Lecture Eleven: Newborn Nutrition

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Lecture Eleven Newborn Nutrition

• NURS 2208
• T. Dennis RNC, MSN

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Nutritional Needs of the Newborn (pg 778-779)

• The neonatal diet should include adequate
  calories and include protein, carbohydrates, fat
  water, vitamins, and minerals.
• Caloric needs 105 to 108 Kcal/Kg/day or 50 to 55
  Kcal/lb/day.
• Water requirements are high 140 to 160 ml/Kg/day
  or 64 to 73ml/lb/day.
• Formula fed babies gain weight faster than
  breastfed babies due to the high protein content
  in commercial formulas and the larger volumes of
  formula needed to deliver adequate nutrition.
• Bottle fed babies regain their birth weight in 10
  days and gain approximately 30 g (1 oz) per day
  up to 6 months.
• Breast fed babies regain their birth weight in 14
  days and gain approximately 15 g (1/2 oz) per day
  up to 6 months.
• Formula fed infants double their weight in 3 ½ to
  4 months.
• Breast fed infants double their weight by 5
  months.

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Breast Milk (pg 779)

• COLOSTRUM
• Contains mostly serum and white blood corpuscles
• Is a yellowish or creamy appearing fluid
• Is secreted from the breast before the onset of
  true lactation
• Has a high protein content, provides some immune
  properties
• Cleanses the neonates intestinal tract of mucus
  and meconium
• Is thicker than milk
• Production begins early in pregnancy and lasts
  several days after birth

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Breast Milk (pg 779)

• Transitional Milk
• Breast milk produced from the end of colostrum
  production until about 2 weeks postpartum.
• Contains more fat, lactose, water soluble
  vitamins and calories than colostrum contains.

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Breast Milk (pg 779)

• MATURE MILK
• Breast milk that contains 10 solids
  (carbohydrates, proteins, fats) for energy and
  growth.
• Contains 90 water.
• Foremilk is the milk obtained at the beginning of
  the feeding.
• Hindmilk is released after the initial let-down
  or release of milk that is higher in fat
  concentration.
• May appear watery and bluish in color.
• Provides approximately 20 kcal per oz.
• AAP and ACOG recommend breast milk as the optimal
  food for the first 6 to 12 months.
• Provides newborns and infants with specific
  immunological, nutritional, and psychosocial
  advantages.

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Breast Milk (pg 779)

• Immunologic Advantages
• Protection from respiratory and gastrointestinal
  infections, otitis media, meningitis, sepsis and
  allergies.
• Provides coverage during the neonatal period
  until the babys own immunoglobulins become
  active by 18 months of age.
• Breast milk is non-allergenic.

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Breast Milk (pg 779)

• Nutritional Advantages
• Breast milk is composed of lactose, lipids, and
  polyunsaturated fatty acids, and amino acids
  (especially taurine) and has a wheycasein
  protein ratio that facilitates its digestion,
  absorption, and full use compared to formula.
• Considered the ideal first food because its
  composition varies according to gestational age
  and stage of lactation.
• Provides newborns with minerals in more
  appropriate doses than do formulas.
• Iron in breast milk is more readily and fully
  absorbed.
• Delivered in an unchanged form (vitamins are not
  lost through processing or heating).

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Breast Milk (pg 779)

• Psychological advantages
• Affects maternal/infant attachment
• Oxytocin level increases coincide with more
  even mood responses and increase feeling of
  maternal well-being.
• Provides the opportunity for frequent, direct
  skin contact between mother and newborn.
• In twin births, enhances individualization and
  attachment of each newborn.
• Fathers can be actively involved in providing
  feedings (pumped).

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Contraindications and Disadvantages

• A mother diagnosed with breast cancer
• A mother diagnosed with AIDS
• Infants suffering from galactosemia
• Medications example - Flagyl
• 9 to 12 feedings a day initially
• Another pregnancy
• La Leche League, lactation Consultants

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Formula Feeding

• A nutritious alternative to breastfeeding
• Both parents may assist in the nurturing process
• Commercial formulas have been developed to
  minimize the harmful components of cows milk.
• Three categories cows milk base, soy-protein,
  and specialized or therapeutic.

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Potential Contraindications (pg 782)

• Improperly prepared formulas may be detrimental
  to the infant (concentrated may lead to kidney -
  overdiluted leads to a deficit in nutrients).
• Allergic reactions vomiting, colic, diarrhea,
  colitis, reluctance to feed and eczema.
• Nutritionists advise against whole cows milk, 2
  cows milk or skim milk for children under 2
  years of age.

