Mbbs, BDS, B-Pharma Notes: Newborn Nutrition

Tuesday 17 July 2012

Newborn Nutrition

Lecture Eleven: Newborn Nutrition

NURS 2208

T. Dennis RNC, MSN

Nutritional Needs of the Newborn (pg 778-779)

The neonatal diet should include adequate calories and include protein, carbohydrates, fat water, vitamins, and minerals.
Caloric needs: 105 to 108 Kcal/Kg/day or 50 to 55 Kcal/lb/day.
Water requirements are high: 140 to 160 ml/Kg/day or 64 to 73ml/lb/day.
Formula fed babies gain weight faster than breastfed babies due to the high protein content in commercial formulas and the larger volumes of formula needed to deliver adequate nutrition.
Bottle fed babies regain their birth weight in 10 days and gain approximately 30 g (1 oz) per day up to 6 months.
Breast fed babies regain their birth weight in 14 days and gain approximately 15 g (1/2 oz) per day up to 6 months.
Formula fed infants double their weight in 3 ½ to 4 months.
Breast fed infants double their weight by 5 months.

Breast Milk (pg 779)

COLOSTRUM:

Contains mostly serum and white blood corpuscles
Is a yellowish or creamy appearing fluid
Is secreted from the breast before the onset of true lactation
Has a high protein content, provides some immune properties
Cleanses the neonate’s intestinal tract of mucus and meconium
Is thicker than milk
Production begins early in pregnancy and lasts several days after birth

Breast Milk (pg 779)

Transitional Milk:

Breast milk produced from the end of colostrum production until about 2 weeks postpartum.
Contains more fat, lactose, water soluble vitamins and calories than colostrum contains.

Breast Milk (pg 779)

MATURE MILK:

Breast milk that contains 10% solids (carbohydrates, proteins, fats) for energy and growth.
Contains 90% water.
Foremilk is the milk obtained at the beginning of the feeding.
Hindmilk is released after the initial let-down or release of milk that is higher in fat concentration.
May appear watery and bluish in color.
Provides approximately 20 kcal per oz.
AAP and ACOG recommend breast milk as the optimal food for the first 6 to 12 months.
Provides newborns and infants with specific immunological, nutritional, and psychosocial advantages.

Breast Milk (pg 779)

Immunologic Advantages:

Protection from respiratory and gastrointestinal infections, otitis media, meningitis, sepsis and allergies.
Provides coverage during the neonatal period until the baby’s own immunoglobulins become active by 18 months of age.
Breast milk is non-allergenic.

Breast Milk (pg 779)

Nutritional Advantages:

Breast milk is composed of lactose, lipids, and polyunsaturated fatty acids, and amino acids (especially taurine) and has a whey:casein protein ratio that facilitates its digestion, absorption, and full use compared to formula.
Considered the ideal first food because its composition varies according to gestational age and stage of lactation.
Provides newborns with minerals in more appropriate doses than do formulas.
Iron in breast milk is more readily and fully absorbed.
Delivered in an unchanged form (vitamins are not lost through processing or heating).

Breast Milk (pg 779)

Psychological advantages:

Affects maternal/infant attachment
Oxytocin level increases coincide with more “even” mood responses and increase feeling of maternal well-being.
Provides the opportunity for frequent, direct skin contact between mother and newborn.
In twin births, enhances individualization and attachment of each newborn.
Fathers can be actively involved in providing feedings (pumped).

Contraindications and Disadvantages

A mother diagnosed with breast cancer
A mother diagnosed with AIDS
Infants suffering from galactosemia
Medications: example - Flagyl
9 to 12 feedings a day initially
Another pregnancy
La Leche League, lactation Consultants

Formula Feeding

A nutritious alternative to breastfeeding
Both parents may assist in the nurturing process
Commercial formulas have been developed to minimize the harmful components of cow’s milk.
Three categories: cow’s milk base, soy-protein, and specialized or therapeutic.

Potential Contraindications (pg 782)

Improperly prepared formulas may be detrimental to the infant (concentrated may lead to kidney - overdiluted leads to a deficit in nutrients).
Allergic reactions: vomiting, colic, diarrhea, colitis, reluctance to feed and eczema.
Nutritionists advise against whole cow’s milk, 2% cow’s milk or skim milk for children under 2 years of age.

