Chapter 9 Infant Nutrition Conditions and Interventions Nutrition
- Slides: 32
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: – – – 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 – – 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: • • • 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 • • • 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.
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