Chapter 9Infant Nutrition:

Conditions and Interventions

Nutrition Through the Life Cycle Judith E. Brown

Key Nutrition Concept #1

• Infants who are born preterm or who are sick early in life often require nutritional assessment and interventions that ensure they are meeting their nutritional needs for growth and development.

Key Nutrition Concept #2

• Early nutrition services and other interventions can improve long-term health and growth among infants born with a variety of conditions.

Key Nutrition Concept #3

• The number of infants requiring specialized nutrition and health care is increasing due to the improved survival rates of small and sick newborns.

Key Terms

• Children with Special Health Care Needs Infants, children or adolescents with, or at risk for, a physical or developmental disability, or with a chronic medical condition

• Low-Birthweight (LBW) Weighing <2500 g• Very Low Birthweight (VLBW) <1500 g• Extremely Low Birthweight (ELBW) <1000 g

Infants at Risk

• Advances in health care have reduced infant mortality

• Advances in neonatal health care have increased survival of infants who were preterm, low birthweight and/or with chronic conditions

• Result: more infants requiring specialized nutritional services

Infants at Risk

• Key questions regarding infants:

– How is the baby growing?

– Is the diet providing all required nutrients?

– How is the infant being fed?

Infants at Risk

• Families of infants with special health care needs should be considered

– Emotional impact of having sick newborn may be overwhelming to parents

– Healthcare providers must be sensitive to parents’ emotional needs

Energy and Nutrient Needs

• Energy Needs– May be the same, more or less depending on the

special needs– Increased calories required for

• Difficulty breathing •Infections• Temperature regulation •Fever • Recovery from surgery

– Decreased calories recommended for spina bifida or Down syndrome

Energy and Nutrient Needs

• Energy Needs– AAP suggests 120 cal/kg for preterm infants– The European Society for Gastoenterology and

Nutrition gives a caloric range of 95-165 cal/kg– Recovering infants may need as much as 180

cal/kg

Energy and Nutrient Needs

• Protein Requirements– 2.2 g/kg adequate if growth or digestion are not

affected

– 3.0-3.5 g/kg required for preterm or recovery from illness

– 4 g/kg may be needed for ELBW

• Form of protein– Hydrolyzed protein or single amino acid formulas

– Specific amino acid formulas such as for PKU

Energy and Nutrient Needs

• Fats– Provide up to 55% calories from fat– Low-fat diet rarely required– Medium-chain triglycerides (MCT) beneficial

to VLBW and ELBW infants because of low pancreatic and liver enzymes

– Essential fatty acids and DHA and AA important

Energy and Nutrient Needs

• Vitamins and Minerals– May need additional vitamins and minerals to

support “catch-up” growth or during recovering from illness

– Human-milk fortifiers provide additional calories and nutrients

– Preterm infant formulas may have higher amounts of vitamins and minerals

Growth

• Tracking growth reflects nutritional status for most infants

• Additional methods to use if underlining conditions exist include:– Growth charts for specific conditions

– Biochemical indicators

– Body composition

– Head circumference

– Medications that impact growth

Growth

• Growth in Preterm Infants– “Neonatal Research Network Growth Observational

Study Research Network” tracks infant BW between 501 and 1501 g

– Infant Health and Development Growth Charts:• For LBW Premature • For VLBW Premature

• Correction for Gestational Age– Gestation-adjusted age calculated by subtracting GA at

birth from 40 weeks

Growth

• Does Intrauterine Growth Predict Outside Growth?– Depends on:

• Intrauterine environment

• Fetal origins theory

• Other factors like air pollution

• Interpretation of growth– Based on a pattern of weight gain

Growth

• Interpretation of Growth– Rate of growth frequently used to measure

improvement in preterm or sick infants– Microcephaly or macrocephaly may affect body

composition and growth– Great variability in growth of infants

Nutrition for Infants with Special Health Care Needs

• Health conditions in infants interfere with growth and development

• Nutrition plays an important role in:– Preventing illness– Maintaining health– Treating conditions in infancy

Nutrition for Infants with Special Health Care Needs

Common Nutritional Problems

• Nutrition Risks to Development

• Developmental delays—range of symptoms reflecting slow development such as:– Slow growth and/or– Feeding problem

Common Nutritional Problems

• Down syndrome– – Incidence is 13 per 10,000 live births– Developmental delays seen in infancy

• Nutrition concerns include:– Weak facial muscles cause feeding difficulty – Overweight common—close monitoring of growth– Low amount of movement resulting in reduced

caloric needs

Severe Preterm Birth and Nutrition

• Incidence and prognosis – About 60,000 VLBW born in U.S. each year

– Survival rate ~ 90%

– Nutrition support generally required

– High metabolic rates

• Preterm infants fed by nutrition support– Parenteral—nutrients delivered directly to the

bloodstream

– Enteral—nutrients delivered directly to GI tract

Severe Preterm Birth and Nutrition

• How sick babies are fed

• Conditions that require parenteral feeding– Gastrointestinal problems may interfere with

oral feeding – Damage or inflammation to GI tract from

necrotizing enterocolitis (NEC)

Severe Preterm Birth and Nutrition

• How sick babies are fed• Conditions that require enteral feeding

– Gastrointestinal reflux, constipation, spitting up, vomiting, etc.

• Types of enteral tube feeding– Oral-gastric (OG)– Transpyloric – Gastrostomy– Jejunostomy

Severe Preterm Birth and Nutrition

• Food Safety

– Vital for preterm infants with immature immune systems

Severe Preterm Birth and Nutrition

• What to feed preterm infants– Breastmilk– Human-milk fortifier– Preterm infant formulas

• Vary in caloric content

• MCT oil

• Whey protein

Severe Preterm Birth and Nutrition

Severe Preterm Birth and Nutrition

Severe Preterm Birth and Nutrition

• Preterm infants and feeding– Challenges in feeding VLBW or ELBW infants

include:• Fatigue

• Low tolerance of volume

• “Disorganized feeding”

Infants with Congenital Abnormalities and Chronic

Illness• GI tract disorders

– Diaphragmatic hernia – displacement of the intestines up into the lungs

– Tracheoesophageal atresia – incomplete connection between the esophagus and the stomach

• Cleft lip and palate – upper lip and roof or mouth are not formed completely

Infants with Congenital Abnormalities and Chronic

Illness• Genetic disorders

– Small subset of congenital anomalies– Includes:

• Galactosemia

• Maple syrup urine disease

• Urea cycle disorders

• Fat-related and carbohydrate disorders

• Disorders sensitive to high-dose vitamins

• Renal or Bone genetic disorders

Feeding Problems

• Seen in 40-45% of VLBW infants

• Feeding problems may cause frustration to families

• Recommendations for introducing solids and weaning with preterm infants are based on corrected gestational age

• Table 9.5 lists Signs of feeding problems in high-risk infants

Nutrition Interventions

• Frequent growth assessment

• Monitor intake

• Adjust feeding frequency/volume

• Adjust timing or nursing, snacks or meals

• Assess feeding position and support

• Nutrient density to facilitate eating

• Parent education

• Observe parent-infant interactions

• Consider developmental abilities

Infant Formulas for Special Needs

• Special infant formulas may be used for some conditions.

Nutrition Services

• Federal disability programs

• IDEA, Part C

• Early Head Start

• WIC

• MCH Block Grant