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Newborn Feeding (pg 783)

• The initial feeding is determined by the
  physiologic and behavioral cues of the newborn.
• Assess for active bowel sounds, absence of
  abdominal distention, and a lusty cry which
  quiets and is replaced with rooting and sucking
  behaviors when a stimulus is placed near the
  lips.
• First feeding assess suck, swallow and gag
  reflexes.
• Breastfeeding should begin immediately.
• Bottle feeding infants are offered formula as
  soon as they show an interest.
• Early feeding stimulates peristalsis, facilitates
  elimination of by products, which decreases the
  risk of jaundice, and enhances maternal-infant
  attachment.
• Observe closely and position on right side after
  feeding to aid in drainage and facilitate gastric
  emptying.

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Establishing a Feeding Pattern (pg 784)

• Breastfeeding on demand, 1 1/2 to 2 hours
  initially is not uncommon.
• Early cues include hand to mouth and/or hand
  passing motion, whimpering, sucking, and rooting.
• Crying may delay adjustment to extrauterine life.
• Formula feedings are every 3 to 4 hours because
  formula is digested more slowly than breastmilk.
• Both formula fed and breast fed infants may
  experience growth spurts and require increased
  feedings.

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Promotion of Successful Infant care (pg 785)

• Parents may see the success of feeding their
  newborn as a sign of parental success.
• Infants may recognize muscular tension from the
  mother.
• Consistency in teaching is paramount.
• The goals of Healthy People 2000are to have 75
  of infants breastfeeding at birth and 50
  continuing to consume at least some human milk
  until 6 months.
• Position comfortably for success breastfeeding or
  bottle-feeding.
• Couplet care facilitates success at feedings.

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Cultural Considerations in Infant Feeding (pg
787)

• North American and European societies sometimes
  consider it indecent to expose the breast,
  believe too much handling spoils the child, and
  that weaning is a sign of development.
• In some cultures, colostrum is not offered to the
  newborn.
• Muslim women may breastfeed for 2 years.

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Physiology of the Breasts and Lactation (pg
788)

• Female breast is divided into 15 to 24 lobes,
  separated by fat and connective tissue.
• Lobes are subdivided into lobules, composed of
  small units called aveoli where milk is
  synthesized by the aveolar secretory epithelium.
• The lobules have a system of lactiferous ductiles
  that join larger ducts and eventually open onto
  the nipple surface.

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Physiology of the Breasts and Lactation (pg
788)

• Increased levels of estrogen during pregnancy
  stimulate breast duct proliferation and
  development.
• Elevated progesterone levels promote the
  development of lobules and alveoli in preparation
  for lactation.
• A rapid drop in estrogen and progesterone and an
  increase in prolactin occur at birth.
• Prolactin promotes milk production by stimulating
  the aveolar cells of the breasts.
• The release of oxytocin from the pituitary is
  stimulated by the infants sucking.
• Oxytocin increases the contractility of the
  myoepitheleal cells lining the mammary duct walls
  and milk flow occurs resulting in the let-down
  reflex.

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Physiology of the Breasts and Lactation (pg
788)

• The let-down reflex causes milk ejection.
• A tingling or prickling sensation is felt at
  let-down.
• Uterine cramps, increased lochia, milk from the
  other breast, and a feeling of relaxation occur
  with let-down.
• A lack of self confidence, fear or embarrassment
  about or pain connected with breastfeeding may
  prevent milk ejection.
• Milk production is decreased with repeated
  inhibition of the milk ejection reflex.
• Failure to empty the breasts frequently and
  completely also decreases production due to
  pressure on the aveoli from accumulated milk.

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Breastfeeding Process (pg 788)

• The objectives of breastfeeding are 1) to provide
  adequate nutrition, 2) to facilitate
  maternal/infant attachment, and 3) to prevent
  trauma to the nipples.
• Arrange for privacy.
• Assist mother to find a comfortable position.
• Mother should use C- hold or scissors hold.
• The gums surround the areola so the jaws compress
  the milk ducts when the baby suckles.
• The baby should be facing the mother (tummy to
  tummy, chest to chest) with the ear, shoulder and
  hip aligned.
• As long as feeds are offered frequently, whatever
  the duration the newborn wishes are appropriate.
• DO NOT watch the clock.

