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FEEDING LOW BRITH WEIGHT/ PRETERM INFANTS

FEEDING LOW BRITH WEIGHT/ PRETERM INFANTS. RACHEL MUSOKE (UON) FLORENCE OGONGO (KNH) KNH/UON SYMPSIUM 10 TH JAN 2013. Definition of Preterm and LBW.

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FEEDING LOW BRITH WEIGHT/ PRETERM INFANTS

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  1. FEEDING LOW BRITH WEIGHT/ PRETERM INFANTS RACHEL MUSOKE (UON) FLORENCE OGONGO (KNH) KNH/UON SYMPSIUM 10TH JAN 2013

  2. Definition of Preterm and LBW • Low birth weight babies - birth weight less than 2500g regardless of gestation age while preterm babies are those born before 37 completed weeks of gestation. Subdivisions by gestation 32 – 36 weeks =Moderate or late preterm 28 - 31 weeks = Very preterm Below 28 weeks = Extremely preterm

  3. MDGs & LBW/preterm feeding FOCUS ON MDG 1, 4 & 5

  4. MDGs 1 & 4 • Being born LBW/Preterm MDG 1 – Poverty & hunger • Higher risk of early growth retardation - stunting • Developmental delay (Feeding the developing brain) MDG 4 – Child survival • Increased risk of infection • Death

  5. MDG 5 Maternal health and nutrition • Child nutrition starts at conception • Maternal undernutrition: Low BMI, micronutrient deficiency predispose to Preterm birth Intrauterine growth restriction (IUGR)

  6. Intervention to improve feeding can have significant impact on all these factors

  7. Deficient stores in LBW • Energy: glycogen and fat • Protein: muscles • Minerals & micronutrients: Calcium, iron, zinc etc Most accumulated in the last 10 weeks of pregnancy

  8. POSTNATAL NUTRITION Birth of LBW/preterm is a shock Physiological stressors: • Temperature regulation • Breathing • Elimination • Separation

  9. Decisions to feed at birth Temp shock at birth require energy Reserve as fat • 1000g baby : 100kcal/kg/day • Term 1500-1800kcal/kg/day Reserve as glycogen • Brain metabolism depend on glucose: brain 10% of body wt (adult 2%) need 6mg/kg/min (8.64g/kg/day

  10. Decisions to feed at birth • Lack of feeds delays lung maturation • Hypoxia increase glucose utilisation • Delayed feeding leads to gut atrophy & increase risk of infection Essential lipids • Deficiency within 2-3 days of starvation Protein: no reserve • Starvation: 1g/kg/day muscle breakdown

  11. NUTRITION: meeting the nutritional needs • Simulate intrauterine growth • Higher needs for: Growth Associated stress events • Poor neurodevelopmental outcome if not adequately fed

  12. Methods of feeding • Parenteral:Total parenteral nutrition; requires a lot of expertise to include medical, nursing, pharmacy and laboratory monitoring. It is not available in our setting • At KNH glucose & electrolytes • Risks: hyperglycaemia • Enteral

  13. Glucose infusions: Complications • Hyperglycaemia in the VLBW - Dehydration - Increased CO2 production • Risk of IVH & death • Hypoglycaemia

  14. Enteral feeding When do you start? Larger LBW/late preterm 32-36wks • Well infant • Size at birth Smaller LBW /early preterm <32wks • Sick infant • Respiratory distress

  15. Assessing readiness to breastfeeding • Weight is not a good indicator . • Maturity should be used to assess readiness . • Signs of readiness -Baby licks lips. -Rooting, sucking and swallowing reflexes established.

  16. Important information for mothers • Baby takes long on breasts • Baby pauses frequently (resting) • Baby may choke because of :- • Low muscle • Uncoordinated suckling • Don’t feed too sleepy or fussy babies • Avoid loud noises, bright lights, stroking, jiggling or talking to the baby during feeding attempts

  17. Enteral Feeding Advantages of early start: 1-2 days of birth • Maturation of the gut • Establish normal gut flora • Reduce risk of late onset sepsis • Enhance lung maturation • Better weight gain • Shorter hospital stay

  18. What milk? • Own mother’s milk - unmodified • Own mother’s milk - fortified • Preterm formula • Parenteral

  19. WHAT MILK? • “Human milk recommended basis of nutrition for the preterm infant” • May be insufficient in some nutrient • Human milk fortification • What do you do if you have no fortifier?

  20. Family Support • Having a preterm/LBW baby is traumatic to parents • Mother needs support to produce enough milk • Children at home without a mother

  21. Family support Care for mother • The mother is very important for baby’s growth and survival. • Mother should stay in hospital • Have place for mothers to rest • Provide adequate food and fluids for mothers • Answer their questions patiently

  22. . THANKS FOR LISTENING AND PARTICIPATING

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