Infant Mortality and Newborn Health

Infant Mortality

• The infant mortality rate estimates the number of infant deaths within the first year per 1,000 live births
• It serves as an indicator of a nation's health and well-being
• The U.S. ranks lower than other wealthy countries in infant mortality
• The top three causes of infant mortality are birth defects, low birth weight/preterm births, and SIDS (Sudden Infant Death Syndrome)
• The infant mortality rate in the United States was 5.96 per 1,000 live births in 2014
• Nutrition is a key factor affecting infant mortality

Assessing Newborn Health

• Birthweight and gestational age are measurements to assess the health of a newborn

Full-term Infant

• Gestation of 37 to 42 weeks
• Weight between 2500-3800 grams or 5 1/2 to 8 1/2 pounds

Preterm Infant

• Born before 37 weeks

Low Birthweight

• Weight is under 2500 grams

Very Low-Birthweight

• Weight is under 1500 grams

Extremely Low-Birthweight

• Weight is under 1000 grams

Newborn Growth Assessment

• Assessment involves gestational age, birthweight, length, and head circumference

Appropriate for Gestational Age (AGA)

• Weight falls between the 10th and 89th percentile

Small for Gestational Age (SGA)

• Weight is below the 10th percentile

Large for Gestational Age (LGA)

• Weight is above the 90th percentile

Intrauterine Growth Retardation (IUGR)

• A condition where an unborn baby is smaller than expected for its gestational age

Interpretation of Growth Data

• Growth charts show weight for age and length
• Also includes length and head circumference for age

Growth Charts

• Monitoring growth includes observing both weight and length charts relative to age

Warning Signs

• No increase in weight or length is a warning sign
• Continued decline or rapid increase in weight, length, or head circumference percentile is also a warning sign

Tracking and Interpreting Data

• There are two main types of growth charts

Growth Reference Charts

• Developed by the CDC
• Illustrate how certain children grew in specific locations and times
• Charts are available for infants from birth to 36 months, and for ages 2 to 20 years

Growth Standard Charts

• Developed by the WHO
• These are designed for children aged 0 to 5 years
• They depict the healthy growth patterns of children under optimal conditions

Motor and Cognitive Development

• Infants initially gain control of their head and neck, followed by the middle and then legs
• Motor development progresses from the center to the periphery
• Increased movement leads to higher energy requirements
• Spoon feeding is appropriate when a baby is able to sit and has head and neck control

Cognitive Development

• Several factors influence cognitive, motor, and socio-emotional development
• Severe, acute malnutrition has an impact
• Chronic undernutrition and iron deficiency anemia are factors
• Iodine deficiency, environmental interactions also play a role

Digestive System Development

• The fetus swallows amniotic fluid, stimulating intestinal maturation and growth
• Healthy newborns can digest fats, protein, and simple sugars at birth
• Colgastroesophageal reflux (GER), diarrhea, and constipation are common problems
• The infant GI tract is fully developed around 6 months
• The gut microbiome begins to develop before birth, influencing health later in life
• Breastfeeding has an impact on the gut microbiome
• Gastrointestinal issues may affect overall gut health/microbiome

Stomach Capacity

• A newborn's stomach capacity on day 1 is about the size of a shooter marble, or 5-7 mL
• By day 3, it expands to the size of a ping pong ball, or 22-27 mL
• By day 10, it's about the size of an extra-large chicken egg, or 60-81 mL

Breast Milk and Formula

• Exclusive breastfeeding is recommended for the first six months, continuing to one year
• Infant formulas are made to mimic human milk but cannot replicate all components
• Growth and health status are better indicators of dietary adequacy than the amount of breast milk or formula

Formula Types

• Regular formulas are iron-fortified for 12 months, and can be cow's milk-based or soy-protein-based
• Hydrolyzed formulas

Cow's Milk-Based Formula

• The American Academy of Pediatrics (AAP) advises using iron-fortified cow milk formula if breastfeeding isn't possible
• Cow's milk-based formulas are similar to breast milk
• They have a good balance of protein, carbohydrates and fat

Soy-Based Formulas

• Formulas are lactose-free and suitable for vegetarians
• Supplementation to match human milk & cow's milk-based formulas
• The American Academy of Pediatrics recommendations published in Pediatrics 2008

Hydrolyzed Formulas

• These formulas have better GI tolerance
• They may have poor acceptance by infants due to bitter taste and are costly
• Recommendation if allergy confirmed is Fully hydrolyzed ( amino acids, peptides)
  • Example: Alimentum
• Partially hydrolyzed formulas may still contain allergens
  • Example: Nutramigen

Infant Feeding Skills

• Infants are born with innate reflexes and the capacity to regulate food intake
• Eating schedules should be driven by the infant's cues
• Cluster feeding, which is most common during the evening and in young infants, may occur

Infant Feeding Reflexes

• Infants have reflexes that prepare them to feed successfully
• Coordination of sucking, swallowing, and breathing is required
• A preference for sweet taste is inherent
• Reflexes fade around four to six weeks, and infants start signaling their wants and needs

