Chapter 9 Infant Nutrition: Conditions and Interventions

1. Chapter 9Infant Nutrition:Conditions and Interventions Nutrition Through the Life Cycle Judith E. Brown

2. 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

3. 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?

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Nutrition for Infants with Special Health Care Needs

16. Common Nutritional Problems • Nutrition Risks to Development • Developmental delays—range of symptoms reflecting slow development such as: • Slow growth and/or • Feeding problem

17. 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

18. 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

19. 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)

20. 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

21. Severe Preterm Birth and Nutrition • Food Safety • Vital for preterm infants with immature immune systems

22. 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

23. Severe Preterm Birth and Nutrition

24. Severe Preterm Birth and Nutrition

25. Severe Preterm Birth and Nutrition • Preterm infants and feeding • Challenges in feeding VLBW or ELBW infants include: • Fatigue • Low tolerance of volume • “Disorganized feeding”

26. 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

27. 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

28. 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

29. 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

30. Infant Formulas for Special Needs • Special infant formulas may be used for some conditions.