Week 12 NB Nutrition, Care, Development Flashcards
1
Q
s/sx adequate breast feeding
A
- Maintaining adequate milk supply depends on nutritive stimulation of the breast and removal of milk on a regular and frequent basis
- More demand = more milk
- Suck-swallow-breathe = 1 second : 1 second : 1 second
- Audible swallow
- Active and alert state
- Good skin turgor and color
- Sufficient soiled diapers at least 6 per day
- Content and satisfied behavior after feedings
- Age appropriate height, wt, and head circumference
2
Q
AAP & WHO recommendations on breastfeeding
A
- AAP recommends exclusive breastfeeding through 6 months and continuing when solids are introduced until at least 1 year or when mom/baby decide to stop
- *WHO recommends for the first 2 years of life
3
Q
benefits of breastfeeding
A
- Antibodies- IgA, first milk
- Building immunity
- Reduces disease risk (respiratory, bowel, allergies, diabetes)
- Promotes healthy weight, prevents obesity (leptin-regulates appetite and fat storage)
- Positive effects on brain development
- Lower estrogen states = decrease risk of breast / ovarian cancer
4
Q
Factors that can affect BF:
A
- Induction of labor with medications
- Epidural anesthesia
- C-section delivery
- Delay in first feeding
- Inadequate milk supply- need regular and frequent nutritive stimulation- SUPPLY/DEMAND loop
- History of previous breast surgery
- Issues with poor latch
- Inverted nipples
- Nipple breakdown or breast infection
- Poor latching causes dry crackled nipples
- Preterm infant
- Palate/lip abnormality in infant
- Breast engorgement
- Difficult for latch
- Thrush
- candida infection first 1-2 weeks after BF
- recent antibiotic therapy risk factor
- GBS+ women should take probiotics x 3 weeks
- Mastitis
5
Q
nipple breakdown from BF tx
A
- All Purpose Nipple Ointment APNO
- Mupirocin
- Betamethasone
- Miconazole
- Teach correct technique for “breaking the seal” to avoid further trauma
- Lanolin (applied to nipples only ) or Soothies may help
5
Q
supplements for BF infants
A
- vitamin D
- healthy bone, prevents rickets
- 400 liquid drops daily first days of birth
- can stop after taking 1 L formula, solid foods, or drinking 4 cups whole milk per day
- Iron
- good for first 3-4 months
- BF need 1 mg/kg/day starting 4 months of age
- at 6 months, need iron foods
6
Q
contraindications to BF
A
- Maternal substance abuse
- Cytotoxic and immunosuppressive drugs
- Active TB
- pumped milk ok
- Active HSV lesions on the breast
- NO BF
- Active varicella infection
- lesion on breast: NO, but can pump and dump so don’t lose the breast supply
- if on any other part of body, can BF
- HIV infections (ONLY in underdeveloped countries)
- Neonatal galactosemia
- Infant can’t break down milk
- Need specialized formula
7
Q
BF - Thrush treatment
A
- *Both mother and baby need to be treated otherwise continual reinfection is likely
- -topical nystatin for infant and for nipples
- -consider systemic fluconazole for mother depending on persistence/severity
8
Q
mastitis
A
- bacterial infection in breast tissue
- 6-7 weeks after birth
- Due to milk stasis, nipple trauma, engorgement, maternal fatigue/stress
- Sudden unilateral red hot swollen area on breast, warm to touch, flu like symptoms, fever over 101F
- Treat with antibiotics and supportive care
- Heat, massage, frequent feeding/pumping, rest, fluids, pain relievers
- Can still BF to release pressure in breast so less painful
9
Q
Colostrum
A
- 1st present milk
- Aka “Liquid gold”
- Very high in protein
- Lasts up to day 5 of infants life
- Yellow gold color
- Considered the first immunization, rich in IgA antibodies, proteins, mineral, vitamins
10
Q
transitional milk
A
- even higher in protein, high in carb
- 5-10 days after delivery
- grey-Bluish color, more translucent
11
Q
mature milk contains
A
- 10 days-2 weeks after delivery
- White milk
- Both foremilk and hindmilk
- 90% water, 10% carbs, protein and fat
- Foremilk- beginning of feed first 5 mins, quenches thirst, lactose and protein but little fat or calories
- Hindmilk- end of feed, higher fat and calories
- Want the HINDMILK from 1 breast, don’t switch off breast
12
Q
BF education
A
- put bb on breast and drain breast completely to get hindmilk (more protein and fat) to keep full longer
- BF babies feed frequently q 1-3 hrs over first couple of weeks of life
13
Q
NB weight loss % and when? what can it lead to?
