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Neonatal and Infant Nutrition PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Neonatal and Infant Nutrition” by Dr Abdolreza Norouzy.

This medical PowerPoint presentation is about neonatal and infant nutrition, a critical component of a childs growth and development. Adequate nutrition during the first few years of life is essential for building a strong foundation for future growth and development. Neonatal nutrition refers to the feeding and nourishment of newborn babies, typically from birth to the first 28 days of life. Infant nutrition refers to the feeding and nourishment of babies from one month to two years of age.

During the neonatal period, the babys nutritional requirements are primarily met through breast milk or formula feeding. Breast milk is the preferred choice, as it provides all the essential nutrients that a baby needs, including antibodies that help protect against infection. Formula feeding may be necessary if a mother is unable to breastfeed or if there are other medical concerns.

As the baby grows and enters the infant stage, the introduction of solid foods becomes an essential component of their nutrition. The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life and the introduction of solid foods around six months of age. Introducing a variety of nutrient-dense foods, including fruits, vegetables, grains, and protein sources, is important for providing the necessary nutrients for growth and development.

It is also essential to ensure that infants receive appropriate amounts of iron, calcium, and vitamin D, as deficiencies in these nutrients can lead to serious health problems. Iron is important for healthy brain development, and calcium and vitamin D are essential for strong bones and teeth.

Overall, neonatal and infant nutrition plays a vital role in a childs growth and development. Parents and caregivers should work closely with healthcare professionals to ensure that infants receive appropriate nutrition and that any concerns or issues are addressed promptly.

Tags : Neonatal and Infant Nutrition, nourishment of newborn babies, neonatal period, Breast milk, Neonatal-Perinatal Medicine, Neonatal-Perinatal Medicine PowerPoint presentation

Published on : Jun 07, 2023 | Views : 2612 | Downloads : 6

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Slide 1-

Neonatal and Infant Nutrition Dr Abdolreza Norouzy Associate Professor in Clinical Nutrition Mashhad University of Medical Sciences
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Introduction What does ‘nutrition’ mean to you?
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The OED definition Nutrition (noun) the process of taking in and assimilating nutrients. the branch of science concerned with this process. DERIVATIVES nutritional adj. nutritionist noun. ORIGIN Latin, from nutrire ‘nourish’.
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Textbook answer Nelson’s Textbook of Paediatrics achievement of satisfactory growth and avoidance of deficiency states.
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‘Normal’ Nutrition
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Fetal nutrition Parenteral (mostly!) Stores are laid late in gestation At 28 weeks, a fetus has: 20% of term calcium and phosphorus stores 20% of term fat stores About a quarter of term glycogen stores
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Adaptation to nutrition after birth Gut adaptation is regulated by Endocrine factors Intraluminal factors Breast milk hormones and growth factors Bacteria
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Feeding the term infant Breast feeding achieves Nutrition Immunological and antimicrobial protection Passage of breast milk hormones and growth factors Provision of digestive enzymes Facilitation of mother-infant bonding
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Supplementing breast milk Should be unnecessary, but Vitamin K levels are low Vitamin D levels are low in areas of little sunlight Iron levels are low (but very well absorbed)
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Normal output
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NEC and IUGR Case-control study (n=74) at 30-36 weeks GA, birth weight <10th centile is a significant risk factor OR 6 (1.3-26)1 Observational study (n= 69) At 30-36 weeks 71% of cases were <10th centile2 1 Beeby and Jeffrey. 1991, ADC:67:432-5 2 McDonnell and Wilkinson. Sem Neonatol 1997
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Cochrane review: early vs late feeding 72 babies in 2 studies Early feeders had Fewer days parenteral nutrition Fewer investigations for sepsis No difference in NEC Weight gain
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Cochrane review: rapid vs slow increase 369 babies in 3 studies Rapid: 20 to 35 ml/kg/day Slow: 10 to 20 ml/kg/day Rapid group: reached full enteral feeds and regained birthweight faster No difference in NEC rate or length of stay
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Cochrane review: minimal enteral nutrition 380 babies in 8 studies 12 to 24 ml/kg/day for 5 to 10 days MEN group Faster to full enteral feeds Shorter length of stay No difference in NEC
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Feeding small or preterm infants: Choices Human milk Mother’s own Banked donor milk Fortified Artificial Term formula Preterm formula Parenteral Nutrition
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Parenteral Nutrition
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Parenteral Nutrition If an infant can’t, won’t or shouldn’t be fed enterally What’s in the bag? Fluid Carbohydrate Protein Fat Minerals and Trace Elements
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Energy Requirements Basal metabolic rate Physical activity Specific dynamic action of food Thermoregulation Growth
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Energy Requirements kcal/kg/day Basal metabolic rate 40 Physical activity 4+ Specific dynamic action of food (10%) Thermoregulation variable Growth 70 (To match in-utero growth of 15g/kg/day)
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Protein With glucose infusion alone, infants lose 1-2% of endogenous protein stores daily 1g/kg/day gives protein balance 2.5 to 3.5g/kg/day allows accretion nb energy requirement Safe to start soon after birth
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Fat Energy source Essential fatty acid source (intralipid) Cell uptake and utilisation of free fatty acids is deficient in preterm infants Start at max 1g/kg/day, increasing gradually to 3g/kg/day (less if septic)
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Growth Goals Weight: 20-30 g/day Length: ~1cm/week HC: 0.5cm/week Correlates with brain growth and later development
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Total Parenteral Nutrition Determine fluid requirement (mL/kg/day) for first day of life Full-term infants: 60–80 mL/kg/day Late preterm and preterm infants (30–37 weeks): 80 mL/kg/day Very-preterm infants: 100–120 mL/kg/day Determine Glucose Infusion Rate (GIR) GIR: (% dextrose x IV rate ) ÷ (6 x wt in kg) Calculate GIR from known dextrose concentration (%). Example: An infant weighs 2 kg and is receiving 100 ml/kg/day of dextrose 15% solution. IV rate: 100 × 2 = 200 ml/day ÷ 24 = 8.3 ml/hr GIR: (15% x 8.3 x 0.1667) ÷ 2 = 10.3mg/kg/min (15% x 8.3 ) ÷ (6 x 2) = 10.3 mg/kg/min
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Total Parenteral Nutrition Protein and amino acids Start with 2- 3 g/kg/day Increase 0.5–1.5 g/kg/day to a total of 3–4 mg/kg/day Goal for premature infants: 4g/kg/day Goal for term infants: 3g/kg/day Source: trophamine
Slide 27-

