I N F A N T N U T I T I O N

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  • Regurgitation is the most prominent presenting symptom of reflux disease in young children. This is in contrast with older children and adults, for whom heartburn is the most common symptom.
  • Symptoms of infantile reflux esophagitis. A, Crying and irritability, commonly believed to be a sensitive indicator of esophagitis in infants, occur in most, but not all, such infants with esophagitis, but also in many infants without esophagitis. B, Arching (torso hyperextension) occurs in infants with esophagitis in a proportion similar to that of those with crying and irritability, but is far more specifically diagnostic for esophagitis than crying. C, Refusing feedings even when hungry occurs in slightly less than half of infants with esophagitis but occurs so infrequently in infants without esophagitis that it is fairly specific. D, Gagging and choking on feedings also occurs somewhat more frequently in infants with esophagitis than those without, although not significantly so [26]
  • Endoscopic view of normal esophageal mucosa and erosive esophagitis in two children. A, The smooth pink mucosa of the normal esophagus contrasts with B, The eroded, bleeding mucosa of the esophagus with severe esophagitis. Histologic esophagitis may be present even in endoscopically normal-appearing mucosa, and subtle changes including erythema, formerly considered to represent mild endoscopic esophagitis, have been found to be nonspecific, at least in children [69]. Histologic samples should be taken during endoscopic evaluation to increase the sensitivity and specificity of the findings. (From Orenstein [55]
  • I N F A N T N U T I T I O N

    1. 1. INFANT NUTRITION
    2. 2. <ul><li>Food and its presentation extremely important during baby’s first year </li></ul><ul><li>First year period of most rapid growth </li></ul><ul><li>Requirement 100kcal/kg/day . </li></ul><ul><li>Ideal infant diet is breast milk </li></ul><ul><ul><li>High nutrition containing easily digestible proteins, carbohydrates, vitamins, mineral, and water. </li></ul></ul><ul><ul><li>Formula is a poor substitute that carries health risks including higher rates of infection ; inadequate nutrition and obesity </li></ul></ul>
    3. 3. Nutritional Requirements of the Infant <ul><li>Iron -fortified cereal is usually started at about 6 months . </li></ul><ul><li>Vitamin K supplement is routinely given shortly after birth . </li></ul><ul><li>Infants should not be given an excess of vitamin A or D . </li></ul>
    4. 4. Bottle Feeding <ul><li>The infant should be cuddled and held in an upright position . </li></ul><ul><li>He should be burped. </li></ul><ul><li>Formulas are developed so that they are similar to human milk in nutrient and kcal values however the best formula is inferior to breast milk. </li></ul><ul><li>Synthetic milk made from soybeans may be used for sensitive or allergic infants . However long term health problems may arise from exclusive soy milk formula </li></ul>
    5. 5. Bottle Feeding <ul><li>Sterile water must be used to mix formula. </li></ul><ul><li>Infants under one year should not be given cow’s milk. </li></ul><ul><li>Consistent temperature should be used. </li></ul><ul><li>Once an infant has started a feeding any left over formula (or breast milk given in a bottle) must be discarded and not saved for the next feeding </li></ul><ul><li>Improper water to powered formula may lead to kidney problems and/or malnutrition </li></ul>
    6. 6. Supplementary Foods <ul><li>Cow’s milk under 1yr may cause: </li></ul><ul><li>Gastrointestinal blood loss </li></ul><ul><ul><li>Protein in cow’s milk and formula causing reaction on small bowel mucosa </li></ul></ul><ul><li>Iron deficiency anemia </li></ul><ul><ul><li>Low iron content and GI bleed </li></ul></ul><ul><li>Excessive Renal Solute Load </li></ul><ul><ul><li>Immature kidneys difficulty handling protein, phosphorous </li></ul></ul>
    7. 7. Burping a Baby
    8. 8. Regurgitation: most prominent presenting symptom ©Copyright Science Press Internet Services
    9. 9. Symptoms of infantile reflux esophagitis ©Copyright Science Press Internet Services
    10. 10. Normal esophageal mucosa erosive esophagitis
    11. 11. <ul><li>Methods </li></ul><ul><li>Infants with recurrent regurgitation and without other symptoms were fed alternately with thickened and non-thickened identical formula. </li></ul><ul><li>Documentation of GER episodes during the study was performed by simultaneous impedance measurement and pH monitoring. </li></ul>
    12. 12. <ul><li>Thickened feeding has a significant effect on the reduction of regurgitation frequency and amount in otherwise healthy infants. </li></ul><ul><li>This effect is caused by a reduction in the number of nonacid (pH >4) GER episodes, but also because of a decrease of mean reflux height reached in the esophagus. </li></ul><ul><li>However, the occurrence of acid GER is not reduced. </li></ul><ul><li>Thickening of formula feedings with carob bean gum is an efficient therapy for uncomplicated GER in infants. </li></ul>
    13. 13. NOVALAC AR For regurgitating infants
    14. 14. Thickens in the stomach, smooth in the feeding bottle <ul><li>thickened with specially treated corn starch (99% amylopectin) highly digestible </li></ul><ul><li>synergy between starch and casein  thick at gastric pH , but not at a neutral pH (viscosity 50 at pH 6.5 vs 200 Cp at pH =3.5) </li></ul><ul><li>homogeneous curd </li></ul>
    15. 15. Novalac AR viscosity In the stomach In the feeding bottle
    16. 16. Novalac AR does not slow down gastric emptying <ul><li>Medium chain triglycerids </li></ul><ul><li>Low osmolarity </li></ul><ul><li>Adapted caloric content </li></ul>
    17. 17. Why not using rice starch? <ul><li>less interesting thickening properties </li></ul><ul><li>20% amylose  low digestibility </li></ul>
    18. 18. NOVALAC AC For infants suffering of colics
    19. 19. What causes colics? <ul><li>colics are multifactorial : physiological, psychological </li></ul><ul><li>colics are related to gas production </li></ul><ul><li>Where does this gas come from? </li></ul><ul><li>Physiological lactase defficiency </li></ul>excess of lactose is fermented by colonic bacteria
    20. 20. Lactose content of different formulae Minimum amount authorized by EU regulation
    21. 21. What would be the best solution ? <ul><li>A FORMULA WITH </li></ul>The benefits of lactose at the duodenal level for minerals absorption Little or no lactose at the colon level to avoid its inconvenience
    22. 22. <ul><li>There is no point replacing lactose fermentation by other starch derivative fermentation : </li></ul><ul><li>the excess of lactose must be replaced by an easily & fully digestible starch derivatives </li></ul>BUT
    23. 23. STARCH DERIVATIVES SPECIAL TREATMENT TO REDUCE THE RESISTANT STARCH (AMYLOSE) CONTENT < 1% AMYLOSE GOOD DIGESTIBILITY = LESS OR NO FERMENTATION
    24. 24. For the comfort of colicky infants Novalac AC
    25. 25. NOVALAC IT... <ul><li> waters the stools </li></ul><ul><li> moistens the rectum </li></ul>… to improve the intestinal transit of infants.  increases the bacterial mass  does not delay the gastric emptying

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