Neonatal and Infant Nutrition Flashcards
particular issues of infancy
- Immature liver function – prone to jaundice
- Immature kidney function – cannot dilute or concentrate urine
- Immature gut - ‘leaky’ epithelium, lacking commensal flora
- Immature immune system – naïve, less able to produce immune factors and discriminate bad from good (or indifferent) – prone to infection
- Period of intense neurological growth and development
- Immature blood clotting – neonatal coagulopathy
what is best to feed a neonate
breast milk
alternatives for breast milk
wet nurses
population of women who are most likely to initiate breast feeding
- first time mother
- mothers greater than 30 years old
- higher social class scale
- longer in education
socioeconomic and cultural factors that stop women from breast feeding
- medical advice
- maternal work demands
- family pressures
- commercial advertising
biological factors that stop women from breast feeding
infant size, development, growth, increased appetite, maternal lactational ability
major reasons women stop breast feeding at less than 1 week, 1 week - 4 months, greater than 4 months
- less than a week: baby rejected milk
- 1 week - 4 months: insufficient milk
- greater than 4 months: mother returned to work
what is the trend of breast feeding as children get older
breast feeding starts higher at 1 week and decreases as child gets older
in countries with highest burden of breast feeding, how can a good percentage of the child death be prevented
by breast feeding the children
mean production of milk a day
700-850mL/day
how does the content of the milk change over time
- colostrum: milk first produced and it has lots of protein, immunoglobulins, T and B cells
- transitional milk
- mature milk: begins watery to quench baby’s thirst but then gets more fatty by the end of breast feeding for nutrition
important content of breast milk
antibodies, immune cells, stem cells
length of time recommended for mother to breast feed
Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond
(the more a child suckles the breast, the more milk is produced)
women who are breastfeeding require how much energy and protein a day
8.10MJ/day = 1,940Kcal/day of energy
45.0g/day of protein
but as the baby age increases, there will be increased demands for protein and energy
intake is 60-80g per day for normal adults so actually no need to increase protein intake
does BMI affect breast milk production
no
in comparison to human milk, what does cow milk have increased amount of
cow milk has higher protein, sodium, and casein fraction with predominant whey protein (absent in human milk)
in comparison to cow milk, what does human milk have increased amounts of
lactose and whey fraction (absent whey protein)
what is positively related to weight gain during pregnancy
fat content of milk
what vitamins are adequate in breast milk and what substances are breast milk inadequate in
adequate - vitamin A and B6 (depending on maternal diet and nutritional status)
inadequate - vitamin D, iron, and zinc
importance of breast milk proteins
- 285 different proteins have been identified in the proteome of human breast milk
- Source of amino acids
- Promote digestion and absorption of other milk nutrients
- Have a role in defence against pathogens
- Promote gut and immune maturation
main carbohydrate in breast milk and what is it made out of
lactose (glucose + galactose)
why is lactase important
it is useful for hydrolysis of lactose on gut mucosal border before it can be digested
when does lactose intolerance begin and why
at six months because of decline of lactase activity
importance of breast milk fats
- Breast milk ~ 40 g/l fat (= Cow’s milk) and provides ~50% of energy in milk
- Promotes the accumulation of body fat (insulation and energy store)
- Allows for absorption of fat soluble vitamins (A, D, E and K)
- Provides essential fatty acids important in brain and eye development, healthy skin and hair and immunity
when does the brain grow rapidly
from fetus to about 1.5 years
two essential fatty acids in human milk
DHA (docosahexanoic acid) and EPA
what is DHA made out of
DHA has 22 carbons with 6 double bonds
importance of pregnancy to DHA
- it promotes maternal DHA status
- increases DHA content in breast milk
- promotes fetal eye and brain development
importance of DHA in infants and children
- brain and eye development
- improves visual acuity
- promotes cognitive performance
importance of DHA in children and adults
cardiovascular heart health
- lowers triglycerides
- increases HDL
- maintains/lowers heart rate
- modest reduction in blood pressure at higher doses
importance of DHA in elderly
brain and eye health and function lower DHA in blood is associated with: -cognitive decline -higher risk of dementia -higher risk of age related macular degneration
US average intake of DHA vs. the recommended
US intake is very low at 30-80mg
recommended is 200mg
how are the neonates micronutrients met
by drinking breast milk with the exception of vitamin D, zinc, and iron
other milk components
LICIO
• Lactoferrin
– Plays a role in iron uptake and in immune defence
• Immunoglobulins (antibodies)
– Involved in immune defence (secretory IgA makes
up 10% of human breast milk protein)
• Cytokines (“hormones of the immune system”)
– Involved in immune defences
• Immune cells
– Involved in immune defences
• Oligosaccharides
– Involved in immune defences and in gut and immune maturation
infant benefits of breast feeding
- reduces risk of neonatal infections
- promotes development of the immature gut
- reduces risk of infant allergy
what do bottle fed infants have an increased risk of getting
diarrhea and pneumonia
downside to breast feeding
areas where HIV is prevalent, there is transmission of the virus through breast milk
population with HIV mother that has highest risk of children being infected with HIV
the kids that drink mixed milk (mother’s milk + formula) then it’s the kids who drink mother’s milk then it’s those who are never breast fed
why is there an increased risk of mortality and morbidity in children whose parents are HIV positive and decide not to breast feed
tends to be in undeveloped areas where formula is being mixed with contaminated water
what are WHO’s recommendation for breastfeeding when anti retroviral drugs are available
exclusively breast feed the child for six months as long as baby and mother are on anti retroviral drugs
what are WHO’s recommendation for breastfeeding when there are no anti retroviral drugs available and formula is affordable
completely avoid breast feeding
what are WHO’s recommendation for breastfeeding when there are no anti retroviral drugs available and formula is not affordable or safe
breastfeed child but for the first few months of life
what is the US CDC policy on breast feeding baby if mother is infected with HIV
DO NOT BREAST FEED!
what are some breast feeding contraindications in infants
inborn errors of metabolism
- galactosemia (unable to metabolize galactose)
- congenital lactase deficiency
- PKU
what are some breast feeding contraindications in mothers
- Maternal infections in which transmission occurs (HIV, Human t-cell lymphotrophic virus, cytomegalovirus, tuberculosis)
- Mother receiving therapeutic drugs which are transferred into the breast milk and may harm the infant
- Mother consuming other drugs (alcohol, opiates etc.)
short term advantages of breast milk over formula
- ↓ necrotising enterocolitis (6 x less)
- ↓ diarrhoea (50% less)
- ↓ gastrointestinal infections
- ↓ respiratory infections
- ↓ otitis media
- ↓ risk of type 1 diabetes
long term advantages of breast milk over formula
- ↓ incidence inflammatory bowel disease
- ↓ diastolic blood pressure
- ↓ systolic blood pressure
- ↓ risk of type 2 diabetes
- ↓ risk of obesity
- ↓ risk of CVD
- ↓ severity and delayed onset of coeliac disease
what does chronic nutritional deficiency lead to
failure to thrive
causes of nutritional deficiency in industrialized places in preschool children aged 1-5years old
– Refusal of solids/high intake of liquids
– Intake of low-density foods (healthy diet)
– Behavioral eating problems
– Physical illness
WHO charts of growth patterns for breast fed infants uses what measurements
head circumference, length/height, weight
what changes in percentiles should be followed up according to the growth chart
if child has an increase or decrease by 2 percentiles
early nutrition is important for calcium deposition so what happens if calcium needs are not met during early nutrition
there is a decreased threshold for increased risk of osteoporosis, falls, and fractures
