1. FEEDING LOW BRITH WEIGHT/ PRETERM INFANTS RACHEL MUSOKE (UON) FLORENCE OGONGO (KNH) KNH/UON SYMPSIUM 10 TH JAN 2013 1

2. Definition of Preterm and LBW Low birth weight babies - birth weight less than 2500g regardless of gestation age while preterm babies are those born before 37 completed weeks of gestation. Subdivisions by gestation 32 – 36 weeks =Moderate or late preterm 28 - 31 weeks = Very preterm Below 28 weeks = Extremely preterm 2

3. MDGs & LBW/preterm feeding FOCUS ON MDG 1, 4 & 5 3

4. MDGs 1 & 4 Being born LBW/Preterm MDG 1 – Poverty & hunger – Higher risk of early growth retardation - stunting – Developmental delay (Feeding the developing brain) MDG 4 – Child survival – Increased risk of infection – Death 4

5. 5 MDG 5 Maternal health and nutrition Child nutrition starts at conception Maternal undernutrition: Low BMI, micronutrient deficiency predispose to Preterm birth Intrauterine growth restriction (IUGR)

6. Intervention to improve feeding can have significant impact on all these factors 6

7. Deficient stores in LBW Energy: glycogen and fat Protein: muscles Minerals & micronutrients: Calcium, iron, zinc etc Most accumulated in the last 10 weeks of pregnancy 7

8. 8 POSTNATAL NUTRITION Birth of LBW/preterm is a shock Physiological stressors: Temperature regulation Breathing Elimination Separation

9. Decisions to feed at birth Temp shock at birth require energy Reserve as fat 1000g baby : 100kcal/kg/day Term 1500-1800kcal/kg/day Reserve as glycogen Brain metabolism depend on glucose: brain 10% of body wt (adult 2%) need 6mg/kg/min (8.64g/kg/day 9

10. Decisions to feed at birth Lack of feeds delays lung maturation Hypoxia increase glucose utilisation Delayed feeding leads to gut atrophy & increase risk of infection Essential lipids Deficiency within 2-3 days of starvation Protein: no reserve Starvation: 1g/kg/day muscle breakdown 10

11. 11 NUTRITION: meeting the nutritional needs Simulate intrauterine growth Higher needs for: Growth Associated stress events Poor neurodevelopmental outcome if not adequately fed

12. Methods of feeding Parenteral: Total parenteral nutrition; requires a lot of expertise to include medical, nursing, pharmacy and laboratory monitoring. It is n ot available in our setting At KNH glucose & electrolytes – Risks: hyperglycaemia Enteral 12

13. 13 Glucose infusions: Complications Hyperglycaemia in the VLBW - Dehydration - Increased CO 2 production Risk of IVH & death Hypoglycaemia

14. Enteral feeding When do you start? Larger LBW/late preterm 32-36wks Well infant Size at birth Smaller LBW /early preterm <32wks Sick infant Respiratory distress 14

15. Assessing readiness to breastfeeding Weight is not a good indicator. Maturity should be used to assess readiness. Signs of readiness -Baby licks lips. -Rooting, sucking and swallowing reflexes established. 15

16. Important information for mothers Baby takes long on breasts Baby pauses frequently (resting) Baby may choke because of :- -Low muscle -Uncoordinated suckling Don’t feed too sleepy or fussy babies Avoid loud noises, bright lights, stroking, jiggling or talking to the baby during feeding attempts 16

17. 17 Enteral Feeding Advantages of early start: 1-2 days of birth Maturation of the gut Establish normal gut flora Reduce risk of late onset sepsis Enhance lung maturation Better weight gain Shorter hospital stay

18. What milk? Own mother’s milk - unmodified Own mother’s milk - fortified Preterm formula Parenteral 18

19. 19 WHAT MILK? “Human milk recommended basis of nutrition for the preterm infant” May be insufficient in some nutrient Human milk fortification What do you do if you have no fortifier?

20. Family Support Having a preterm/LBW baby is traumatic to parents Mother needs support to produce enough milk Children at home without a mother 20

21. Family support Care for mother The mother is very important for baby’s growth and survival. Mother should stay in hospital Have place for mothers to rest Provide adequate food and fluids for mothers Answer their questions patiently 21

22. . THANKS FOR LISTENING AND PARTICIPATING 22