RACHEL SCHEER Energy and Nutrition Needs For Infants with Special Circumstances

Nutrient Needs Based nutrient recommendations for healthy infants DRI used Based on EER and AI Normal DRI=540 kcal/day Adjust Nutrients Caloric needs may need to be the same, lowered, or increased

Situations where calories are based on DRI Cleft Lip Phenlyketonuria (PKU)

Situations where infants need less energy Smaller muscles or lower activity  Result of inability to move certain muscles Down Syndrome Repaired Spina Bifida  Too many calories would interfere with the infants effort to crawl.  The weak muscles would have more body weight to move.

Situations where infants need more energy Infections Fever Difficulty breathing Temperature regulation Recovery from surgery Preterm VLBW ELBW

First-Week Protein and Energy Intakes Are Associated With 18-Month Developmental Outcomes in Extremely Low Birth Weight Infants. Bonnie E. Stephens, Rachel V. Walden, Regina A. Gargus, Richard Tucker, Leslie McKinley, Martha Mance, Julie Nye, and Betty R. Vohr May 2009; 123:

Hypothesis Infants who receive a higher protein and energy intake during the first week would have a higher:  MDI  PDI  Better Growth

Experiment 148 ELBW Infants Total Daily Enteral and Parenteral intakes for first four weeks recorded Follow up at 18 months Mental and physical evaluations  MDI, PDI, Weight, Height, Hear Circumference

Results Correlation between energy/protein intake and increased MDI Every 42 kJ (10 kcal)/kg/day was associated with a 4.6 point increase in the MDI Every g/kg/day in protein intake was associated with an 8.2 point increase in their MDI.

Energy Expenditure in Preterm Infants Supplemented With Canola Oil Versus Medium-Chain Triglyceride Oil. Shlomi Cohen, Shaul Dollberg, Francis B. Mimouni, Yohanan Peled, and Dror. Mandel ICAN: Infant, Child, & Adolescent Nutrition, February 2012; vol. 4, 1: pp

Hypothesis Preterm infants given long-chain Triglycerides will no be able to as effectively digest the fats as compared to when given medium-chain triglycerides.

Esperiment 6 preterm infants weeks Infants were supplemented either Canola oil or a medium-chain triglyceride oil for the first three days then switched for the last three Metabolic measurements taken using an indirect calorimeter at both 3 day marks. Stool Sample

Results Paired Wilcoxon ranked test. Confirmed Supplementation of MCT is better absorberd for preterm infants. Measurements of Energy Expenditure MCTCOP Value Fat absorption (%) 99.5% ± % ± 16.2%0.56 Energy Increase (kcal/kg/day) 4.17 ± ± 5.96NS Energy retained (kcal/kg/day) 30.1 ± ±

Breastfeeding, infant formula supplementation, and Autistic Disorder: the results of a parent survey Stephen T Schultz, Hillary S Klonoff-Cohen, Deborah L Wingard, Natacha A Akshoomoff, Caroline A Macera, Ming Ji, Christopher International Breastfeeding Journal 2006, 1:16

Hypothesis Breastfeeding and the use of infant formula supplemented with DHA and ARA will be protective against developing Autistic Disorder

Survey For parents with non-autistic and autistic children Questions on:  Breastfeeding Duration  Type/brand of formula used Subcategories:  No formula  Formula with DHA/ARA  Formula without DHA/ARA

Results Analysis using logistic regression Infants not supplemented with DHA/ARA are much more likely to develop Autistic Disorder Age-adjusted associations of breastfeeding and autistic disorder for children aged 2–18 years. VariableOdds Ratio95% CIP value No Breastfeeding Breastfeeding <2 months Breastfeeding 2-6 months

Aggressive Early Total Parental Nutrition in Low-Birth-Weight Infants Hassan M Ibrahim MD1, Majied A Jeroudi MD1, R J Baier MD1, Journal of Perinatology (2004) 24, 482–486. doi:

hypothesis Determine if aggressive Early Total Parenteral Nutrition (ETPN) in very low birth weights infants (VLBW) would increase nitrogen retention and energy intake as compared to Late Total Parenteral Nutrition (LTPN)

Experiment 32 ventilator-dependent preterm infants were randomly assigned to either the ETPN or LTPN ETPN Group-2 hours after birth received:  3.5 g/kg/day AA  3 g/kg/day of 20% Intralipid LTPN Group  solution containing 5-10% glucose for first 48 hours  then 2 g/kg/day of AA after 48 hours  0.5 g/kg/day of Intralipid after 48 hours  Increased 0.5 g/kg/day to a max of 3.5 and 3 g/kg/day, respectively Urine Collected and analyzed by BUN/Urea slides at 3,5, and 7 days.

Results ETPN infants  Nitrogen retention was greater; Mean of mg/kg/day  Higher caloric intake; kcal/kg/day LTPN infants  negative nitrogen balance during the first 48-hours; Mean of mg/kg/day  Lower caloric intake; kcal/kg/day Aggressive intake of AA and Intralipids of VLBW infants immediately after birth, compared to the conventional delivery of glucose alone, can prevent negative nitrogen balance and increase caloric intake.

Conclusions The early feeding of a LBW or preterm infant with the proper nutritional requirements is necessary during that crucial period of development where inadequacies, excesses, or imbalances are most likely to influence permanent change.