Infant nutrition

Question 1

what controls growth of an infant and child

Answer 1

Infant (nutrient-led)
Child (GH-led)
Pubertal (sex steroid-led)

Question 2

describe the energy balance equation

Answer 2

energy intake is divided into losses e.g. urine and stools and metabolizable energy

Metabolizable energy is then divided into energy expended- BMR, activity, synthesis, thermo-regulation AND energy stored- protein and fat

Question 3

finish the equation: energy intake= ___ + ___ + ___

Answer 3

energy expended + energy stored + energy excreted

Question 4

what are energy requirements (kcal/kg/d) for the following:

• 1m
• 3y
• 5y
• 18y

Answer 4

1m: 115
3y: 95
5y: 82
18y: 34

Question 5

4 components of nutrient supply for the term infant

Answer 5

Human milk
Formula milk
Vitamin supplementation
weaning

Question 6

benefits of breast feeding

Answer 6

Baby: Nutritional, Gastro-intestinal function, Immunity
Mother
Societal

Contains Lactoferrin, lysozyme and sIgA are whey proteins important in host defence

Human milk contains LCPUFA important for brain/retinal development (AA, C20, n-6, DHA, C22, n-3). Cow’s milk contains only C18 LCPUFA, linoleic (n6) and linolenic (n3) precursors
Bile salt activated lipase

Human milk improves gastric emptying
Human milk important in preventing NEC (necrotising enterocolitis) in the preterm infant

Question 7

components of breast milk important in immunity

Answer 7

sIgA
lactoferrin
lysozyme
cytokines
PAF acetylhydrolase
oligosaccharides
epidermal GFs
cellular elements

Question 8

role of sIgA

Answer 8

Specific immune response, binds bacterial adherence sites

Question 9

role of lactoferrin

Answer 9

Inhibits bacterial growth by binding iron

Question 10

role of lysozyme

Answer 10

Lyses bacterial cell walls

Question 11

role of cytokines

Answer 11

anti-inflammatory cytokines predominate in human milk, allows human milk to protect but not injure the gastrointestinal tract

Question 12

role of PAF acetylhydrolase

Answer 12

Inhibits platelet activating factor

Question 13

role of oligosaccharides

Answer 13

Inhibit binding of enteric/respiratory pathogens epithelial cells

Question 14

role of epidermal growth factors

Answer 14

Enhance development of gastrointestinal epithelium

Question 15

role of cellular elements

Answer 15

Neutrophils and macrophages

Question 16

short term benefits of breast feeding (2)

Answer 16

Improved immunity, less infections and infectious morbidity

This study shows that breastfeeding reduced the risk of sudden infant death syndrome by around 50% at all ages throughout infancy and for as long as the infant is breastfed

Question 17

6 long term infant benefits of breast feeding

Answer 17

Type 1 and type 2 diabetes.

Obesity: Breastfeeding has been found to generally reduce the risk of obesity.

Allergic disease: There is evidence that breastfeeding for at least four months, compared with feeding infant formula made with intact cow’s milk protein, prevents or delays the occurrence of atopic dermatitis, cow’s milk allergy, and wheezing in early childhood.

Childhood leukaemia: A meta-analysis has concluded that both short-term and long-term breastfeeding reduce the risk of childhood acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML).

Cholesterol levels: adolescents have a reduction of 14% in their ratio of LDL to HDL cholesterol if they were fed breastmilk in infancy.

Blood pressure in young adults.

Question 18

benefits of breast feeding for the mother

Answer 18

Breastfeeding releases oxytocin, which causes the uterus to contract , and reduces the risk of postpartum haemorrhage

Women who breastfed are at lower risk of:
-Breast cancer : good evidence to suggest that breastfeeding protects against breast cancer-
Biological mechanism: reduced oestrogen exposure

No significant effect of menopausal status

Ovarian cancer : suggestive evidence that lactation protects against ovarian cancer

Also:
Breastfeeding uses calories equivalent to swimming 30 laps in a pool!

Question 19

societal benefits of breast feeding

Answer 19

Contraceptive effect, better family spacing, improved maternal health, and so improved child health
Less cost to individual families (cost of formula milk)
Less health care costs through reduced hospital admissions in infancy
Less health care costs through both child and adult chronic disease

Question 20

which babies need vitamins

Answer 20

Current DOH advice is that all babies from 6 months onwards until their 4th birthday require a multivitamin supplement, unless consuming > 500mls formula milk/day
For preterm babies, there is no clear guidance on the gestational limit below which vitamin supplements are needed.
A pragmatic approach would be that babies > 34 weeks are usually able to establish oral feeding reasonably quickly, and are therefore able to ‘catch up’
a nutritional deficit
more rapidly than more
preterm infants.
Healthy start vitamin drops
contain vitamins A, D and C

Question 21

why is vitamin K given?

Answer 21

prevent haemorrhagic disease of the newborn

Question 22

Why is vitamin D important in infants

Answer 22

Vitamin D is required for the absorption of calcium and phosphorous from the intestine to enable bone mineralisation.
Vitamin D also has other functions including modulation of cell growth, neuromuscular and immune functio

Question 23

what illness is caused by vit D def

Answer 23

rickets

Question 24

infant nutritional intake components by end of 1st year

Answer 24

~500ml breastmilk/formula/full fat milk

3 meals

snacks between meals

multivitamin supplement

Question 25

choice of milk in preterm infants

Answer 25

Maternal breast milk is the gold standard for feeding any baby, regardless of size or gestation.
For high risk infants, such as the growth restricted preterm infant, using formula milk will increase the baby’s chances of getting NEC 6-10 fold.

Preterm breast milk contains more protein, fat and sodium in the first few weeks of lactation, but this then drops to the same levels as seen in mature milk for term infants within 2-3 weeks (Hill et al, 2001).
The energy needs of the preterm infant can be met by breast milk, especially if mothers are encouraged to express the fat rich hindmilk.
Very small infants (< 1000 grams) may well need higher volumes of breast milk to meet their protein requirements (200+ ml/kg/day). Tolerance and fluid overload may preclude using these higher volumes.
All preterm infants receiving breast milk will need additional phosphorous.

Question 26

do we need to fortify breast milk for preterm infants and why/not?

Answer 26

Yes- do not lactate according to gestation

Question 27

what initial weight loss is expected for term babies

Answer 27

5-10%