Feeding The Newborn PDF

Feeding the Newborn V. White-Barrow, PhD  Objectives Compare the nutrient needs per unit body weight of an infant to those of an adult List the pros and cons of breastfeeding for baby Discuss the recommendations for feeding an infant from birth to 6 months of age Compare...

Feeding the Newborn V. White-Barrow, PhD  Objectives Compare the nutrient needs per unit body weight of an infant to those of an adult List the pros and cons of breastfeeding for baby Discuss the recommendations for feeding an infant from birth to 6 months of age Compare the nutrient content of breast milk with infant formula and cow’s/goat’s milk Compare the effect of breastfeeding and infant formulas on the nutritional status of the infant  Remember Martha? Martha is a 24 year old Bank accountant. She and her husband are expecting their first child and are quite anxious and excited. She considers herself healthy because she has always been eating a healthy diet and exercise at least 30 minutes on weekdays. She has been trying to learn all she can about pregnancy; so that she can have a healthy baby.  Remember Sarah Sarah - a 47 year old Entrepreneur - and her husband, are also having expecting their first child for the first time. They are both excited but anxious because of her age; as well as the fact that she has a pre-pregnancy BMI of 37 kg/m-2 Sarah is also a diabetic and hypertensive.  24 year old Martha has just given birth by vaginal delivery to her first baby, John after 9 months. He was born weighing 8lbs 6 Meet John oz and cried a lot. and Justina! 47 year old Sarah gave birth to her first baby girl Justina prematurely by cesarean section. She weighed 3 lbs 6 oz. Her cries were weak.  While in the womb, the foetus is passively fed via the placenta Feeding Vital nutrient stores the are built up during gestation foetus Once the umbilical cord is cut after birth, the child is actively fed  WHO Guidelines for Feeding the Neonate Both Martha and Sarah were encouraged to start breastfeeding within one hour of giving birth John could breastfeed but Justina was too weak to breastfeed Both should be given breast milk exclusively for 6 months The newborn’s stomach is small  The Nutritional Needs of Infancy Must support the continuing growth and development, and increasing level of activity Copyright 2008 John Wiley & Sons, Inc. 14-38  Nutrient needs of the newborn Infant nutrient needs (expressed in kg/d) are higher than adults Infant caloric needs increase per pound of weight and increases as activity and mobility increase. LBW (like Justina) and VLBW infants may need a specialized diet to enable continued growth and development. Estimated Energy Requirements (EER) 0-3 months (89 x wt -100) + 175 4-6 months (89 x wt -100) + 56 7-12 months (89 x wt -100) + 22 13-35 months (89 x wt -100) + 20 Equations for older children factor in weight, height and physical activity level (PAL)  Infant nutrient needs Carbohydrate (lactose) provides 30% energy for growth and development Recommendation based on average content of breast milk AI = 60g/d  Macronutrient Needs Carbohydrate Fats – The percentage of – 55% of calories total energy required obtained from fats increases as infants for the first six grow months and 40% for the second six Protein months – Very high need – Omega-3 and compared with omega-6 fatty acids adults assist with the – Ideal source for development of the newborns is human nervous system, milk Copyright 2008 John Wiley & Sons, Inc. cell membranes, 14-40  Infant nutrient needs (cont’d) 50% Protein used up for growth and development Too much protein can lead to dehydration in infants; despite this, infants require more protein per kilogram of body weight than the average adult (1.52g versus 0.8).  Energy Needs and Fat Intake Newborns need more kcalories per pound of body weight than anyone at any other time Need sufficient supply of docosahexaenoic acid and arachidonic acid derived from essential fatty acids Copyright 2008 John Wiley & Sons, Inc. 14-39  Energy Needs and Fat Intake DHA and arachidonic acid deficiency associated with – poor development and functioning of the brain and eyes – poor growth of the infant Copyright 2008 John Wiley & Sons, Inc. 14-39  Nutrient needs cont’d Infants have a higher body weight percentage of water, and infants lose more water through urination and evaporation than do adults, increasing their risk of dehydration. (Grosvenor & Smolin, 2006)  Infant’s fluid needs Fluid – Higher proportion of body water than adults – Water losses are higher, too – Breast milk usually can meet the needs in healthy infants – Additional fluid is needed if infants are dehydrated by diarrhea or vomiting  Micronutrient Needs Iron Vitamin D – The most – All breast-fed commonly deficient infants should nutrient receive – Iron should be supplementation added after 4 to 6 Vitamin K months – All breast-fed Fluoride infants should receive a single – Dependent on intramuscular access to injection fluoridated water, infants may or may Vitamin B12 not need to be – Breast-fed infants14-41 Copyright 2008 John Wiley & Sons, Inc.  