Week 12 Newborns: Nutrition, developmental care, and hyperbilirubinemia Flashcards
how much of their body weight can an infant lose after delivery?
7-10% up to 3 to 4 days after delivery
- normal weight gain is ____ per day
- infant will return to birth weight by _____ weeks
- Failure to return to birth weight by ___ weeks = failure to thrive
- 0.5oz to 1oz/day
- 2 weeks
- 3 weeks
- An infant will double their birth weight by ___ months
4 to 6 months
infants typically ____ their birth weight by 1 year and height is increased by ____% by the end of 1st year
double & 50%
Extrinsic Factors of Poor Weight Gain
- infants should not be encouraged to sleep throughout night before _____ weeks
- Fewer than ____ bottle feedings
- Fever than ____ breast feedings in 24 hours
- 8 to 12 weeks
- 8 bottle feedings
- 12 breast feedings
T/F
- Infants who do not regain BW by 3 wks should be referred for failure to thrive
- A weight gain of 0.25oz/day represents adequate growth for an infant
- Inadequate milk supply or error in formula recipe are 2 potential etiologies for poor weight gain in the infant
- The WHO growth chart is recommended for all children under 2 years, especially those who are exclusively breastfed
- Yes
- No; 0.5 to 1oz
- yes
- yes
What are contraindications to breast feeding?
- maternal substance use
- Cytotoxic & immunosuppressive drugs
- HIV in developed countries
- Active TB (pumped milk ok)
- Active varicella (pumped ok)
- HSV lesions on breast
- neonatal galactosemia
What are the stages of breast milk?
- colostrum 1 to 5 days
- Traditional 5 to 10 days (breast milk with some colostrum) Thin blue/grey
- Mature milk 10+ days
how do you know if a baby has been adequately fed?
- audible swallow
- active & alter
- good skin
- 6 soiled diapers/day
- satisfied behaviors
- height/weight/head circumference
What is the pattern of breast feeding?
suck swallow breathe
When should you start vitamin D supplementation?
When can you stop?
Start: few days after birth 400 IU
Stop: 1L formula OR solid foods or 4c whole milk/day
When do you start iron supplementation in exclusively BF infants?
How much?
When can you stop iron supplementation?
Start: 4 months
Dose: 1mg/kg/day
Stop: 6 months from iron fortified meals
What makes up the “all purpose nipple ointment”
mupirocin
betamethasone
miconazole
what is a risk factor for developing a candidal infection?
what should women take to prevent this?
recent abx for GBS+ women
Tx: take probiotics for 3 weeks to rebalance flora
When is mastitis most common?
Cause of mastitis?
Symptoms?
Treatment
- 6-7 weeks after birth; 10-30%. mothers
- Cause: milk stasis, nipple trauma, engorgement, maternal fatigue/stress
- S/S: Unilateral/red/hot/swollen
- “flu like”
- Fever >101
- Treatment: antibiotics
- IgG is the most abundant antibody found in breast milk
- signs of adequate BF include 6+ wet/soiled diapers/day, audible swallowing, infant content, sleeping between feeds
- NO; IgA
- yes
- formula fed infants start being offered ____ every ____
- On avg, formula fed infant should take ____ oz of formula for every pound of body weight
- 1-2oz Q2-3 hours in first few day life of
- 2.5 oz of formula per lbs/body weight
What is the criteria for constipation?
No stooling for 2 weeks time
what would you give to an infant <6 months old for constipation?
laculose
what would you give to a constipated infant >6months old?
miralax
What is supportive care for infant with constipation?
- 5 to 15ml prune juice 1-2x/day
- glycerin suppository (soap stimulant)
*
when would you refer a constipated infant to GI?
refractory to tx
affecting feeding/growth
concern for underlying condition
When does colic occur and what age is it most common
- 1-3 months; common first 6 weeks
how to diagnose colic
“rule of 3s”
3+ hrs/day
3+ days/week
3 week period
What are the causes of hyperbilirubinemia?
- Immature liver
- decreased ability to conjugate bilirubin
- decreased exretion
- poor feeding caused mild dehydration
- Prematurity
When does bilirubin peak?
Day 3 to 4 of life
level peak 6mg/dl
when does jaundice usually resolve on its own?
after 2 weeks
What are the parameters for pathologic jaundice?
TSB rise of 5mg/dl per day of life
or
TSB >15mg/dl
Potential causes of pathologic jaundice
- erythrocyte defects
- structural abnormalities in liver (biliary atresia)
- infection
- sequestered blood
what are the risk factors for hyperbilirubinemia
- Jaundice within 1st 24 hrs of birth
- sibline w/jaundice
- unrecognized hemolysis
- non optimal feeding
- G6PD
- Infection
- Cephalohematoma
- East Asian/Mediterranean descent (ABO incompatibilities)
When do you screen for hyperbilirubinemia?
prior to d/c AND 3-5 days after birth
What are the complications of hyperbilirubinemia?
Acute bilirubin encephalopathy
Kernicterus (nuclear jaundice)
describe acute bilirubin encephalopathy
- Fever
- Lethargy
- High pitch cry
- Arching body/neck
- poor feedings
what is Kernicterus
- High bilirubin
- sight/hearing deficits
- athetoid cerebral palsy
- cognitive delays
- death
permanent!!!
how to manage low risk bilirubin infants
recheck levels
check I/O
When can bilirubin levels rebound after phototherapy?
18-24 hours
What are the potential side effects of phototherapy?
skin rash
loose stools
overheating/dehydration
“bronze baby” syndrome
- All infants should be screened for hyperbilirubinemia prior to hospital dc and again 3-5 days after birth?
- Cephalohematoma is a risk factor for jaundice?
- BF infants undergoing phototherapy for tx of hyperbilirubinemia require supplemental formula?
- yes
- yes
- no; unless there is a issue where they’re not feeding vigorously
