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Chapter 9 Infant Nutrition:Conditions and Interventions

Introduction

• This chapter addresses nutritional needs of infants before or shortly after birth– Infants who are sick or small as neonates

are likely to have conditions that may change the course of growth or development

• Demonstrates how nutrition assessment, diagnoses, and nutrition interventions are aligned with medical treatment

Infants at Risk

• Advances in health care have reduced infant mortality

• Advances in neonatal health care have increased survival of infants who were preterm, low birthweight and/or with chronic conditions

• Result: more infants requiring specialized nutritional services

Infants at Risk

• Key questions regarding infants:

– How is the baby growing?

– Is the diet providing all required nutrients?

– How is the infant being fed?

Infants at Risk

• Families of infants with special health care needs should be considered

– Emotional impact of having sick newborn may be overwhelming to parents

– Healthcare providers must be sensitive to parents’ emotional needs

Energy and Nutrient Needs

• Energy Needs– May be the same, more or less depending

on the special needs– Increased calories required for

• Difficulty breathing • Infections• Temperature regulation • Fever • Recovery from surgery

– Decreased calories recommended for spina bifida or Down syndrome

Energy and Nutrient Needs

• Energy Needs– AAP suggests 120 cal/kg for preterm

infants– The European Society for

Gastroenterology and Nutrition gives a caloric range of 110-135 cal/kg

– Recovering infants may need as much as 180 cal/kg

Energy and Nutrient Needs

• Protein Requirements– 1.52 g/kg adequate if growth or digestion are not

affected– 3.0-3.5 g/kg required for preterm or recovery from

illness– 4 g/kg may be needed for ELBW

• Form of protein– Hydrolyzed protein or single amino acid formulas– Specific amino acid formulas such as for PKU

Energy and Nutrient Needs

• Fats– Provide up to 55% calories from fat– Low-fat diet rarely required– Medium-chain triglycerides (MCT)

beneficial to VLBW and ELBW infants because of low pancreatic and liver enzymes

– Essential fatty acids and DHA and AA important

Energy and Nutrient Needs

• Vitamins and Minerals– May need additional vitamins and minerals

to support “catch-up” growth or during recovering from illness

– Human-milk fortifiers provide additional calories and nutrients

– Preterm infant formulas may have higher amounts of vitamins and minerals

Growth

• Tracking growth reflects nutritional status for most infants

• Additional methods to use if underlying conditions exist include:– Growth charts for specific diagnoses– Biochemical indicators– Body composition – Head circumference– Medications that impact growth

Growth

• Growth in Preterm Infants– Variety of growth charts

• Olsen Intrauterine Growth charts• Fenton chart

– All preterm growth charts show head circumference as main indicator of healthy recovery

– Correction for gestational age• 40 - Gestational age at birth /4= months,

subtract from current age

Growth

• Does Intrauterine Growth Predict Outside Growth?– Depends on:

• Intrauterine environment• Fetal-origin errors• Unknown factors such as toxins and air

pollution

Growth

• Interpretation of Growth– Rate of growth frequently used to measure

improvement in preterm or sick infants– Microcephaly or macrocephaly may affect

body composition and growth– Great variability in growth of infants

Nutrition for Infants with Special Health Care Needs

• Health conditions in infants interfere with growth and development

• Nutrition plays an important role in:– Preventing illness– Maintaining health– Treating conditions in infancy

Nutrition for Infants with Special Health Care Needs

Common Nutritional Problems

• Nutrition Risks to Development– Developmental delay—range of symptoms

reflecting slow development such as:• Slow growth• Feeding problem

– Autism – condition of deficits in communication and social interaction

• Mealtime behavior and eating problems occur

Common Nutritional Problems

• Down syndrome– – Incidence is 13 per 10,000 live births– Developmental delays seen in infancy

• Nutrition concerns include:– Weak facial muscles cause feeding difficulty – Overweight common—close monitoring of growth– Low amount of movement resulting in reduced

caloric needs

Severe Preterm Birth and Nutrition

• Incidence and prognosis – About 60,000 VLBW born in U.S. each year – Survival rate ~ 90%– High metabolic rates

• Preterm infants fed by nutrition support– Parenteral—nutrients delivered directly to the

bloodstream– Enteral—nutrients delivered directly to GI tract

Severe Preterm Birth and Nutrition

• How sick babies are fed

• Conditions that require parenteral feeding– Gastrointestinal problems may interfere

with oral feeding – Damage or inflammation to GI tract from

necrotizing enterocolitis (NEC)

Severe Preterm Birth and Nutrition

• Conditions that require enteral feeding– Gastrointestinal reflux, constipation,

spitting up, vomiting, etc.• Types of enteral tube feeding

– Oral-gastric (OG)– Transpyloric – Gastrostomy– Jejunostomy

Severe Preterm Birth and Nutrition

• Food Safety

– Vital for preterm infants with immature immune systems

Severe Preterm Birth and Nutrition

• What to feed preterm infants– Breastmilk– Human-milk fortifier– Preterm infant formulas

• Vary in caloric content• MCT oil• Whey protein

Severe Preterm Birth and Nutrition

Severe Preterm Birth and Nutrition

Severe Preterm Birth and Nutrition

• Preterm infants and feeding– Challenges in feeding VLBW or ELBW

infants include:• Fatigue• Low tolerance of volume• “Disorganized feeding”

Infants with Congenital Abnormalities and Chronic Illness

• GI tract disorders– Diaphragmatic hernia – displacement of

the intestines up into the lungs– Tracheoesophageal atresia – incomplete

connection between the esophagus and the stomach

• Cleft lip and palate – upper lip and roof or mouth are not formed completely

Infants with Congenital Abnormalities and Chronic Illness

• Genetic disorders– Small subset of congenital anomalies– Includes:

• Galactosemia• Maple syrup urine disease• Urea cycle disorders• Fat-related and carbohydrate disorders• Disorders sensitive to high-dose vitamins• Renal or Bone genetic disorders

Feeding Problems

• Seen in 40-45% of VLBW infants• Feeding problems may cause

frustration to families• Recommendations for introducing solids

and weaning with preterm infants are based on corrected gestational age

• Table 9.5 lists Signs of feeding problems in high-risk infants

Nutrition Interventions

• Frequent growth assessment• Monitor intake• Adjust feeding frequency/volume• Adjust timing of nursing, snacks or meals • Assess feeding position and support• Nutrient density to facilitate eating• Parent education• Observe parent-infant interactions• Consider developmental abilities

Infant Formulas for Special Needs

• Special infant formulas may be used for some conditions

Nutrition Services

• Federal disability programs

• IDEA, Part C

• Early Head Start

• WIC

• MCH Block Grant