Calculate electrolytes to add to bag DOL#1: dextrose in water with no eletrolutes is usually appropriate except in premies with low Ca stores who may require Ca DOL#2: add electrolytes to the bag based on estimated daily requirements and BMP Estimated Needs: NaCl = 2-4 mEq/kg/day KCl = 1-2 mEq/kg/day (NOTE: Do not supplement K until UOP >1cc/kg/hr, especially in premies) CaGluconate =200-400mg/kg/day (NOTE: mg not mEq and Ca cannot be infused at >200mg/kg/day through a central line)
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Total Parentral Nutrition Other added nutrients Lipids Cystein Phosphrous Magnesium Trace Minerals MVI Heparin
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Total Parenteral Nutrition Central TPN Peripheral TPN Easy to meet nutrition needs No limits on osmolarity Little risk of phlebitis Long term use May require general anesthesia Greater risk of infection Increased cost Greater risk of mechanical injury, air embolism, venous obstruction Unable to meet needs for Ca/Phos needs Maximum rate of Calcium gluconate is 200mg/kg/d Maximum % dextrose is 12.5% Short term use Less risk for catheter related infections Lower cost ? Less risk of mechanical injury, air embolism, venous obstruction
Slide 30-

Nutrition Goals
Slide 31-

Energy needs
Slide 32-

Fluid and Nutrition Needs - Term RDA for calories for term infant = 108 kcal/kg/day, 20 cal/oz breast milk has 68 kcal/100 ml, How much milk does the baby need to meet RDA? x ml/kg/day = 108 kcal ÷ 68 kcal X 100 ml = 160 ml/kg/day
Slide 33-

Fluids to meet nutritional needs- enteral nutrition
Slide 34-

Comparison of nutrient concentrations of parenteral & enteral fluids
Slide 35-

Benefits of PN Earlier, faster weight gain Avoidance of problems associated with enteral feeds
Slide 36-

