Infant feeding - NNU teaching

Question 1

Triad of RD of NEC

Answer 1

• Substrate
• Hypoxic injury
• Premature gut

Question 2

What can help reduce risk of NEC?

Answer 2

1. Breastmilk (can use donor)
2. Feeding protocol - follow guideline for amounts

Question 3

Why are babies fed via NG when premature?

Answer 3

No sucking reflex before 34 weeks

Question 4

Why is feeding neonate important?

Answer 4

• Growth
• Brain development
• If chronic lung disease due to prematurity - can help overcome this

Question 5

How long is breastfeeding recommended for?

Answer 5

First 6 months of life
Also recommended to continue alongside solids up to 2 years

Question 6

Benefits of breastfeeding

Answer 6

• Reduced risk of allergy if FH
• Reduced admission for resp/GI infections in first year - immune protection
• Improve feed tolerance
• Bonding between baby and mum
• Reduce chance of SIDs
• No need to clean bottles etc - easier prep
• Free
• Contraception for first 6 months
• Intelligence
• Reduce risk NEC if preterm

Question 7

Not breasfed more likely to:

Answer 7

• NEC
• Gastroenteritis
• Chest infection
• UTI
• Juvenile diabetes

Question 8

What is the UK baby friendly initiative?

Answer 8

• Includes 10 step plan for successful breastfeeding
• Includes rooming in - if baby needs tp stay in hosptial, room for mother to ensure not seperated

Question 9

What is periprem 10 bundle?

Answer 9

Involves package that premature babies should receive
eg birth in the correct palce, steroids, optimal cord management, maternal early breast milk

Question 10

Supply breastmilk

Answer 10

• First 3-4 days, not lots of milk as colostrum
• Will then start to increase

Question 11

When to cup feed?

Answer 11

• If latching problems - can express into cup
• If mother then wants to breastfeed after - if use bottle, these are very easy and babies will then prefer this and not breastfeed

Question 12

Types of breastmilk

Answer 12

• Colostrum
• Foremilk - start feeding
• Hindmilk - late feeding

Start of feed is hugh in water, sugar and proteins, low in calories and fat. Then calorie and fat content rises later in the feed as breast empties.

Question 13

Breast milk contains…

Answer 13

• Protein - lactoambulin and lactoferrin
• Fat - VLCPUFA
• Carbohydrate
• Vitamins
• Minerals - Ca, Cl, Mg etc
• Iron
• Immunoglobulins
• Hormones eg thyroid, calcitonin

Lots more too

Question 14

Contraindications to breastfeeding

Answer 14

• Certain maternal cytotoxic drugs
• Galactosaemia - inborn error metabolism, deficiency of galactose to glucose
• Other drugs - amiodarone, lithium, gold
• HIV (in UK)

Question 15

Types of formula

Answer 15

• Whey based
• Casein based
• Preterm
• High energy formulas - more calories/ml
• Pre-digested/lactose free
• Follow on/’comfort’ formula - colic babies etc

Question 16

Weaning age

Answer 16

• 6 months
• Individual development - sitting up, eye-hand-mouth co-oridination, swallowing

Question 17

Cows milk - what age cna give?

Answer 17

• Should not give until after 12 months of age as it is very low in iron
• Can have alongside foods during weaning

Question 18

Birthweight - thresholds for low, very low and extremely low

Answer 18

LBW - less 2500g
VLBW - less 1500g
ELBW - less 1000g

Question 19

What to feed premature babies to begin with?

Answer 19

• Buccal colostrum
• Balance with parenteral nutrition
• Follow feeding guidelines - increase milk by 30ml/kg/day, if very high risk different guideline 20ml/kg/day
• Start every 2hrly
• Give gut priming - small amount

Question 20

If mother breastmilk not available…

Answer 20

• Human donor breastmilk OR preterm formula

Question 21

Normal fluid intake baby

Answer 21

135-200ml/kg/day
110 kcal/kg/day

Question 22

Criteria for parenteral nutrition

Answer 22

• Birthweight under 1000g
• Gestational age under 30 weeks
• Failure to establish nutrition (more than 100ml/kg/day) by day 5

Question 23

What can be added to breastmilk?

Answer 23

Breastmilk fortifier - increase nutritional value