Nutrient needs cont’d Iron deficiency is the most common nutrient deficiency found in infants. For the first six months, infants receive the iron they need (0.27mg per day) from breast milk and stores Breast milk high iron bioavailability From seven to twelve months the need for iron increases to 11 mg per day, usually met through iron-fortified cereal and formula.  Nutrient needs cont’d Breast milk is low in Vitamin D, so infants are at risk for a deficiency. Fifteen minutes of facial exposure to the sun per day for light-skinned babies is adequate to supply the amount of Vitamin D needed. Vitamin K enables blood clotting, but very little Vitamin K crosses the placenta or is excreted in breast milk, so to prevent hemorrhage, Vitamin K is given by injection at birth  Nutrient needs cont’d Fluoride supplements in formula fed babies may be needed at six months of age. Nutrient intakes in infants cannot be measured, so growth charts are used to monitor infant growth and as an indicator of adequate nutrition. Some fluctuations are normal, but significant changes indicate possible malnutrition  Guidelines for Infant feeding Breast milk exclusively from 0 to 6 months Exclusive breastfeeding – giving an infant no food or drink (not even water) apart from breast milk Birth weight doubles by 6 months and exclusive breastfeeding becomes insufficient to meet increasing energy and nutrient demands for growth  Guidelines after 6 months After 6 months complementary feeding to meet nutritional gaps Complementary (weaning) foods – foods suitable to complement breast milk or commercial or home-prepared formula when either becomes insufficient to satisfy the nutritional requirements of the infant Infant is developmentally ready to eat other foods Breastfeeding may continue up to 2 years  Breast milk is the best food for ALL Babies ALL babies (Normal weight, LBW, VLBW, Large BW) should get breast milk Composition changes as the baby grows and develops Nutrient supply is perfect for baby Easily digested Stages of breast milk  Colustrum Rich in nutrients needed in the first days of life – proteins*, minerals, fat soluble vitamins Proteins- immunoglobulins Breastfeeding should be initiated within 1 hour after birth Breastfeed on demand thereafter  Transition milk 7 – 21 days postpartum Higher concentration of water soluble vitamins Higher concentration of fat and lactose Higher calorie content than colustrum  Mature Milk After 21 days postpartum 90% water High in protein, fats, carbohydrates for growth needs Iron and Vitamin D content low John loves breast milk because:  Nutritional advantages Immune factors – He doesn’t get sick frequently or for too long Easily digestible proteins lactalbumin; low in methionine and phenylalanine; good source of taurine Easily digestible lipids, essential for brain development Lactose stimulates growth of acid-producing bacteria and promotes absorption of calcium and other minerals Low in sodium Zinc, iron and calcium present in the forms that are easily absorbed Copyright 2008 John Wiley & Sons, Inc. 14-43  Other reasons Breastfeeding will allow regulation of baby’s growth, development and metabolism Reduce their risk of hospital admission related to diarrhoea and respiratory tract infections by 50% Reduce the risk of morbidity by 30% Reduce their risk of mortality by 60% Reduce their risk of SIDs  Other reasons cont’d Kidney (renal function is immature at birth and does not reach complete maturity until 2 years. The ability to handle free water and high solute loads is impaired in neonates By 4 – 6 months, the kidneys are able to excrete waste from foods with high solute loads but foods such as cow’s and goats milk with very high solute loads due to high protein content should be avoided  Breast milk cont’d Other advantages of breast-feeding – A relaxing, emotional enjoyable interaction for both John and his mother Sarah – Allergic reactions to human milk are minimal – Reduces risk of atopic diseases (e.g. eczema) if there is a family history of such – Aids in development of facial muscles, speech development, and correct formation of teeth – Protects against immune related diseases e.g. Type I diabetes, Inflammatory Bowel Disease – Associated with increase performance in intelligence tests in childhood and adolescents of 3.5 points on average Copyright 2008 John Wiley & Sons, Inc. 14-44  Breastmilk/feeding benefits Breastmilk contains nutrients and tastants and dietary exposures from the mother’s environment The composition of breastmilk changes as does the baby  Feeding during the first 7 days Colustrum secreted during the first week postpartum is high in antibodies to convey passive immunity to the offspring. Subsequently, the secretion from the mammary glands become a fluid that provides all the nutrients required for growth and survival of the newborn. The volume of milk secreted increases to maximum then gradually declines, paralleling the offspring’s graduation to a solid diet.  