Nutrition in Premature Infants 3/17/10

Generally, the more premature the baby, the more serious and long lasting are the health problems.

Preterm Infant: Infants born <37 weeks of gestation Low Birth Weight (LBW): Birth weight < 2500 grams (5½ lbs) Very Low Birth Weight (VLBW): Birth weight < 1500 grams (31/3 lbs) Extremely Low Birth Weight (ELBW): Birth weight <1000 grams (2¼ lbs) Small for Gestational Age (SGA): Infants born with growth parameters below the 10th percentile. Intrauterine Growth Retardation (IUGR): Failure to sustain intrauterine growth at expected rates; can be caused by placental insufficiency, infection, malnutrition, etc. – may or may not be born prematurely.

Infants at highest risk post discharge • VLBW and ELBW • Small for gestational age (SGA) and Intrauterine Growth Retardation (IUGR) • Primarily breastfeeding with no fortification • Infants on special formulas • Infants who require tube feedings at home • Infants on total parenteral nutrition (TPN) > 4 weeks during hospitalization or on parenteral nutrition after hospital discharge • Infants with gastrostomies or tracheotomies • Infants with slow weight gain prior to hospital discharge (gaining less than 15 gm/kg/day) • Infants with any of the following complications of prematurity: o Bronchopulmonary dysplasia/chronic lung disease o Chronic renal insufficiency o Congenital alimentary track anomalies o Short bowel syndrome o Cyanotic congenital heart disease o Osteopenia of prematurity o Anemia of prematurity o Severe neurological impairments o Drug and/or alcohol exposure in utero o Poverty or low socioeconomic status

Problems for premature infants temperature instability respiratory problems cardiovascular PDA, hypo/hypertension, low HR blood and metabolic gastrointestinal - NEC neurologic infections – decreased immunity

Care of premature babies may include: temperature-controlled beds monitoring - temperature, blood pressure, heart and breathing rates, and oxygen levels extra oxygen by a hood or by a ventilator mechanical ventilators intravenous (IV) fluids - IV placed in a hand, foot, or scalp umbilical catheter Peripherally inserted central catheter (PICC) x-rays medications Kangaroo care

Oxygen Tent/Hood

PICC line - Peripherally inserted central catheter

Nasogastric Feeding Tube

Tracheostomy and Ventilator

Kangaroo care

Infant Mortality Infant mortality is defined as death that occurs within the first year Major cause is low birthweight (< 2500 g) Other leading causes inlcude: 1) congenital malformations 2) preterm births 3) SIDS- sudden infant death syndrome

Combating Infant Mortality Factors associated with mortality: Social and economic status Access to health care Medical interventions Teenage pregnancy Availability of abortion services Failure to prevent preterm & LBW births

Premies have higher nutritional needs Due to: 1) inadequate nutrient stores 2) immature physiological systems 3)  rapid growth rate 4) medical complications/illnesses

Table 8-3, p. 227

Estimating Energy Needs in Pediatrics

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