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Breastfeeding Process (pg 788)

• Breastfeeding assessment infant cues, latch on,
  position, let down, nipple condition, infant
  response, and maternal response.
• Leaking initial supply increased, stimuli of
  infant crying, thinking of infant.
• Pads or cups are used to avoid irritation.
• As milk supply is established, leaking decreases.
  
• Direct pressure applied to the breast also
  decreases leaking.
• Client places a finger inside the infants mouth
  to break suction so the newborn releases the
  breast.

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Breastfeeding Process (pg 788)

• Supplementary feedings
• May weaken or confuse the suckling reflex or
  decrease the infants interest in nursing.
• Artificial nipples should not be introduced until
  breastfeeding is well established.
• Milk transfer signs, audible swallowing, milk in
  the babys mouth, moms breast soft after a feed,
  leaking from the opposing breast.
• Infant weight gain and six or more wet diapers a
  day indicate adequate intake.

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Breastfeeding Process (pg 791)

• Expression of Milk
• Choice of methods depends on mothers
  capabilities and personal preference.
• Electric breast pump may be used 8 times in a 24
  hr period during the early postpartum.
• Manual expression.
• Battery pumps and cylinder pumps are available.

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Breastfeeding Process (pg 791)

• Storing Breast Milk
• Breast milk can be stored for up to six hours at
  room temperature.
• Breast milk can be stored up to eight days in the
  refrigerator.
• Breast milk should be stored in plastic
  containers (wbcs adhere to glass).
• Breast milk may be stored in the refrigerator
  freezer for up to 2 weeks and a deep freezer for
  6 months at 0 degrees.

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Breastfeeding Process (pg 791)

• External Supports
• Father or partner.
• Mothers, grandmothers and sisters.
• Nurses, dieticians, childbirth educators, CNMs.
• Lactation consultants, breastfeeding support
  groups, La Leche League.
• Breastfeeding mothers who work outside the home
  and receive support tend to breastfeed for longer
  periods of time.

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Breastfeeding Process (pg 791)

• Drugs and breastfeeding
• Most drugs pass into breast milk.
• Almost all medications appear in small amounts in
  human milk (usually less than 1 of the maternal
  dosage).
• Very few drugs are contraindicated for the
  breastfeeding woman.
• Drug characteristics that influence the amount of
  a medication in breast milk area degree of
  protein binding, degree of ionization, molecular
  weight, degree of solubility in fat and water,
  mechanism of transport, the pH, half life and
  Milk/plasma ratio.

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Breastfeeding Process (pg 791)

• Potential Problems in Breastfeeding
• Nipple soreness position at breast is one of the
  most critical factors in nipple soreness. Breast
  milk on the nipples after feeding helps heal sore
  nipples. Thrush may occur.
• Flat or inverted nipples cups or shields may
  help. Exercises may help. Latex shield may be
  used as last resort.
• Cracked nipples Breast milk for healing. Avoid
  lanolin, masse cream and/or ointments.
• Breast engorgement Are hard, painful and appear
  taut and shiny. Infant may not be able to latch
  on. Nursing more frequently, pumping and support
  may relieve.
• Plugged ducts heat massage relieve.
• Breastfeeding and working refrigerated milk,
  pumping.
• Weaning personal choice, substitute 1 cup
  feeding for nursing.

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Bottle-Feeding (pg 799-800)

• Infant is held for all feedings to prevent otitis
  media.
• Nipples should have a hole big enough to allow
  milk to flow in drops when the bottle is
  inverted.
• Nipples vary in size and shape.
• Infant is burped at intervals.
• Regurgitation may occur initially or with a
  feeding that is too fast.
• Formula preparation ready to feed, concentrated
  and powder.
• Never add honey as a sweetenermay cause
  botulism.

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Nutritional Assessment of the Infant (pg 800)

• Nutritional history from the parent
• Weight gain since the last visit
• Growth chart percentiles
• Physical examination

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Questions?
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Medical Blooper for A Chuckle A Dayfrom the
medical community

• An ill-prepared nursing student sat in my
  classroom, staring at a question on the final
  exam. The question directed Give four advantages
  of breast milk.
• What to write? He sighed and began to scribble
  whatever came into his head, hoping for the best.
• No need to boil
• Never goes sour
• Available whenever necessary.
• So far so good maybe. But the exam demanded a
  fourth answer. Again, what to write? Once more he
  sighed. He frowned. He scowled, then sighed
  again. Suddenly he brightened and grabbed his
  pen, and triumphantly, he scribbled his
  definitive answer
• 4. Available in attractive containers of
  varying sizes.