A
- healthy NB can lose 7-10% of body weight in the first few days after birth
- Nadir (lowest point) is typically 3-4 days after delivery
- Breastfed and babies born via C/S tend to to be on the higher range for weight loss
- Mostly water in breast milk thats why its watery
- Excessive weight loss can lead to hypoglycemia, hyperbilirubinemia (can lead to kernicterus = irreversible brain damage), dehydration, and electrolyte imbalances, all which can negatively affect brain development
14
Q
normal weight gain per day? when would infant return to birth weight? failure to return to birth weight by what age requires FTT workup?
A
- weight gain 0.5-1 oz a day
- by 2 weeks, return to birth weight
- failure by 3 weeks of age needs FTT workup
15
Q
Poor weight gain in NB Contributing factors:
A
- Infrequent or inadequate feedings
- need 6 wet diapers a day
- Inadequate milk production
- Genetic predisposition
- Hypermetabolic
- Poor absorption of nutrients
- Infection
- Organic disease (error in metabolism)
- Physical anomaly that prevents good suck/swallow
- Anatomically preventing form latching on appropriately
- Have mom nurse in office to see to attached whole areola
16
Q
Poor weight gain in NB - Clinical findings
infant factors:
A
- Continued weight loss after 5 to 7 days
- Failure to regain weight by 2 to 3 weeks
- Failure to maintain ongoing weight gain of 0.5 to 1 ounce daily
- Weight below the 3rd percentile
- Lethargic, sleepy, inactive, unresponsive
- Sleeping > 4 hours between feedings
- ONE 5-hr stretch at night may be normal in NB but not every time
- Want baby to eat every 4 hours
- Dry mucous membranes
- Poor skin turgor
- Ineffective latch or sucking
- Short time at the breast (reduces hind milk consumption)
- Preset schedule that ignores hunger cues
- Giving water between feedings
- hyponatremic = seizures and brain damage
- No excess water until > 6 months old
- Infant allowed or encouraged to sleep through the night before 8 to 12 weeks old
- < 8 feedings in 24 hours
- Should be 8-12 / day
- Formula fed 7-8 feedings a day in beginning
- Infant fed in distracting environment
17
Q
Poor weight gain in NB - Clinical findings
maternal factors:
A
- Does not respond to or recognize the infant’s hunger cues
- Hectic schedule with limited time for breastfeeding
- Recent illness with weight loss
- Use of COCs or other hormones
- Should use progestin only BC so doesn’t interfere with BM
18
Q
early cues to hunger
A
stirring
mouth opening
turning head
seeking/rooting 4
19
Q
mid cues to hunger
A
stretching
increased physical movement
hand to mouth
20
Q
late cues to hunger
A
- crying
- agitated body movements
- turning red
- SHOULD NOT WAIT FOR LATE CUES BEFORE FEEDING
43
Q
Exchange transfusion treatment
A
- urgent procedure to prevent or minimize bilirubin-related brain damage.
- Replaces infant’s blood with donated blood to quickly lower bilirubin levels
- performed if not responded to other treatments and who have signs of or at significant neurologic risk of bilirubin toxicity
52
Q
Suctioning, pets, temp
A
- tube that the parent attaches to their mouth, and little tube portion that goes to the nose
- suck the snot from the infants nose.
- removing mucus from the infant’s nose
- Pets
- never leave a newborn alone with a pet unsupervised.
- Temp
- educate any rectal temperature > 100.4, call to come in for sepsis workup
- lubricate the thermometer, and you gently insert until you meet resistance.
