Nutrition for Premature Infants

Nasogastric or Nasoenteral

Tube goes through the nose into the stomach or small intestine

Nutrition intervention after nutritional assessment

Typically will be to increase calories, fluid, protein, calcium, phosphate

Parenteral Nutrition (PN) - Peripheral

Peripheral PN route is used for partial or supplemental parenteral nutrition - short term

Enteral Feeding Numbers

- 105-130 Kcal/kg/d - 20ish kcal/ounce - Protein 3.5-4 g/kg/d - Fat: 5-7 g/kg/d

Parenteral Feeding

- 90-100 Kcal/kg/day - lower because it does not have to be digested - Protein 2.7-4 g/kg/d - Fat: 1-3 g/kg/d Why is it less? No need to count for fecal loss nor TEF (thermic effect of food)

Very Low Birth Weight (VLBW)

- A body weight at birth of less than 3 pounds, 5 ounces (1500 grams) (1.5 kg)

Three Factors that allow babies to be discharged

- Cardio and lung function - Body temperature is stable - Nutrition is going to support their growth

Electrolyte Requirements

- Close monitoring is essential - K & Na is only added once renal status is normal & diuresis begins - Similar to FT infants, except Ca & P (↑ need for the preterm infant)

Nutritional assessment

- Daily weight and weekly height and head circumferences - Body composition - Assessment of feeding/tolerance - Wet diapers, stools - Blood nutrients, vitamins, electrolytes, function markers, urine N balance - Tonicity of abdomen - Close monitoring is essential

Nutrition Intervention in the NICU - Enteral or Parenteral?

- Decision made by physician - Need to initiate within 24 hours of life

Things to consider about premature digestion and nutrition

- Fetal nutrient stores are established within the last 3 mos of pregnancy - Premature infants have minimal caloric reserves - GI motility does not begin until 32-34 weeks gestation - Indications for parenteral nutrition vs. enteral nutrition

Nutrition in the NICU

- Infant outcomes depend on nutrition intervention, especially within the NICU - Preterm infants needs are based on weights (LBW, VLBW, ELBW, & Micropremies) - Critical to be aware and monitor biomarkers and anthropometrics closely to determine if outcomes are being met

Macronutrients Found in TPN - Fats/Lipids

- Lipid emulsion (Omegaven, SMOFlipid) - Soy oil, MCT oil, olive oil and fish oil - EFA: 0.5-1 g/kg/d

Growth Patterns of ELBW Hospitalized Preterm Infants Study - Methods

- Retrospective, Descriptive Design Study - N=35 ELBW infants (<1000gm)

Why would you choose PN?

- Various medical conditions - If bowel rest is needed - GI malformation - When desired outcome is reached return to EN and then PO

Equipment used to keep a premature baby alive and well

- Ventilator - Feeding Tube - Oxygen Saturation Monitor - IV Pump - Umbilical Artery Catheter - ECG and blood pressure monitor - Temperature Monitor - Overhead Warmer - Billirubin Lights

Low Birth Weight (LBW)

A body weight at birth of less than 5.5 pounds/2500 grams (2.5 kg)

Enteral Nutrition

A way to provide food through a tube placed in the nose, the stomach, or the small intestine - can feed breastmilk this way but if not they can use the formula

Growth Patterns of ELBW Hospitalized Preterm Infants Study - Discussions

Aggressive nutrition intervention needed to help infants reach proper gestational age weight goals

Macronutrients Found in TPN - Protein

Amino acid solution (4 kcal/g, TrophAmine + cysteine)

Jaundice Cause

Bilirubin soulubilized in liver and excreted through urine or stool, but these babies can't do that so bilirubin will build up and give the appearance of jaundice which is very common in pre mature infants, the bibilirubin lights break this up so it doesn't happens

Extremely Low Birth Weight (ELBW)

Birth weight below 2 lb 3 oz (1,000 grams) (1 kg)

Pea Pod

Bod Pod but for babies

Premature Infant

Born before 37 weeks, especially before 34 weeks

Parenteral Nutrition (PN) - Central

Central PN is delivered by a venous catheter with the tip in central location - long term - TPN

Macronutrients Found in TPN - Carbs

Dextrose Solution (3.4kcal/g)

Micropremies

Less than 750 grams (range of 800-500 grams)

Growth Patterns of ELBW Hospitalized Preterm Infants Study - Results

Number of days to reach full enteral feeding status negatively correlated to total growth velocity and birth weight

PEG Tube

Percutaneous endoscopic gastrostomy tube placed in the stomach wall that goes into the stomach

PEJ Tube

Percutaneous endoscopic jejunostomy tube placed on the abdominal wall that travels into the small intestine through the stomach

Neonatal Intensive Care Unit (NICU) Staff

•Neonatologist •PT/OT •Nursing Staff (Charge, Primary, Practitioner) •Respiratory Therapist •Pharmacist •Dietitian

Causes of a premature birth

•Poor nutrition and poor gestation weight gain •Genetics - if it runs in the family •Pregnancy-induced hypertension (Eclampsia) - detrimental for kidneys •Hypertension •Diabetes •Intrauterine infection •Smoking •Alcohol abuse •Maternal age young or advance - young mothers don't want to gain weight

Potential problems of the premature infants

•Undernutrition - fat comes in at the end •Poor growth - organs develop towards the end •Glucose instability •Hypoglycemia •GI malabsorption •Decreased GI motility •Respiratory problem •Heat loss •Infection •Inflammation