Exam 2 - Study Material (Nutrition + FHR) Flashcards
1
Q
What is a neonate?
A
An infant during first 28 days of life
2
Q
Describe neonate weightloss right after birth
A
- Infants lose weight after birth due to ECF loss and meconium passage
- Weight loss of <10% of birth weight (BW) for formula fed NB and <7% of BW for breastfeeding infants okay prior to hospital discharge home
- Weight loss of >7% in first few days of life may indicate BF difficulties-assessment of feeding ability and lactation consult
3
Q
When should neonates begin gaining weight? Describe the weight gain
A
- Should be gaining weight by day 5 of life and back up to BW by 2 weeks
- After neonatal period should be about 35gms (1oz) QD or 5-7oz per week
- Breastfed (BF) and formula fed (FF) infants have different growth rates and different growth charts (WHO)
4
Q
Describe the composition of breast milk
A
- Nutritional gold standard
- Colostrum – early milk produced in first days PP lower in lactose, fats and cholesterol and higher in proteins and immune factors
- Very small amounts required first 3 days
- Kcal requirements 110 to 120kcal/kg/QD
- Fluid requirements 140-160cc/kg/QD
- Fat content ↓ between 1 & 4 months, then ↑ in fat content
- Protein content ↓ by 6 months when table foods should be introduced
- Long chain PUFAs and other essential fatty acids that can’t be replicated in formula
- Multiple immune factors
- Lactose content constant through the 1st year
- Mean total milk production for both breasts avg 798 ml per day over 12 months;
- Growth R/T milk intake; quality not an issue (even malnourished mothers can provide quality)
5
Q
What is a normal breastfeeding schedule?
A
- 8-12 feeds a day and not always from both breasts during a single feed
- Feeds range from 1-240 mls; average 76 mls
- No relation between size of feed and desire to eat again
- May be R/T faster gastric emptying or a relatively small stomach or stage of infant growth
6
Q
What are the differences between whole milk vs formula/breast milk?
A
- AAP recommends that whole cow’s milk and low-iron formulas not be used during the first year of life.
- Whole bovine milk is inadequate amounts in
- Vitamin E
- iron
- essential fatty acids.
- Bovine milk has excessive protein, sodium, and potassium for infant.
- Whole bovine milk proteins and fat are more difficult to digest and absorb.
- The most dramatic effects are on iron levels in the body. Infants fed breast milk or iron fortified formula have normal iron levels. Recent studies show infants often have depleted levels when started on cow’s milk at six months of age
7
Q
What are the differences between breastmilk vs formula?
A
- Note the large difference in whey/casein ratio between the two in neonatal period
- Whey easier to digest/Breastmilk higher content of whey and lower casein than formula
- DHA and arachidonic acid (AA) cannot be exactly replicated in formula (long chain poly faty acids)
- Formula preparations differ greatly in vitamins and minerals
8
Q
Describe the beneficial contents in breastmilk
A
- Oligosaccharides promote colonization of lactobacilus bifidus. Beneficial for GI tract environment protects against GI viruses and bacterial. GI disease much less pronounced in BF babies and provides lifetime protection.
- Provides proteins and sufficient vitamins (exception is Vit D)
- Breastmilk provides more minerals in more appropriate doses than formula
- There are many elements in breast milk that cannot be replicated artificially
9
Q
When should an infant receive vitamin K?
A
- Give vitamin K in sufficent amounts by day 3
- All infants get the injection of vitamin K after birth. IF NOT, Hemorrhagic events can occur but are rate, if they occur they are ALWAYS devastating
10
Q
What are the nutritional needs for infants?
A
- NB to 3 months old need 110-120 kcal/kg/day
- From 3-6 months need 100 kcal/kg/day
- Formula and breastmilk = 20 kcal/oz
- Carbohydrates= 40-45% calories
- Fat= 15% calories
- Protein= 40-45% calories
- Excessive protein can damage kidneys
11
Q
What are the fluid needs for infants?
A
Fluid = 140-160ml/kg/day
- Fluids met with breastmilk/formula
- Breastmilk is 87% water
- Water in addition to breastmilk or formula should not be given without APN or physician direction.
12
Q
How much vitamin D should infants receive?
