Paediatrics: Neonatal nutrition Flashcards
Advantages of breastfeeding to baby, mother family, society
Disadvantages of breastfeeding/milk
10 steps to successful breastfeeding
What is colostrum?
- 1st milk
- Yellow to orange in color, thick and sticky
- Low in volume but high in concentrated nutrition
- Low in fat, high in carbs and protein
- large amount of immune factors (antibodies, secretory IgA; leukocytes, protective white cell)
- Extremely easy to digest
- Laxative effect and helps baby pass early stools
What are the 4 main breastfeeding positions?
What position for twins?
What position for C-section?
What is correct latch on?
What is the optimal attachment for latch on during breastfeeding?
How to establish milk flow?
- Optimal delivery room care:early skin skin contact of mother and infant, breastfeeding within the 1st hour after birth
- Optimal postdelivery hospital routines: continuous rooming in, on demand feedifng schedule, guidance to mother on successful initiation of BF. Scheduling a primary care appt 24-48 hours after discharge
- Optimal postdischarge care: evaluate within 24-48 hours with asessemtn of adequate fluid intake, exam for evidence of jaundice or dehydration, detect any BF problems, provide additional support and/or resources to parents as needed
- Feeding on demand: in response to infant cues (move hands towards mouth, suck on fists/fingers, fussiness, agitation, loud, persistent crying)
- Offer both sides each for 20-30 mins during the intial period. Mainly on one side and other side when milk flow is established. The 1st breast offered should be alternated in consecutive feedings
- Duration depends in part upon sufficiency. 20-30 mins on each side initially. 8-15 mins when milk flow is well established
- Nursing frequency:
1st week: on demand or when 4 hours have elapsed since the last feeding. 8-12 times/day for the 1st 1-2 weeks postpartum
Subsequent weeks: 7-9 times per day by 4 weeks
Thorough emptying promotes lactogenesis (NOT HALF EMPTY)
What is abnormal body weight loss in newborn?
More than 7% is excessive (will lose weight initially due to fluids)
Size and volume of a newborns stomach on day 1, day 3, one week and 1 month
How to asess if baby is getting sufficient milk by urination and stool?
What is the axis involved in the let down release?
What are signs of dehydration in newborn?
Which are specific to neonates?
What are the dehydration states in newborn?
What are the risks of neonatal dehydration?
- Hyperbilirubinemia
- Hypernatremia dehydration: poor breastfeeding techniques –> insufficient lactation secondary to ineffective milk removal –> low volume intake of breast milk. High levels of Na in breast milk closely related with lactation failure.
Complications: seizures, intracranial hemorrhage, vascular thrombosis or death
Poor latching identified from mother. Doctor advises supplement after breastfeeding until milk flow is better established.
How to ensure milk flow is better?
What types of supplement?
- Any reduction in frequency of breast emptying will decrease milk production and volume –> encourage mother to pump to empty her breast after each nursing and each time a supplemental feeding is given
Types of supplement
* Banked human milk
* Commercial infant formula
What are the choies of formula?
Infant formula (for neonates >1 years of age)
* Cows protein formula
* Soy formula
* Lactose free formula (for neonates with secondary lactase deficiency and diarhea)
* Hydrolyzed formula
* Amino acid formula (extensively hydrolyzed formula (cut finer): tastes bad and expensive but no allergens)
- Goats milk
- Cows milk
- Evaporated milk
- Skimmed milk
Compare human milk to infant formula and the benefits of human milk
Human milk has higher whey: casein 70:30 ratio. Casein becomes curds in the stomach while whey remains a liquid and is easier to digest.
Traditionally, infant formulas are high in casein, making them harder to digest compared to breast milk.
Factors associated with changes in composition of human milk
Composition of lipids and lactose in foremilk, midmilk and hindmilk
Is milk composition different in malnourished mothers?
No
Nutritional comparison of mature human milk to cow, soy
Mature human milk has less iron but has higher bioavailability in comparison to formula milk.
How does nipple confusion occur?
Pacifier use
* Discouraged during the initiation of breastfeeding
* Reduced risk of sudden infant death syndrome
* AAP recommends pacifier use after breastfeeding is established no earlier than 3 weeks of age
What is normal weight gain in neonates per day?
15-40g per day after initiating breastfeeding. Regain weight after 1-2 weeks
If mother is feeding on both sides of breast what counselling is done?
- Ensure that one breast is finished before switching to other side. Milk stores must be empty to induce lactogenesis.
- Baby will have more foremilk and not as much hindmilk (contains more lipids and lactose, fat free.
Compare foremilk vs hindmilk
What are the reasons for poor weight gain?
What is the normal weight gain at 4 months and 1 year for normal baby?
Double birth weight by 4 months
Triple birth weight by 1 year
What is the usage of expressed breast milk?
Baby staying in hospital because it is preterm/sick
Mother cant stay with the baby all the time because of work, travel or other reasons
Usually start pumping the milk 2 weeks before back to work
How to express breast milk?
Storage of expressed breast milk
- Room temp up to 4 hours
- Refrigerator up to 3 days
- Freezer up to 3 months
