Chapter 9 Infant Nutrition: Conditions and Interventions Nutrition Through the Life Cycle Judith E. Brown

Key Terms Children with Special Health Care Needs Infants, children or adolescents with, or at risk for, a physical or developmental disability, or with a chronic medical condition Low-Birthweight (LBW) Weighing <2500 g Very Low Birthweight (VLBW) <1500 g Extremely Low Birthweight (ELBW) <1000 g

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?

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

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

Energy and Nutrient Needs Energy Needs AAP suggests 120 cal/kg for preterm infants The European Society for Gastoenterology and Nutrition gives a caloric range of 95-165 cal/kg Recovering infants may need as much as 180 cal/kg

Energy and Nutrient Needs Protein Requirements 2.2 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

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

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

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

Growth Growth in Preterm Infants Correction for Gestational Age “Neonatal Research Network Growth Observational Study Research Network” tracks infant BW between 501 and 1501 g Infant Health and Development Growth Charts: For LBW Premature For VLBW Premature Correction for Gestational Age Gestation-adjusted age calculated by subtracting GA at birth from 40 weeks

Growth Does Intrauterine Growth Predict Outside Growth? Depends on: Intrauterine environment Fetal origins theory Other factors like air pollution Interpretation of growth Based on a pattern of weight gain

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

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

Nutrition for Infants with Special Health Care Needs

Common Nutritional Problems Nutrition Risks to Development Developmental delays—range of symptoms reflecting slow development such as: Slow growth and/or Feeding problem

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

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

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)

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

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

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

Severe Preterm Birth and Nutrition

Severe Preterm Birth and Nutrition

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

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

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

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

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

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