Chapter 9 Infant Nutrition: Conditions and Interventions

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Chapter 9Infant NutritionConditions and
Interventions
Nutrition Through the Life Cycle Judith E. Brown
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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 lt2500 g
• Very Low Birthweight (VLBW) lt1500 g
• Extremely Low Birthweight (ELBW) lt1000 g

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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?

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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Nutrition for Infants with Special Health Care
Needs
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Common Nutritional Problems

• Nutrition Risks to Development
• Developmental delaysrange of symptoms reflecting
  slow development such as
• Slow growth and/or
• Feeding problem

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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 commonclose monitoring of growth
• Low amount of movement resulting in reduced
  caloric needs

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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
• Parenteralnutrients delivered directly to the
  bloodstream
• Enteralnutrients delivered directly to GI tract

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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)

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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

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Severe Preterm Birth and Nutrition

• Food Safety
• Vital for preterm infants with immature immune
  systems

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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

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Severe Preterm Birth and Nutrition
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Severe Preterm Birth and Nutrition
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Severe Preterm Birth and Nutrition

• Preterm infants and feeding
• Challenges in feeding VLBW or ELBW infants
  include
• Fatigue
• Low tolerance of volume
• Disorganized feeding

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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

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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

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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

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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

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Infant Formulas for Special Needs

• Special infant formulas may be used for some
  conditions.

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