Breastfeeding and Nutrition Basics

Premature Newborn

• A premature newborn is a baby born before week 37 of gestation.
• Mothers' age less than 17 or over 35 years.
• Minimal breast tissue (less than 10 mm in diameter), flat nipples, barely visible.

Post-Term Newborn

• Born after 42 weeks of gestation (calculated from the mother's last menstrual period).
• Incidence: nearly 12% of pregnancies.

Newborn Temperature

• Normal axillary temperature: 36.3-37.3°C.
• Hypothermia: body temperature below 36.5°C axillary.
• Monitor temperature every 30 minutes or as needed to maintain proper range.

Newborn Care

• Use portholes instead of larger doors whenever possible during care (incubation temperature: 28-32°C to 35°C.)

Hyperthermia

• Body temperature above 37.5°C axillary.
• Associated conditions (causes): hyperthermia.
• Jaundice may appear if serum bilirubin is above 7 mg/dL due to an increased number of red blood cells.

Serum Bilirubin Levels

• Total serum bilirubin should never exceed 12 mg/dL in full-term newborns and 15 mg/dL in pre-term newborns.
• Direct bilirubin should not exceed 1 mg/dL.
• Daily increase of serum bilirubin should never exceed 5 mg/dL;

Phototherapy Indications

• Used when bilirubin levels reach certain thresholds based on the day of life:
  • Day 1: 5-9 mg/dL
  • Day 2: 9-15 mg/dL
  • Day 3: 15-20 mg/dL.

Nursing Responsibilities

• Keep the newborn NPO for 2-4 hours before exchange transfusion to prevent aspiration.
• Tachypnea: up to 80-120 breaths per minute.

Daily Caloric Requirements

• Approximately 80-110 kcal/kg for the first year of life, decreasing by about 10 kcal/kg every three years until adolescence.
• Ideal food provides carbohydrates, fats, and proteins in a balanced way.

Feeding/Breastfeeding

• Breastfeeding mothers initiate breastfeeding within half an hour after birth.
• Breastfeeding for 24 months. Introduce complimentary foods around 6 months.
• Number of feeds: varies (6-7 feeds/day, 5-6 feeds/day, or 4-5 feeds/day)

Newborn Feeding Quantities

• First week: 10 ml/feed/day gradually increasing by 10 ml/feed by the end of the first day.
• Week 1-month: 70 ml/feed/day, gradually increasing by 10 ml/week.
• After one month: 110 ml/feed/day, gradually increasing by 10 ml/month

Infant Nutritional Requirements

• Infant daily fat requirements: 2.5-3.5 g/kg for infants and 2 g/kg for older children.
• Fats provide energy, aid in vitamin absorption, and are essential for nervous system function

###Dehydration

• Daily water requirement: approximately 150 ml/kg/day in the first year of life decreasing by 25 ml/kg per 3 years, till adolescence.

Vomiting/Nausea

• Vomiting: forceful emptying of stomach contents through the mouth.
• Nausea and abdominal discomfort often precede vomiting.

Intestinal Obstructions

• Symptoms appear within 24 hours after birth.

Diarrhea

• Acute: Watery diarrhea (common, 80% of cases), lasting 3-4 days and improving over the next 4-5 days.
• Dysentery: Loose stools containing blood (less common, 5-10% of cases).

Dehydration Levels

• Mild: Weight loss less than 5% of body weight.
• Moderate: Weight loss 5-10% of body weight.
• Severe: Weight loss greater than 10% of body weight.

Infant Feeding Methods

• Calculate feeding quantities per feed based on infant weight (60 g x 2 + 20 = 140 cc/feed)
• b-protein milk: Acidified milk with added milk curd (casein), high protein content (4%).

Kwashiorkor

• Protein deficiency despite adequate calories.
• Symptoms include apathy, edema, anorexia, growth failure, and fatty liver infiltration.

Marasmus

• Severe deficiency of calories and proteins.
• The diagnosis is characterized by extreme emaciation, weighing less than 60% of standard weight.
• Symptoms include growth failure, dehydration, loss of body fat, and muscle wasting.

Bacterial Pneumonia

• Streptococcus pneumoniae is more frequent than H influenzae in infants (up to age 5).
• Mycobacterium tuberculosis can be a cause
• Treatment: parenteral cefuroxime or Vancomycin if penicillin or cepahlosporein resistance is noted.

Other Notable points

• Fever treatment: Antipyretics (acetaminophen).
• Vitamin D administration: 1500–5000 IU/day (in 3 divided doses), for 4 weeks.
• Shock therapy (IM injection) of 600,000 IU vitamin D in a single dose may be needed if healing does not occur within the first 2 weeks.
• In case of complete healing, reduce the dose to 400 IU/day.

Diabetes Mellitus

• Ketoacidosis (initial presentation in approximately 25% of children)
• Laboratory diagnosis: glucosuria, ketonuria, random plasma glucose ≥ 200 mg/dL, or fasting plasma glucose ≥ 126 mg/dL.