A
- Maternal Vitamin D stores depend on her intake and metabolism
- 2008: CDC and AAP recommend that babies who are exclusively BF or supplemented with < 500ml fortified formula be given Vitamin D
- 400 IU Vitamin D supplement per day
- Vitamin D levels also linked to sun exposure
- 15 minutes exposure daily before 1000 or after 1400 helps body make Vitamin D
13
Q
How do you know if a baby is intaking enough food?
A
Breast or Bottle fed
- Baby should sleep ONCE in 24 hours for 4-5h
- Acts satisfied and relaxed after feeding
- By day 5-6 should void 6-7X/day minimum
- Grows and gains weight
Breast fed
- Colostrum phase monitor output
- After Day one = 1 wet/dirty diaper, Day 2 two wet/dirty, ect. So on until day 6 then 6-7 wets and 4 stools per day
- Breasts are full before, emptier after feed
- Consistent weight gain
14
Q
What are the different types of speciaal formulas and when is each used?
A
- Metabolic disorders- hypoallergenic formulas with hydrolyzed protein and added amino acids
- Very premature infants- mix high Kcal formula with breastmilk. Preterm breastmilk lacks sufficient Kcal but provides higher levels of proteins, vitamins, and immune factors.
- Soy formulas for term infants only
- Lactose free formulas
15
Q
When is breastmilk produced?
A
- Breast growth during pregnancy stimulated by estrogen
- Colostrum is produced by week 16 of gestation
- Some milk may leak from ducts during pregnancy but progesterone prevents much production
- Placental fragments will produce progesterone and result in delayed production
- Colostrum is put out by the breasts for the first 72 hours
- Prolactin necessary for production, but amounts less significant
- Milk production dependent on frequency and amount of feeds (autocrine regulation after 3rd day PP)
- Prolactin levels decrease after birth until about 2 weeks PP. Output of milk is dependant on breast stimulation and not prolactin levels
- Pumping only for medical need
- Oxytocin release from posterior pituitary gland results from suckling and causes myoepithelial cells in breasts to eject milk (called “letdown”)
- Start of feed has “Foremilk” that is low in fats, high in lactose and proteins
16
Q
When is breastfeeding contraindicated?
A
- Contraindicated in HIV positive moms in US
- Drug addiction
- HTLV1 virus
- Active TB
- Herpes lesion on breast/nipple
- Metabolic disorder such as galactosemia
- Radioactive isotopes or mom on some chemos
- Most medications have low systemic absorption into breastmilk
- Penetration into milk depends on:
- Protein binding, half-life, first pass (through Maternal GI and then liver), molecular size and weight }Milk/plasma ratios in Hale’s book
17
Q
What are some characteristics of breastmilk storage?
A
- Pumping to return to work
- Double pumping more efficient}
- Glass or plastic bottles (disposable plastic bags not advised-bind to SIgA)
- Fresh milk: 4 hours room temp. In refrigerator for one week or freeze within 48 hours if freezing desired
30
Q
What are accelerations in relation to FHR’s and what do they mean?
A
- Accelerations are an increase in FHR with response to contractions or fetal activity
- They are normal and desirable
- They are a sign of fetal well being
31
Q
What are variable decelerations in relation to FHR’s and what do they mean?
A
- Variable decelerations are decreases in the fetal heart rate at any point in time, it does not have to occur with a contraction
- They are due to umbilical cord compression
- Goodlin’s rule of 60’s (severe variables)
- ↓ HR 60 bpm
- ↓ HR to 60 bpm
- ↓ HR for 60 seconds
- Mild decelerations = 90 bpm for <30 sec
- The decelerations are V-shaped on the FHR
32
Q
What are late decelerations in relation to FHR’s and what do they mean?
A
- Late decelerations occur after a contraction; onset, nadir, and recovery delayed in respect to contraction
- Reflex response of ↑pCO2 sensed by chemoreceptors
-
Fetal hypoxia due to uteroplacental insufficiency
- Loss of short term variability
- Occurs at peak of contraction
33
Q
What are early decelerations in relation to FHR’s and what do they mean?
A
- Early decelerations are a decrease in FHR simultaneously with uterine contraction
- Not <100bpm
- VAGAL dischare due to dural stimulation from head compression
41
Q
What are the different classifications of FHR variabilities?
A
- Decreased 0-5 bpm
- Average/ moderate 6-25 bpm
- Marked/ saltatory 25 bpm+