Risks of PN Line associated sepsis Line related complications (eg thrombosis) Hyperammonaemia Hyperchloraemic acidosis Cholestatic jaundice Trace element deficiency
Slide 37-

Laboratory assessment TPN requires regular monitoring of acid base status, liver function, bone profile and electrolytes In enterally fed infants, monitoring albumin, transferrin, total protein, urea, alkaline phosphatase and phosphate may be useful
Slide 38-

Milk Feeds
Slide 39-

Human milk advantages Protection from NEC Improved host defences Protection from allergy and eczema Faster tolerance of full enteral feeds Better developmental and intellectual outcome
Slide 40-

Human milk shortcomings if preterm Human milk may not provide enough Protein Energy Sodium Calcium, phosphorus and magnesium Trace elements (Fe, Cu, Zn) Vitamins (B2,B6,Folic acid, C,D,E,K)
Slide 41-

Breast milk fortifiers Improved short term growth nutrient retention bone mineralisation Concerns trend towards increased NEC
Slide 42-

Term vs preterm formulas Term formulas do not provide for preterm protein, calcium, sodium and phosphate requirements, even at high volumes Term formula (vs preterm formula) fed infants Grow more slowly Have lower developmental score and IQ at follow up
Slide 43-

Evidence Based Nutrition RA Ehrenkranz, Seminars in Perinatology 2007 (31): 48-55
Slide 44-

Post-Discharge Nutrition
Slide 45-

The evidence Comparison of breast milk with term formula Calcium and phosphate deficiency in breast milk fed infants in first year resolves by age two Little difference in growth (although small numbers)
Slide 46-

Catch-up Growth Enhanced nutritional intake sufficient to allow ‘catch-up’ growth improves long term neurodevelopmental outcome
Slide 47-

Nutrition Assessment
Slide 48-

How best to assess growth and nutrition? Weight Reflects mass of lean tissue, fat, intra- and extra-cellular fluid compartments Length More accurately reflects lean tissue mass Head circumference Correlates well with overall growth and developmental achievement
Slide 49-

Nutritional Standards Standard for determining nutritional needs - for term infants - human breast milk for preterm infants - growth rate that mimics in utero growth Adequacy of growth compared to standards – growth charts Birth weight charts – Babson, Fenton Growth charts - WHO
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Slide 55-

Composition of Breast Milk and Formulas
Slide 56-

Human Breast Milk Gold standard for modeling term infant formulas Preferred source of enteral nutrition for all infants, including premature and sick newborns Contraindications- galactosemia, congenital lactase deficiency, maternal HIV or use of some medications Protein – whey:casein ratio- early milk – 90:10 vs. mature milk – 60:40 CHO – lactose (40% of energy content) Fat – (40-50% of energy content); ~ 12% of fatty acids are medium chain
Slide 57-

Dietary Supplementation
Slide 58-

Vitamin D needs at NICU discharge Poly-vi-sol drops, 400 units Vitamin D per 1 ml Enfamil D-Vi-Sol Vitamin D (D3) Supplement Drops, 400 units per 1 ml (50 ml bottle costs ~$11)
Slide 59-

Term Infants – Additional supplements Healthy Breast fed Iron after 4-6 months (usually enriched cereal) Fluoride after 6 months Formula fed – depending on intake Chronic diseases Multivitamin for chronic intake < 500 kcal/day Seizures treated with phenobarbital – extra Vitamin D Abnormal GI losses– ?need for zinc, copper, fat-soluble vitamins and electrolytes
Slide 60-

Preterm Infants – Stable, Growing No daily multivitamin mineral supplements - premies on preterm formulas or human milk fortifiers Ex-premies on transitional/premature discharge formulas <4.2 kg If standard term infant formula or breast milk – multivitamins, folic acid, calcium, phosphorus, and zinc may be needed Need for iron supplements depends on milk & presence of anemia
Slide 61-

Bone meds Prevent need with optimal nutrition throughout NICU stay Refer to Calcium and phosphorus supplements used to treat osteopenia Target intake – 200 mg elemental calcium/kg/day 115 mg elemental phosphorus/kg/day Doses must be staggered to prevent formation of calcium-phosphorus precipitates
Slide 62-

