1. Nutrition in Premature Infants 3/17/10

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

9. 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.

10. 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

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

12. 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

13. Oxygen Tent/Hood

14. PICC line - Peripherally inserted central catheter

16. Nasogastric Feeding Tube

17. Tracheostomy and Ventilator

18. Kangaroo care

21. 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

22. 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

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

25. Table 8-3, p. 227

27. Estimating Energy Needs in Pediatrics

31. Interesting, right?
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