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

2. 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

3. 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?

4. 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

5. 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

6. 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 cal/kg
Recovering infants may need as much as 180 cal/kg

7. Energy and Nutrient Needs
Protein Requirements
2.2 g/kg adequate if growth or digestion are not affected
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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Nutrition for Infants with Special Health Care Needs

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

17. 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

18. 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

19. 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)

20. 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

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

22. 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

23. Severe Preterm Birth and Nutrition

24. Severe Preterm Birth and Nutrition

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

26. 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

27. 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

28. 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

29. 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

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