Infant Nutrition: Conditions

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Infant Nutrition Conditions Interventions

• Chap 9 Brown

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See Cloud Feeding Problems DVD

• Follow Cloud Power point
• Answer Cloud questions Midterm on Website

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Infants At Risk

• Most infants are born healthy and then grow and
  develop in a usual manner
  
• Some have special needs
• Infant mortality decreased 39 between 1980 and
  1995 in US. Health Care is now better at saving
  ill children than preventing chronic conditions
  
• Advances in Neonatal intensive care
• Preterm infants who died in the past are now
  being saved

4
Preterm Infants

• Much more likely to have nutrition needs
• Questions to ask in all cases
• How is the baby growing?
• Is the diet providing all of the necessary
  nutrients?
  
• How is the infant being fed?

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Energy and Nutrient Needs of Infants with Health
Conditions

• Best determined by indirect calorimetry
• Generally 120 cal/kg
• Modifications to this based on condition
• Eg. Downs syndrome may be 108 kcal/kg

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Correction for Gestational Age

• 40 weeks from last menstrual cycle is a term
  delivery
  
• If born at 30 weeks, 10 weeks or approx. 2.5
  months early
  
• 2.5 months subtracted from infants current
  chronological age and plotted on Infant Health
  and Development Program (IHDP) Growth Premature
  Growth Charts
• http//www.cdc.gov/growthcharts/
• http//www.who.int/childgrowth/en/

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Severe Preterm Birth

• Preterm 11.6 of all births
• LBW 7.6 of all births, almost 300,000 in 1998.
  Most observed and go home in a week.
  
• VLBW(under 1500 grams) 1.4 of all births, over
  55,000 in 1998.
  
• Near 1500 grams, Usually 28-32 weeks gestation
  Nearly 90 survival immediate intensive care
  long term nutritional care
  
• ELBW(Extremely Low) less than 1000g 23-28 weeks
  Often lifelong consequences.

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How Sick Babies are Fed

• VLBW and ELBW babies are at high risk for GI
  tract problems
  
• Necrotizing enterocolitis damage to a section of
  the GI tract resulting in bleeding
  
• Parenteral Nutrition required

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Feeding Methods

• If GI tract works, use it
• Oral gastric feeding
• Transpyloric feeding
• Gastrostomy feeding
• Jenunostomy feeding

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What to Feed Preterm Infants?

• Breast Milk Recommended, by the mother if
  possible with active feeding
  
• If not possible, use banked breast milk
• May require supplementation
• If Breast milk not possible, pre-term formula is
  recommended.

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Problems Feeding Preterm

• Fatigue
• Low tolerance to volume
• Disorganized feeding

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Case Study 9.1

• Premature Birth in an At-risk Family

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Infants With Genetic Disorders

• Maple Syrup Urine Disease
• Rare genetic condition of protein metabolism in
  which breakdown by-products build up in blood and
  urine, causing coma and death if untreated.
  Branched chain aas (leucine, isoleucine and
  valine) accumulate and their keto acid
  derivatives become toxic
• http//www.msud-support.org

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Maple Syrup Urine Disease

• Diet needed within days of birth or brain damage
  or death will occur
  
• Referred to Genetic Centers for additional
  screening and treatment.
  
• Screening is done in some states at birth. Not
  Washington.
  
• Washington Screens for PKU and congenital
  hypothyroidism but not the 30 other screenable
  disorders.
  

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MSUD Symptoms

• Infant with poor appetite
• Irritable
• Characteristic odor in urine burnt sugar
• Within days of birth lost sucking reflex
• Listless, high-pitched cry, rigid and limp
  episodes
  
• With no treatment seizures, come and death

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MSUD Inheritance

• Recessive disorder
• Parents are carriers of MSUD gene so dont show
  the disease
  
• Each pass the gene on to their offspring

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MSUD Treatment

• Carefully controlled diet with synthetic formula
  with no leucine, isoleucine, valine
  
• These aas are added to diet in carefully
  controlled amounts of food to provide for
  necessary growth and development

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Genetic Problems

• Galactosemia Inability to convert galactose to
  glucose. Galactose part of lactose Avoid
  lactose No breastfeeding Not screened for in
  Washington
• DiGeorge Syndrome
• Chromosome 22 has a small deletion resulting in
  wide range of speech, heart, and learning
  difficulties
  

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DiGeorge Syndrome(22q11.2)

• Genetic Problem with part of Chromosome 22
  missing. Symptoms may include
  
• Heart defects in 74 of patients
• Cleft palate or palate anomalies in 69 of
  patients
  
• Results in 30 of patients having feeding
  problems
  
• May require naso-gastric or gastrostomy

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DiGeorge Syndrome

• Hypocalcemia is common
• Impaired immune function with poor thymus
  function and T cell production
  
• Dx with facial features(hooded eyelids, long
  face) and then FISH (Fluorescence in situ
  hybridization) a chromosome test which shows a
  missing portion of the 22nd chromosome.

21
DiGeorge Syndrome

• Nutritonal Tx Variable
• Cleft palate may require tube feeding until
  repaired
  
• Heart defects may affect energy level and tires
  infant significantly during feeding.

22
Case Study 9.2

• Di George Syndrome

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Down Syndrome

• Trisomy 21
• Sucking problems due to hypotonicity
• Other contributing factors
• Cardiac Problems
• Fatigue
• Delayed dentition
• Show Cloud Module II G

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Prader-Willi Syndrome

• http//www.pwsausa.org/
• Disorder of 15th chromosome 2 mother 15s and no
  father 15
  
• Dx FISH (Fluorescence in situ hybridization, a
  chromosome test)
  
• Hypotonia in neonate and infant
• Feeding problems
• Excessive wt gain between 1 and 6 years

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Prader-Willi Syndrome

• Distinctive facial features narrow face, almond
  shaped eyes, small-appearing mouth with thin
  upper lip, down-turned corners of mouth
  
• Hypogonadism
• Global developmental delay before age 6
• Food foraging/obsession with food maybe due to
  hypothalmic dysfunction Urge to eat is
  physiological and overwhelming
  
• High calorie intake coupled with low energy
  expenditure results in wt gain

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Prader-Willi Syndrome

• Treatment
• Early feeding problems failure to thrive may
  require tube feedings
  
• Later food obsession lock kitchen cupboards
  increase activity
  
• Behavior management with positive rewards
• Meds psychotropic meds serotonin uptake
  inhibitors such as fluoretine and sertoline are
  used to treat obsession-compulsive eating
  behavior.