Newborn Feeding (pg 783)

The initial feeding is determined by the physiologic and behavioral cues of the newborn.
Assess for active bowel sounds, absence of abdominal distention, and a lusty cry which quiets and is replaced with rooting and sucking behaviors when a stimulus is placed near the lips.
First feeding : assess suck, swallow and gag reflexes.
Breastfeeding should begin immediately.
Bottle feeding infants are offered formula as soon as they show an interest.
Early feeding stimulates peristalsis, facilitates elimination of by products, which decreases the risk of jaundice, and enhances maternal-infant attachment.
Observe closely and position on right side after feeding to aid in drainage and facilitate gastric emptying.

Establishing a Feeding Pattern (pg 784)

Promotion of Successful Infant care (pg 785)

Parents may see the success of feeding their newborn as a sign of parental success.
Infants may recognize muscular tension from the mother.
Consistency in teaching is paramount.
The goals of Healthy People 2000are to have 75% of infants breastfeeding at birth and 50% continuing to consume at least some human milk until 6 months.
Position comfortably for success breastfeeding or bottle-feeding.
Couplet care facilitates success at feedings.

Cultural Considerations in Infant Feeding (pg 787)

North American and European societies sometimes consider it indecent to expose the breast, believe too much handling spoils the child, and that weaning is a sign of development.
In some cultures, colostrum is not offered to the newborn.
Muslim women may breastfeed for 2 years.

Physiology of the Breasts and Lactation (pg 788)

Female breast is divided into 15 to 24 lobes, separated by fat and connective tissue.
Lobes are subdivided into lobules, composed of small units called aveoli where milk is synthesized by the aveolar secretory epithelium.
The lobules have a system of lactiferous ductiles that join larger ducts and eventually open onto the nipple surface.

Physiology of the Breasts and Lactation (pg 788)

Increased levels of estrogen during pregnancy stimulate breast duct proliferation and development.
Elevated progesterone levels promote the development of lobules and alveoli in preparation for lactation.
A rapid drop in estrogen and progesterone and an increase in prolactin occur at birth.
Prolactin promotes milk production by stimulating the aveolar cells of the breasts.
The release of oxytocin from the pituitary is stimulated by the infant’s sucking.
Oxytocin increases the contractility of the myoepitheleal cells lining the mammary duct walls and milk flow occurs resulting in the let-down reflex.

Physiology of the Breasts and Lactation (pg 788)

The let-down reflex causes milk ejection.
A tingling or prickling sensation is felt at let-down.
Uterine cramps, increased lochia, milk from the other breast, and a feeling of relaxation occur with let-down.
A lack of self confidence, fear or embarrassment about or pain connected with breastfeeding may prevent milk ejection.
Milk production is decreased with repeated inhibition of the milk ejection reflex.
Failure to empty the breasts frequently and completely also decreases production due to pressure on the aveoli from accumulated milk.

Breastfeeding Process (pg 788)

The objectives of breastfeeding are 1) to provide adequate nutrition, 2) to facilitate maternal/infant attachment, and 3) to prevent trauma to the nipples.
Arrange for privacy.
Assist mother to find a comfortable position.
Mother should use C- hold or scissors hold.
The gums surround the areola so the jaws compress the milk ducts when the baby suckles.
The baby should be facing the mother (tummy to tummy, chest to chest) with the ear, shoulder and hip aligned.
As long as feeds are offered frequently, whatever the duration the newborn wishes are appropriate.
DO NOT watch the clock.

Breasfeeding Process (pg 788)

Breastfeeding assessment: infant cues, latch on, position, let down, nipple condition, infant response, and maternal response.
Leaking: initial supply increased, stimuli of infant crying, thinking of infant.
Pads or cupts are used to avoid irritation.
As milk supply is established, leaking decreases.
Direct pressure applied to the breast also decreases leaking.
Client places a finger inside the infant’s mouth to break suction so the newborn releases the breast.

Breastfeeding Process (pg 788)

Supplementary feedings:

May weaken or confuse the suckling reflex or decrease the infant’s interest in nursing.
Artificial nipples should not be introduced until breastfeeding is well established.
Milk transfer signs, audible swallowing, milk in the baby’s mouth, mom’s breast soft after a feed, leaking from the opposing breast.
Infant weight gain and six or more wet diapers a day indicate adequate intake.