Neonatal Nutrition Part II Flashcards
(T/F) Unfortified breat milk may not meet the recommended nutrient needs of growing pre-term infants
T
Even though human milk is the recommended nutritional source for newborn infants for at least the first six months of post-natal life, we need to increase the nutrient concentration so that infant meets requirements at the customary feeding volume
(T/F) For the first 2-3 weeks the milk of the pre-term mother is notably sub-optimal
F
It is nutritionally optimal to compensate for the needs of the pre-term baby. However, after 3 weeks it becomes the composition of the term babies mothers milk, but the premie is still a premie, thus after 3 weeks the mothers milk is sub-optimal. If we provided them with this milk, we would need to provide a LOT of volume to meet their nutritional requirements, and often pre-term babies are on fluid restrictions.
Indications for breastmilk fortification?
- Infants = to 34 weeks gestation
- = 1500 g at brith
- On PN > 2 weeks
- > 1500 g at birth with suboptimal growth
- > 11500 g at birth with the limited ability to tolerate increased volumes
What is the safe volume to being fortifying breast milk?
- From 80 ml/kg/day to 120 ml/kg/day
- -> Some newer studies recommend fortification as early as 50 ml/kg/day
- ->Re-call that fortification is a process that increases the osmolarity of the formula, where we dont want to feed a hyperosmolar solution into the gut (which is immature) if unstable.
- ->Therefore we want to achieve an adequate rate of EN before we add the fortifier to know that the baby can tolerate it OK
(T/F) In fortification n of breast milk, we are able to achieve optimal composition of protein, energy, calcium, phosphorous, vitamin D and iron
F
We do not get enough iron even with fortification, and requires another source of supplementation
An infant weight 1250g (BW of 1150g) takes 12 ml every 2 hours of BM via EN. How many ml/kg/day?
12 ml q 2 hours = 12 feeds per day x 12ml = 144 ml/day
144 m/day /1.250 kg - 115 ml/kg/day
in EN calculations, which weight should we use?
The actual birthweight as lone as the birthweight has been re-gained. If the baby has not yet re-gained the birthweight, use the birthweight (an IBW)
An infant with a TFI of 150 ml/kg/day and is taking fortified breast milk at 81 kcal/100ml. How many kcal/kg/day of BM?
81kcal/100ml means 81% of the TFI is breastmilk. Therefore, 0.81 x150 ml/kg/day = 121.5 kcal/kg/day of breastmilk
An infant with a TFI of 150ml/kg/day where fortified BM provides 2.15g/100 ml of protein. How many g/kg/day of protein is the infant receiving?
2.15g/100ml means 2.15% of the TFI is protein. Therefore, 0.0215 x 150 ml/kg/day = 3.22 g/kg/day
What is the acceptable weight loss within this first 4-6 days of life?
10-15%
When should the regain of birth weight occur? What is ideal?
- Between 10-14 days of life
- Ideal is 10 days of life
What is the desirable growth velocity once the BW is regained?
15-20 g/kg/day
What is the goal for length growth?
0.9-1cm/week
What is the goal for HC growth?
0.5-0.9 cam/week
What is measured daily? Weekly?
- Weight
- Length and HC
Until the birthweight is regained, what should always be calculated?
The percentage of weight loss
An infant with a current body weight of 1500g at day of life 14, but weighed 1350 g at day of life 7. What is the growth velocity of the infant? Use the formula of [1000 x (Wn-W1)] / [(Dn-D1) x (Wn+W1/2)]
[1000 x (1500-1350)] / [(14-7) x (1500+1350/2)]
= 15 g/kg/day over last 7 days
–> within desirable growth velocity range
If there is inadequate growth velocity, what are our options? (3)
- Increase total fluid intake if not at maximum level
- If only on breastmilk, try fortifying
- If already on FBM< can further enrich with pre-term discharge formula to provide more kcals and protein
What is catch-up growth?
-The accelerated growth of an organism following a period of slowed development, particularly as a result of nutrient deprivation
Is there a clear quantification of catch up growth rate or velocity?
No
When a preterm infant has catch-up growth, is the order of catch-up?
Weight –> HC –> length
–> This is why premature babies are usually shorter
What nutrient requirements are higher during catch-up growth?
Energy and protein
What is the simpler, easier way to calculate growth adequacy?
1) Current DOL - Previous DOL ex: 14-7 = 7 (The change in days between weight gain)
2) Current weight-Previous weight ex: 1500-1350 = 150g (The change in weight between days)
3) Find the change in grams per day (150/7 = 21.4 g)
4) 21.4 g/kg/day –> 21.4 g/1.5 kg = 14 g/kg/day
Basically change in weight over time = x, then x/current weight = growth velocity
How should “catch-up” be monitored?
ideally, they should go back to their initial percentile, and should not exceed it
- -> beyond that, there may be fat deposits
- ->
When are energy and protein increased to sustain catch-up growth?
-Requirements are increased for the first 26-40 weeks
In terms of catch-up growth, what is the best result that we could achieve within the context of a premie?
-When the length catches up, this means that the baby is caught up completely
Biochemical parameters to monitor in PN?
- Glucose
- Electrolytes
- Ca, Mg and P
- TGs
- BUN/Creatinine
- Serum proteins
- Liver enzymes
- Alk phos
- CBC
Biochemical parameters to monitor in EN?
- Electrolytes
- BUN/Creatinine
- BUN alone
- Alk phos and C/P ratio
- Vitamin D
- Albumin, pre-albumin
- Liver enzymes
- CBC
