HUN 3403 Wk2 D2a Chapter 9 Infant Nutrition: Conditions and Interventions

1. HUN 3403 Wk2 D2aChapter 9 Infant Nutrition:Conditions and Interventions

2. Introduction • This chapter addresses nutritional needs of infants before or shortly after birth • Infants who are sick or small as neonates are likely to have conditions that may change the course of growth or development • Demonstrates how nutrition assessment, diagnoses, and nutrition interventions are aligned with medical treatment

3. Infants at Risk • Advances in health care have reduced infant mortality • Advances in neonatal health care have increased survival of infants who were preterm, low birthweight and/or with chronic conditions • Result: more infants requiring specialized nutritional services

4. 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?

5. 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

6. 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

7. Energy and Nutrient Needs • Energy Needs • AAP suggests 120 cal/kg for preterm infants • The European Society for Gastroenterology and Nutrition gives a caloric range of 110-135 cal/kg • Recovering infants may need as much as 180 cal/kg

8. Energy and Nutrient Needs • Protein Requirements • 1.52 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

9. 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

10. 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

11. Growth • Tracking growth reflects nutritional status for most infants • Additional methods to use if underlying conditions exist include: • Growth charts for specific diagnoses • Biochemical indicators • Body composition • Head circumference • Medications that impact growth

12. Growth • Growth in Preterm Infants • Variety of growth charts • Olsen Intrauterine Growth charts • Fenton chart • All preterm growth charts show head circumference as main indicator of healthy recovery • Correction for gestational age • 40 - Gestational age at birth /4= months, subtract from current age

13. Growth • Does Intrauterine Growth Predict Outside Growth? • Depends on: • Intrauterine environment • Fetal-origin errors • Unknown factors such as toxins and air pollution

14. 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

15. 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

16. Nutrition for Infants with Special Health Care Needs

17. Common Nutritional Problems • Nutrition Risks to Development • Developmental delay—range of symptoms reflecting slow development such as: • Slow growth • Feeding problem • Autism – condition of deficits in communication and social interaction • Mealtime behavior and eating problems occur

18. 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

19. Severe Preterm Birth and Nutrition • Incidence and prognosis • About 60,000 VLBW born in U.S. each year • Survival rate ~ 90% • High metabolic rates • Preterm infants fed by nutrition support • Parenteral—nutrients delivered directly to the bloodstream • Enteral—nutrients delivered directly to GI tract

20. 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)

21. Severe Preterm Birth and Nutrition • Conditions that require enteral feeding • Gastrointestinal reflux, constipation, spitting up, vomiting, etc. • Types of enteral tube feeding • Oral-gastric (OG) • Transpyloric • Gastrostomy • Jejunostomy

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

23. 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

24. Severe Preterm Birth and Nutrition

25. Severe Preterm Birth and Nutrition

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

27. 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

28. 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

29. 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

30. Nutrition Interventions • Frequent growth assessment • Monitor intake • Adjust feeding frequency/volume • Adjust timing of nursing, snacks or meals • Assess feeding position and support • Nutrient density to facilitate eating • Parent education • Observe parent-infant interactions • Consider developmental abilities

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

32. Nutrition Services • Federal disability programs • IDEA, Part C • Early Head Start • WIC • MCH Block Grant