Newborn Nutrition

Question 1

Current recommendations for infant feeding?

Answer 1

• American Academy of Pediatrics: mothers breastfeed their infants for 2 years, or as long as mutually desired by mother and infant.
• World Health Organization: infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond.
• American Dietetic Association: breastfeeding exclusively for the first six months of life, continuing in conjunction with other food at least until the newborn’s first birthday.

Question 2

Benefits of breastfeeding for the mother?

Answer 2

• Rapid uterine involution
• Early return to pre-pregnancy weight (additional 250-500 calorie expenditure)
• Decreased risk of ovarian cancer
• Decreased risk of breast cancer
• Decreased risk of type II diabetes
• Increased bone density

Question 3

Benefits of breastfeeding for the baby?

Answer 3

• Decreased incidence of many infectious diseases including:
  
  • Bacteremia
  • Diarrhea
  • Respiratory infections
  • Necrotizing enterocolitis
  • Middle ear infections
  • Urinary tract infections
• 21% lower post-neonatal infant mortality rate in U.S.
• Provides pain relief for infants during or after procedures
• Higher IQ scores
• Decreases length of hospitalization time for preterm infants

Question 4

What do infants need for proper nutrition?

Answer 4

• Fluids
  
  • Infants can become dehydrated quickly
• Energy
• Carbohydrates
  
  • First 6 months of life need 60 g/day and the second 6 months need 95 g/day
• Fat
  
  • Major energy source for infants, 50% of the calories in breastmilk and formula
• Protein
• Vitamins
  
  • With the exception of vitamin D, human milk contains all of the vitamins required for infant nutrition
• Minerals

Question 5

Describe anatomical aspects of human lactation.

Answer 5

• Alveoli: grapelike clusters of milk-producing cells
• Milk Ducts: intricate system of ducts that transport milk from alveoli to the nipple
• Nipple: delivery system for milk
• Areola: dark circle that surrounds the nipple
• Montgomery Glands: secrete a lubricating and sterilizing substance onto the areola and nipple

Question 6

What are the hormones used in lactation?

Answer 6

• Prolactin: triggers synthesis and secretion of colostrum and milk
• Oxytocin: triggers milk ejection from alveoli to nipple (let down)

Question 7

Describe Lactogenesis Stage I.

Answer 7

• 16-18 weeks gestation
• Colostrum production begins
• Immunoglobulins: IgA (main one), IgM, IgG, IgD, IgE

Question 8

Describe Lactogenesis Stage II.

Answer 8

• After delivery of placenta
• Colostrum rich in antibodies, very concentrated
• High in protein
• ”Milk comes in” around day 3 postpartum
• Transitional milk introduces Lactobacillus bifidus flora to infant intestinal tract

Question 9

Describe Lactogenesis Stage III.

Answer 9

• 10-14 days after delivery
• Mature milk higher in fat
• Production responds to growth spurts
• Promotes colonization of infant’s microbiome

Question 10

What are the different types of human milk?

Answer 10

• Colostrum, a clear, yellowish fluid (day 1 to 3)
  
  • More concentrated than mature milk
  • Extremely rich in immunoglobulins
  • Higher concentration of protein and minerals
  • Less fat than mature milk
• Mature Milk-Composition changes during each feeding
  
  • Lower fat “foremilk” changes to higher fat “hindmilk”

Question 11

Newborn hunger cues?

Answer 11

• Hand-to-mouth or hand-to-hand movements
• Sucking, mouthing motions
• Rooting reflex—infant moves toward whatever touches the area around the mouth and attempts to suck
• Crying is a late hunger cue

Question 12

Indicators of effective breastfeeding?

Answer 12

• Most breastfed infants should have 3-4 stool diapers by 4th day of life
• Stool should no longer be meconium-like, but yellow in color
• Urine is pale yellow and not concentrated
• Infant seems content between feeds
• Infant gains weight

Question 13

Nursing care to promote successful breastfeeding?

Answer 13

• Newborn infants should breastfeed 8-12 times per day to establish a breastfeeding pattern and optimize the hormone levels.
• Most newborn infants feed on average 15-20 minutes each side.
• Encourage parent to offer both breasts at each feeding.
• Start feedings on the breast on which the infant completed the last feeding.
• Encourage parents to respond to hunger cues even if that means breastfeeding more frequently than every 2-3 hours!

Question 14

Describe proper latch & positioning for breastfeeding.

Answer 14

• Hand in “C-shape” or “U-shape”
• Express colostrum
• Infant should have wide-open mouth
• Point nipple toward infant’s nose to facilitate filling infant’s mouth with breast tissue
• Infant’s top and bottom lip should be “flanged outward”
• Infant’s mouth should cover or almost cover the entire areola
• Avoid letting the infant “hang” from the nipple
• Break suction by a clean, dry finger between the infant’s jaw to avoid “tugging” on the nipple

Question 15

What are the categories of the LATCH assessment?

Answer 15

• Latch
• Audible swallowing
• Type of nipple
• Comfort of nipple
• Hold (positioning)

Question 16

Common concerns associated with breastfeeding?

Answer 16

• Diet
• Engorgement
• Sore nipples
• Insufficient milk supply
• Plugged milk ducts
• Mastitis

Question 17

Engorgement treatments for breastfeeding mothers?

Answer 17

• Frequent feeding
• Warmth before, ice after feed
• Mild analgesia

Question 18

Engorgement treatments for non-breastfeeding mothers?

Answer 18

• Well-fitted supportive bra
• Ice
• Cabbage leaves
• Mild analgesia
• Don’t stimulate milk production

Question 19

What to assess for with sore nipples?

Answer 19

• Flat? Inverted? Cracks? Soreness? Blisters? Bleeding?
• Assess and correct latch
• Proper feeding position

Question 20

Treatments for sore nipples?

Answer 20

• Colostrum or Lansinoh/nipple butter
• Hydrogel pads
• Breast shells
• Lactation Consultant

Question 21

Describe plugged ducts.

Answer 21

• Mom is afebrile
• One area swollen and tender, may have some localized redness
• May feel hard, small pea-like lump
• Caused by tight clothing or some kind of pressure on breast
• Warm compress, frequent feeding, massage

Question 22

Describe Mastitis.

Answer 22

• Flu-like symptoms
• Breast pain, tenderness, reddened area, fever
• Antibiotics, rest, warm compress, adequate fluid and nutrition
• Breastfeeding and/or pumping to encourage emptying of that side

Question 23

Patient education for formula fed infant?

Answer 23

• Amount depends on age and nutritional needs
  
  • First 48 hours: 15-30 mL/feeding
  • By 2nd week: 90-150 mL/feeding
• Feed every 3-4 hours initially
• Never prop a bottle, always hold
• Nipple flow, slow-flow in newborn stage
• Burping techniques
• Washing bottles
  
  • Sterilize prior to use, then use hot soapy water and bottle brush
• Vitamin D supplementation may be needed if combo feeding (formula and human milk)