Preterm Birth
and Nutrition
Severe Preterm Birth
and Nutrition
• Preterm infants and feeding
– Challenges in feeding VLBW or ELBW infants
include:
• Fatigue
• Low tolerance of volume
• “Disorganized feeding”
Infants with Congenital
Abnormalities and Chronic
Illness
• GI tract disorders
– Diaphragmatic hernia – displacement of the
intestines up into the lungs
– Tracheoesophageal atresia – incomplete
connection between the esophagus and the
stomach
• Cleft lip and palate – upper lip and roof or
mouth are not formed completely
Infants with Congenital
Abnormalities and Chronic
Illness
• Genetic disorders
– Small subset of congenital anomalies
– Includes:
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Galactosemia
Maple syrup urine disease
Urea cycle disorders
Fat-related and carbohydrate disorders
Disorders sensitive to high-dose vitamins
Renal or Bone genetic disorders
Feeding Problems
• Seen in 40-45% of VLBW infants
• Feeding problems may cause frustration to
families
• Recommendations for introducing solids
and weaning with preterm infants are based
on corrected gestational age
• Table 9.5 lists Signs of feeding problems in
high-risk infants
Nutrition Interventions
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Frequent growth assessment
Monitor intake
Adjust feeding frequency/volume
Adjust timing or nursing, snacks or meals
Assess feeding position and support
Nutrient density to facilitate eating
Parent education
Observe parent-infant interactions
Consider developmental abilities
Infant Formulas for Special
Needs
• Special infant formulas may be used for
some conditions.