True/False: as long as the infant is growing in height and weight and head circumference, it's good even if they are not where we want them to be in terms of percentile
True
Increased calories required for (4)
difficulty breathing (any condition with SOB)
infection and fever
temperature regulation (shivering)
recovering from surgery and complications
What conditions are decreased calories needs recommended
spina bifida
down syndrome
Why do conditions with less muscle mass need less calories?
less activity
less muscle tone, muscles burn calories so decreased muscles decreased burning and decreased need
Energy needs for premie infants
105-130 kcal/kg
Protein requirement for preterm infants or recovery from illness of surgery
3.0-3.5 g/kg
Protein for VLBW infants
4 g/kg
**must provide adequate fluid and infant must have adequate renal function
MNT for protein malabsorption in infants
hydrolyzed protein formulas
need this because they can't even digest easy to digest protein in breast milk
Infants need up to ___ calories from fat
55%
What are good for infants that are VLBW and ELBW because of low level of pancreatic enzymes and bile?
MCT--low levels of enzymes and bile needed to digest these
what are essential fatty acids and DHA important for infants?
brain and retina development
why can fluid restrictions cause micronutrient deficiency?
all of their intake as a baby is from fluid (milk)--put on concentrated formulas
These can be added to milk to provide additional calories, protein, vitamins and minerals
human-milk fortifiers
Why may preterm infant formulas have higher amounts of vitamins and minerals
baby is so premie that mom isn't making milk yet or for mothers that have alcohol and drug disorders/diseases where their breast milk CANT be used
inadequate weight or length gain though to result from an energy deficit
failure to thrive (FTT)
FTT is highly associated with
poverty
First step in treating FTT
increasing energy and protein intake
Growth chart for premie infant
Fenton Preterm Growth Chart
Why can't premie babies use a WHO growth chart?
they start at age 0 and so you can't go backwards to assess growth
fenton growth chart starts at 22 weeks gestation
infants health and development program growth charts are for
LBW premie
VLBW premie
Gestation adjusted age calculated by
subtracting GA at birth from 40 weeks
Example: baby born at 30 weeks gestation and is now 3 months old
40-30=10 weeks
10 weeks/ 4 wk/month= 2.5 months
3 months -2.5 months= 0.5 moths gestation adjusted age
gestation adjusted age is used to (2)
plot a babies growth on a growth chart and is a better assessment of actual growth
for feeding times (start puree at 6 months but real unadjusted 6 months may not be ready for it)
an impairment int he performance of tasks of achieving developmental milestones that an infant or child should achieve by a specific chronological age
developmental delays
a chromosomal condition that is associated with intellectual disability and shows hypotonia, short stature, distinct facial characteristics
Down syndrome
Nutrition problems associated with downs (4)
dysphagia due to weak facial muscles
self-feeding difficulty
overweight status common due to excessive energy intake and decreased activity
constipation
delayed development, decreased academic achievement and higher risk of behavioral and attention problems, high metabolic rates are common with
severe preterm birth (<34 weeks)
what is an initial problem after birth with severe premie birth?
cannot nurse due to required respiratory support
what kind of enteral nutrition is used for baby who's stomach isn't emptying properly at all?
nasojejunal (tube extends into jejunum)
4 types of enteral nutrition
oral gastric
nasojejunal
gastrostomy
jejunostomy
nutrients delivered directly to the GI tract
enteral nutrition
nutrients delivered directly to the bloodstream (IV)
parenteral nutrition
____ and ___ infants are especially vulnerable to GI upset and complications
VLBW and ELBW
Why might premies have GI problems that are caused by slow or uncoordinated movements?
their GIT is not fully developed yet
Why is food safety important for preterm infants?
they have immature immune systems
Recommendations for tube feeding and food safety (4)
change feeding set (bag and tubing) every 4 hours (6 times a day)
limit duration of hang time to 4 hours (if longer can grow bacteria)
avoid powered infant formulas (not as sterilized--use premixed)
proper time guidelines for using refrigerated or frozen and thawed breast milk, must use the same day
Preterm human milk has higher ___ than term milk
protein
Preterm milk may not be as high enough in calories, so you need to add
human-milk fortifier
provide higher energy and nutrient levels to meet needs, contain MCT oil, and whey protein (preferred)
preterm infant formulas
What is recommended if the infant fatigues too early or is too weak to suck?
22-24 kcal/oz formula
What is the problem with 28 kcal/oz formulas?
cause diarrhea because of high osmolality
inflammation in the testing which can cause severe damage that may be due to decreased blood flow to the intestine or v. bad infection
necrotizing enterocolitis (NEC)
high risk being premature
when and who does NEC affect?
happens to premature, formula-fed infants in the second to third week of life
What is associated with a lower incidence of NEC?
breast milk
Feeding problems with preterm infants (3)
fatigue and lethargy may lessen feeding duration
low tolerance to volume
disorganized feeding due to unpleasant oral experiences (feeding tube/vent)-->resulting in stress reaction to feeding
When is intro to solid baby foods recommended to be based on for premies
based on corrected gestational age
What is a problem that a occurs with weak mouth muscle tone?
cannot wrap mouth around the nipple or bottom and milk leaks out (not getting all of the nutrients)
what infants require more nutrition services than typical infants?
infants with congenital anomalies
condition where upper lip and roof of mouth are not formed completely and require corrective surgery
cleft lip and palate
RD needs to work closely with who for feeding plan for CL and P patients?
SLP
Problems with cleft lip and palate and eating? (2)
can't close lips around nipple--will have milk come out
opening to nasal passages so feeding babies will have food and milk come out of their nose
Risk factors for cleft lip and palate
smoking and drinking during pregnancy
displacement of the intestines up into the thoracic cavity (chest) due to incomplete formation of the diaphragm in utero
diaphragmatic hernia
incomplete connection between the esophagus and the stomach
esophageal atresia
for both diaphragmatic hernia and esophageal atresia infants can't eat safely by mouth require
parenteral nutrition
surgery
MNT for diaphragmagtic hernia
NPO to TPN
MNT for esophageal atresia
TPN-->surgery
what causes breathing problems with diaphragmatic hernia?
intestines up in the thoracic region and therefore there is decreased expansion of the lungs
What is the treatment for most genetic metabolic disorders
removal of one or more nutrients form the diet and provision of a therapeutic infant formula to meet needs
mom can rarely breast feeding
Some nutrition interventions for feeding problems (4)
