Transcript c39b1545f3dda7c

Chapter 9
Infant Nutrition:
Conditions and Interventions
Key Nutrition Concept #1
• Infants who are born preterm or who are
sick early in life often require nutritional
assessment and interventions that ensure
they are meeting their nutritional needs for
growth and development.
Key Nutrition Concept #2
• Early nutrition services and other
interventions can improve long-term health
and growth among infants born with a
variety of conditions.
Key Nutrition Concept #3
• The number of infants requiring specialized
nutrition and health care is increasing due to
the improved survival rates of small and
sick newborns.
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
• Advances in health care have reduced infant
mortality
• Advances in neonatal health care
have increased survival of infants who were
preterm, low birthweight and/or with
chronic conditions
• Result: more infants requiring specialized
nutritional services
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.
Nutrition Services
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Federal disability programs
IDEA, Part C
Early Head Start
WIC
MCH Block Grant