Feeding Readiness Cues

• Cues include watching food being opened in anticipation of eating
• Tight fists or reaching for a spoon are cues
• Displaying displeasure if feeding is too slow or stops temporarily is a cue
• Playing with food or a spoon is a cue
• Slowing intake, turning away, refusing, or spitting out food when full are cues

Complementary Foods

• Introducing complementary foods is typically appropriate around 6 months
• Readiness signs include moving the tongue side to side, keeping the head upright, and sitting with limited support
• Solids should be offered via spoon, with a total quantity of 1–2 tablespoons given

Complementary Feeding

• Infants can swallow pureed foods at six months
• Infants can swallow very soft, lumpy foods at six to eight months
• Infants can consume soft, mashed foods at eight to ten months
• A variety of foods are suitable for infants in the nine to 12 month age range

Feeding Recommendations

• Ensure the infant isn't too tired or hungry
• Use a small spoon with a shallow bowl
• Allow the infant to open their mouth and extend their tongue
• Place the spoon on the front of the tongue with slight downward pressure
• Avoid scraping the spoon on the infant’s gums
• Pace the feeding to give the infant time to swallow
• Initial meals should be small in volume

Infant Feeding Position

• Improper positioning during feeding may lead to choking, discomfort, and ear infections
• Position young bottle-fed infants in a semi-upright manner
• When spoon-feeding, ensure the infant is seated with their back and feet supported
• Adults who are feeding infants should position themselves directly in front of the infant, maintaining eye contact

Drinking From A Cup

• Readiness for drinking from a cup typically begins at six to eight months
• Infants can transition to a cup between 12 and 18 months
• Initial servings from a cup should be one to two ounces
• Reduced total fluid consumption may result in constipation

Fluids

• Breast milk or formula provide sufficient hydration for healthy infants in the initial six months
• Fluid needs during illness are a concern because dehydration is a common response in infancy
• Juice is not needed to meet fluid needs in infants

Food Preference Influence

• Infants are exposed to flavors in utero
• The mother’s diet influences the flavor of breast milk
• Infants have a genetic, unlearned preference for sweet and salty flavors, but they reject sour and bitter tastes

Human Milk

• Gold standard for nutrient content

Intake Guidelines

• Research based

Recommendations

• Created based on research from The Academy of Pediatrics
• The National Academy of Medicine (develops Dietary Reference Intakes [DRIs]) and The Academy of Nutrition and Dietetics
• The European Society of Pediatric Gastroenterology, Hepatology, Nutrition Committee on Nutrition base recommendations on research

Energy Needs

• Infants need more energy per bodyweight than at any other time of life
• Calorie needs are about twice that of an adult, relative to size
• Most infants require 100 kcal/kg of body weight
• Nutritional needs change with age
• During infancy, the calorie distribution should be 40–50% from fat, 7–11% from protein, and the remaining from carbohydrates
• Fat is essential

Lipids

• Triglycerides are the primary energy source in human milk
• Infants need at least 30 grams of fat daily
• Human milk provides essential fatty acids, including ARA, EPA, and DHA

Protein

• Protein requirements are determined as grams per kilogram of body weight
• Protein needs change with development and growth
  • Infants aged 0-6 months need 1.5 g/kg
  • Infants aged 7-12 months need 1.2 g/kg or 11g /day

Carbohydrates

• Glucose is imperative for proper growth/development
• Growth stunting can occur without an adequate glucose supply

Vitamin D

• Fat soluble
• Vitamin D is required for bone mineralization and proper calcium and phosphorus utilization in blood
• Exclusively breastfed infants need vitamin D supplementation of 400 IU/day
• Vitamin D deficiency leads to rickets

Iron

• Infants are born with iron stores reflective of maternal iron stores
• Breastfed infant need an additional iron source by 6 months
• Formula-fed infant need iron fortified formula
• Iron deficiency can cause irreversible behavioral and brain function abnormalities

Fluoride

• Not an essential nutrient
• Helps to create stronger teeth
• The DRI is 0.1 mg/day for infants younger than 6 months, and 0.5 mg/day for infants 7–12 months
• Special circumstances may require fluoride supplementation

Sodium

• Essential mineral
• Needed for fluid maintenance
• Infants requirements are 120 mg from birth to 5 months, and 200 mg for 6- to 12-month-olds
  • Based on the amount of sodium found in breast milk

Lead

• Lead toxicity can interrupt brain development, slow growth, and interfere with calcium and iron absorption
• Found in water, in paint
• Infant can be exposed if caregivers carry home lead dust

Fiber

• Fiber-containing foods may be gradually introduced to infants from 6 months to 12 months until they consume 5 g of fiber per day
• Sources of fiber for infants include whole-grain cereals, green vegetables, and legumes

Water

• Water needs are typically met via breastmilk/formula
• Excessive intake can be harmful, and infants should be monitored for dehydration