Nutrition in Premature Infants 3/17/10

1. Nutrition in Premature Infants3/17/10

8. Generally, the more premature the baby, the more serious and long lasting are the health problems.

9. Preterm Infant: Infants born <37 weeks of gestation • Low Birth Weight (LBW): Birth weight < 2500 grams (5½ lbs) • Very Low Birth Weight (VLBW): Birth weight < 1500 grams (31/3 lbs) • Extremely Low Birth Weight (ELBW): Birth weight <1000 grams (2¼ lbs) • Small for Gestational Age (SGA): Infants born with growth parameters below the 10th percentile. • Intrauterine Growth Retardation (IUGR): Failure to sustain intrauterine growth at expected rates; can be caused by placental insufficiency, infection, malnutrition, etc. – may or may not be born prematurely.

10. Infants at highest risk post discharge • VLBW and ELBW • Small for gestational age (SGA) and Intrauterine Growth Retardation (IUGR) • Primarily breastfeeding with no fortification • Infants on special formulas • Infants who require tube feedings at home • Infants on total parenteral nutrition (TPN) > 4 weeks during hospitalization or on parenteral nutrition after hospital discharge • Infants with gastrostomies or tracheotomies • Infants with slow weight gain prior to hospital discharge (gaining less than 15 gm/kg/day) • Infants with any of the following complications of prematurity: o Bronchopulmonary dysplasia/chronic lung disease o Chronic renal insufficiency o Congenital alimentary track anomalies o Short bowel syndrome o Cyanotic congenital heart disease o Osteopenia of prematurity o Anemia of prematurity o Severe neurological impairments o Drug and/or alcohol exposure in utero o Poverty or low socioeconomic status

11. Problems for premature infants • temperature instability • respiratory problems • cardiovascular • PDA, hypo/hypertension, low HR • blood and metabolic • gastrointestinal - NEC • neurologic • infections – decreased immunity

12. Care of premature babies may include: • temperature-controlled beds • monitoring - temperature, blood pressure, heart and breathing rates, and oxygen levels • extra oxygen by a hood or by a ventilator • mechanical ventilators • intravenous (IV) fluids - IV placed in a hand, foot, or scalp • umbilical catheter • Peripherally inserted central catheter (PICC) • x-rays • medications • Kangaroo care

13. Oxygen Tent/Hood

14. PICC line - Peripherally inserted central catheter

16. Nasogastric Feeding Tube

17. Tracheostomy and Ventilator

18. Kangaroo care

21. Infant Mortality • Infant mortality is defined as death that occurs within the first year • Major cause is low birthweight (< 2500 g) • Other leading causes inlcude: • 1) congenital malformations • 2) preterm births • 3) SIDS- sudden infant death syndrome

22. Combating Infant Mortality • Factors associated with mortality: • Social and economic status • Access to health care • Medical interventions • Teenage pregnancy • Availability of abortion services • Failure to prevent preterm & LBW births

23. Premies have higher nutritional needs Due to: 1) inadequate nutrient stores 2) immature physiological systems 3)rapid growth rate 4) medical complications/illnesses

25. Table 8-3, p. 227

27. Estimating Energy Needs in Pediatrics

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