FEEDINF LOW BRITH WEIGHT INFANTS

Report
FEEDING LOW BRITH WEIGHT/
PRETERM INFANTS
RACHEL MUSOKE (UON)
FLORENCE OGONGO (KNH)
KNH/UON SYMPSIUM 10TH JAN 2013
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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
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MDGs & LBW/preterm feeding
FOCUS ON MDG 1, 4 & 5
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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
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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)
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Intervention to improve feeding can
have significant impact on all these
factors
6
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
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POSTNATAL NUTRITION
Birth of LBW/preterm is a shock
Physiological stressors:
• Temperature regulation
• Breathing
• Elimination
• Separation
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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
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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
10
NUTRITION: meeting the nutritional needs
• Simulate intrauterine growth
• Higher needs for:
Growth
Associated stress events
• Poor neurodevelopmental outcome if not
adequately fed
11
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
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Glucose infusions: Complications
• Hyperglycaemia in the VLBW
- Dehydration
- Increased CO2 production
• Risk of IVH & death
• Hypoglycaemia
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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
14
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.
15
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
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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
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What milk?
• Own mother’s milk - unmodified
• Own mother’s milk - fortified
• Preterm formula
• Parenteral
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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?
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Family Support
• Having a preterm/LBW baby is traumatic to
parents
• Mother needs support to produce enough
milk
• Children at home without a mother
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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
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THANKS FOR LISTENING AND
PARTICIPATING
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