Iron supplements Iron source - Formulas provide ~ 2 mg/kg/day elemental iron per 160 ml/kg/day Growing, preterm infants @ 1-2 months or 2X BW. Healthy, term infants @ 4-6 months Dose (elemental iron) - Preterm = 4-6 mg/kg/day Term = 2 mg/kg/day Max= 15 mg/day of supplemental iron
Slide 63-

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Slide 64-

Enteral Nutrition Breast milk is best! The American Academy of Pediatrics (2005) recommends breastfeeding for the first year of life. Started when an infant is clinically stable Absence of food in the GI tract produces mucosal and villous atrophy and reduction of enzymes necessary for digestion and substrate absorption Trophic hormones normally produced in the mouth, stomach, and gut in response to enteral feeding are diminished. Breastmilk and standard infant formula have 20kcal/30cc (30cc=1oz) Specialized formulas and fortifiers allow caloric content to be increased
Slide 65-

Breastmilk Preferred source of enteral nutrition Very well tolerated by most infants Improves gastric emptying time Matures the mucosal barrier Promotes earlier &  appearance of IgA Vastly ’s incidence of NEC More significant induction of lactase activity compared to formula fed premies Composition: Varies with gestation Varies according to maternal diet Varies within a feeding( fat in last ½ fdg) Varies within the day( fat in PM over AM)
Slide 66-

Enteral Nutrition in the NICU Term: If clinically stable, start PO ad lib feeds and advance as tolerated Preterm Feeds are often initiated with breastmilk, Sim 20 or SSC 24 Trophic tube feeds may be continuous or bolus and advanced gradually (10-20mL/kg/day) Transition to bolus from continuous typically begins after achieving full feeds PO feeds typically attempted around 32-34 weeks, when premies develop suck and swallow coordination Premies are often supplemented with TPN as they work up on feeds Goal discharge formula is Neosure 22
Slide 67-

Goals Ensure continuation of growth by giving enough calories Provide balance in fluid homeostasis keep electrolytes normal range Avoid imbalance in macro-nutrients Provide micro-nutrients and vitamins
Slide 68-

Guidelines fluid management 80 cc/kg/day, increase to 100-120cc/kg/d with increase IWL Increase to 100cc/kg/d 2nd day add sodium 2-4 mEq/kg/d and K= 2 mEq/kg/d. Calcium may be added after 2nd day adjust according to urine output 2-3cc/kg/hour with 110-140cc/kg/d Specific gravidity 1.008-1.012, watch weight change, total in/out
Slide 69-

others Minerals Zinc, copper, molybdenum, chromium, selenium Calcium, phosphorous, Magnesium Na, K Vitamins Fat soluble Water soluble
Slide 70-

Biochemical testing for patient on TPN Urine glucose Triglyceride BUN, Albumin Ca, P, Mg, creatinine, Na, Cl, CO2 direct (conjugated) bilirubin, ALT Trace element level
Slide 71-

Trophic Feeding Keeping infant fasting (NPO) Decrease in intestinal mass Decrease in mucosal enzyme Increase in gut permeability Trophic feeding: small amount of feeding to prepare the intestine release enteric hormones, better tolerance to feeds
Slide 72-

breastfeeding DOL# 1: Colostrum and transitional milk average volume 35 mL (7-125mL) DOL# 3-5: Increasing milk production
Slide 73-

Breast feeding Q2-3 hours = 8-12 feeds per day Quicker gastric emptying frequent breast stimulation and emptying increase milk supply Watch for feeding cues Duration 10 minutes or longer As long as swallowing continues Cluster feeds is normal Growth spurts Baby may feeds more frequently for 1-2 days Many growth spurts at 2wks, 6, wks, 2-3 months, and 5-6 months they feed more during them
Slide 74-

Maternal factor of low milk Gestational diabetes Hypothyroid Retained placental fragments Dehydration, hemorrhage, hypertension, infection Previous breast surgery Lack of prenatal engorgement Psychosocial Previous unsatisfactory experience Lack of partner support Post-partum depression Separation from infant
Slide 75-

Human milk Human milk is Ideal food for full term infant Inadequate components for premature infant <1500gm (human milk fortifier needed to be added) Protein Vitamin D Calcium Phosphorous Sodium