Feeding

Question 1

What is good weight gain in a neonate?

Answer 1

25g/an ounce a day with a day off on Sunday

Question 2

What are indications for NG tube feeding in neonates?

Answer 2

Any sick infant who is too ill of too young to feed normally

Expressed breast milk or formula milk is fed by NG/OG tube

Question 3

What is trophic feeding

Answer 3

Minimal enteric feeding, gut priming

This is to maintain normal GI structure and function

Question 4

What are indications for parental nutrition?

Answer 4

Via central vein
Post-op
Trauma
Burns
If oral nutrition is poor
Gut rest - necrotising enterocolitis

Question 5

What are complications of parenteral nutrition?

Answer 5

Infection
Acidosis
Metabolic imbalances
Thromboembolic
Hepatobiliary stenosis
Cholelithiasis
Osteopenia

Stop in stages to avoid hypoglycaemia

Question 6

What are reflexes associated with breastfeeding

Answer 6

Rooting
Suckling - jaw goes up and down while the tongue compresses the areola against the palate
Swallowing - larynx rises, epiglottis falls

Question 7

What are signs of correct attachment?

Answer 7

Mouth wide open, chin touching breast
Baby should be seen to be drawing in the breast not just the nipple
Lower lip curled back, maximally gobbling areola
Slow, rhythmic deep jaw movements as well as suckling movement

Question 8

When is expressing breast milk valuable?

Answer 8

To relieve painful breast engorgement between feeds
To keep milk production going when it is necessary to give nipples a rest
o aid nutrition if sucking is reduced - cleft lip, prematurity
If the mother is going to be separated from baby

Question 9

How long can breast milk be kept?

Answer 9

5 days in the fridge

Frozen milk should be used within 6 months

Question 10

What are symptoms of mastitis?

Answer 10

Tender, hot, red breast

Fever

Question 11

What is treatment of mastitis?

Answer 11

Flucloxacillin
Ibuprofen
Continue breastfeeding
Express if too painful

Question 12

What are factors that make breastfeeding harder?

Answer 12

If mother and baby are separated at night
Unfriendly working environment
Cultural reframing of breasts as sex objects

Question 13

what are advantages of breast feeding?

Answer 13

Sucking promotes uttering contractions so avoiding some PPHs
Breastfeeding induced oxytocin surges promote trust and diminish fear
Less insulin resistance, hypertension, obesity due to long chain polyunsaturated fatty acids
Breast milk is free and clean and gives baby attractive smell
Colostrum has good endorphins
IgA, macrophages, lymphocytes protect from infection

Question 14

Why is feeding on demand encouraged?

Answer 14

Keeps baby happy and enhances milk production

Fewer breast problems - engorgement, abscesses

Question 15

What are CI to breastfeeding?

Answer 15

HIV +ve
Amiodarone
Antimetabolitses
Antithyroid drugs
Opiates

Question 16

What milk is given in cows milk allergy?

Answer 16

Hydrolized formula - protein hydrolysed into short peptides

Question 17

How much milk do babies need?

Answer 17

150ml/kg/24h over 4-6 feeds

Question 18

What drugs are contraindicated in breastfeeding?

Answer 18

Lithium
Amiodarone
Methotrexate
Benzos
Aspirin
Sulphonamides
Tetracyclines

Carbimazole, Cipro, Chloramphenicol, Cytoxics