Assessing Infant Growth Growth charts: monitor an infant's pattern of growth and to compare length, weight, and head circumference to standards A consistent pattern of not following the growth curve or a sudden change in growth pattern may indicate over- or under-nutrition – Failure to thrive: slower growth than the predicted pattern Copyright 2008 John Wiley & Sons, Inc. 14-42  Mother’s needs She needs to continue to have a balanced diet to meet baby’s demands She needs adequate rest and relaxation to keep up with baby  Bottle-Feeding the Newborn When breast-feeding is not the best choice The same feeding frequency and amount as breast-feeding should be used Practical issues: – Careful preparation to avoid mixing errors ad contamination – Maintain the proper position of the infant – Avoid nursing bottle syndrome Copyright 2008 John Wiley & Sons, Inc. 14-46  Formula Choices Unmodified cow’s milk should never be fed to infants Unmodified goat’s milk is not recommended for infants Special formulas are available for infants with allergies, premature infants, and those with genetic abnormalities that alter their needs Preterm Infants need special formulas Copyright 2008 John Wiley & Sons, Inc. 14-47  Justina was breastfed but… Breastfeeding was difficult because she was so small… Her mother found the cradle and football holds most comfortable Justina fell asleep during breastfeeding … too tiresome for her. Her mother had to tickle her feet Her mother was producing small amount of milk…Justina was hungry Justina started formula at 2 months  FORMULAS Have been formulated to be as close as possible to the composition of human milk: Enfamil and SMA have been modified to provide a whey: casein protein ratio similar to that of human milk. Similac, Bonamil and Gerber are subject to heat treatment to reduce the curd tension, Good Start contains hydrolyzed reduced mineral whey; it is higher in protein and lower in fat than others; vegetable oils are added to ensure fat absorption similar to that from human milk and vitamins and minerals have been added.  FORMULAS Soy products are recommended for: children of vegetarians children who suffer from lactose intolerance Potentially allergic infants Breastfeed vs. Formula Copyright 2008 John Wiley & Sons, Inc. 14-48  Cow’s milk is inappropriate for humans (at least until 1 year of age) because: the tough hard curd is difficult for young infants to digest less cow’s milk fat is absorbed than that of human milk The much higher protein and ash content results in a higher renal solute load ~ which is the amount of nitrogenous waste and minerals that must be excreted by the kidney.  Cow’s milk compared: Although they both provide 20kcal/oz the nutrient sources of the calories are different: Human milk Protein provides 6 to 7% of the calories while cow’s milk provides 20% of the calories. The amino acids taurine and cystine are present in higher concentrations in human milk than in cows milk…they may be essential for premature infants. Lactose provides 42% of calories in human milk and only 30% of the calories in cow’s milk.  Cow’s milk compared Lipids provide 50% of the calories in both milks and the monounsaturated oleic acid is the predominant fatty acid in both., the essential fatty acid , linoleic acid provides 4% of calories in human milk and only 1% in cow’s milk. The cholesterol content of human milk is 7 to 47 mg.dl and 10 to 35 mg/dl in cow’s milk. Cow’s milk has adequate quantities of the B Vitamins but very little vitamin C.  Cow’s milk compared Human milk is a richer source of Vitamin E 49% of the iron in cow’s milk but less than1% iron in cow’s milk is absorbed. The bio-availability of zinc is higher from human milk Cow’s milk may cause a small gastrointestinal blood loss. Failure to thrive while breast fed: Maternal causes: Poor production: Hypothyroidism Insufficient development of alveolar tissue Excessive caffeine use Illness Poor diet Fatigue Stress anxiety Hypertension Smoking Failure to thrive while breast fed: Infant causes: Poor intake: – Poor suck – Contented, sleepy nature – Infrequent feed – Some craniofacial abnormalities Vomiting and diarrhoea Mal-absorption Infection  Infant cont’d: High Energy requirement CNS defect Congenital heart disease Small-for-gestational age  LBW Infant Weighs