Neonatal nutrition and feeding

1. Neonatal Nutrition and
Feeding
Presenter: PRAK Viroth, BSN
Paediatric Nurse
BTB Provincial Referral Hospital
Battambang Provincial Referral Hospital
30th June, 2017

2. Prepared by: PRAK Viroth, BSN
By the end of this session the subjects will able to:
Describe neonatal daily energy requirements
Describe Essential nutrients
Describe daily fluid requirement (Neonate)
Describe daily electrolyte requirement
Describe how to feeds newborn
Objective

3. Prepared by: PRAK Viroth, BSN
Introduction
Water 70-80% of body mass
Fat accounts for 40% weight gain from the birth to
four months of age
Human milk contains higher fat to support growth,
especially brain
Newborn infant implications
Very vulnerable to low glucose
Higher need for fat intake
Neonatal Nutrition & Feeding
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4. Prepared by: PRAK Viroth, BSN
Introduction (cont’)
 Normal newborn will successful growth, with appropriate,
adequate feeds
 At-term infant:
-Physiology wt loss 5-8% Bwt within 7-10d of life
-Expected growth 1-1.5% bwt, at 10-15g/kg/d
 In preterm infant:
-Initially wt loss 8-20% Bwt within 10-21d
-Expected growth at 15-20g/kg/d
 Growth parameters
Wt daily
HC, and Infant growth records weekly
Neonatal Nutrition & Feeding
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5. Prepared by: PRAK Viroth, BSN
5
Energy daily requirements
Daily Energy Consumption is
- Basal energy expenditure (BEE) Plus
- Stress factor energy (SF) and plus
- Energy growth
 BEE is the amount of energy required to maintain the body's normal
metabolic Activities OR at Rest
BEE: 50-75kcal/kg/d
 E. growth: - Term-infant: 50-60kcal/kg/d
- Preterm-infant: 60-70kcal/kg/d
 SF energy : XX kcal in case needed
Critical ill child feeding
Adequate growth for healthy
infants:
-Term infant 100-120kcal/kg/d
-Preterm infant 120-
150kcal/kg/d

6. Prepared by: PRAK Viroth, BSN
SF % Energy added
Body T increases 12 each degree of T >37.5c
Cold stress 20
Sepsis 40-50
Injury 15-20
Major surgery 20-30
Burns 100
Critical ill child feeding
6 Some stress factor need extra energy

7. Essential nutrients
 Water/fluids and essential electrolyte
 Protein
 Mineral and vitamins
 Carbohydrates
 Fat
 Electrolytes
Critical ill child feeding
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8. Prepared by: PRAK Viroth, BSN
Day of life
Preterm
(ml/kg/day)
Term
(ml/kg/day)
Day 1 60 60
Day 2 90 80
Day 3 120 100
Day 4 140 – 150 120
Day 5 – Day 7 160 - 180 130 - 150
Fluid composition: Dextrose 10%
Daily fluid requirement (Neonate)

9. Prepared by: PRAK Viroth, BSN
Electrolytes Baseline requirement
Sodium (Na+) 2 - 4 mEq/kg/day (135-145 mmol)
Potassium (Kcl+) 1 - 2 mEq/kg/day (3.5-5.2mmol)
Calcium (elemental) or 0.1 - 0.5 mEq/kg/day (1.0 - 1.2 mmol)
Cal glunate/Calcium levulinate 50 -100 mg/kg/day
Glucose 4-8 mg/kg/min(2.5-4.8mmol)
Daily electrolyte requirement (Neonate)

10. Prepared by: PRAK Viroth, BSN
1-Bolus OGT feeds
Breast milk or Formula
Indication newborn infant <34 wks EGA, Sick infant, SGA, IUGR
When will feed?
Trophic feeds is a choice 12ml/kg/d
- Bwt< 1000g, 28-32wk second day of life
- Bwt 1000-1500g, 33wk fist day of life
2-Achievement of total enteral feed
• Decrease infusion and Increase enteral feeding gradually bases on
tolerance feeds
• Volume of feed increases 10-30ml/kg/d
Neonatal Nutrition & Feeding
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How to feeds

11. Prepared by: PRAK Viroth, BSN

12. Prepared by: PRAK Viroth, BSN
3-Converting OGT feeds to breast-fed or bottle fed
 Consider lip feeds when
Infant >34 wks of Gestational Age
OGT feeds well-tolerated at ¾ of total feeds
 Start one at lip feeds of total feeds per day
If lip feeds taken well tolerance, then gradually increase one per day to
reach haft of total frequently feeds, final is time that infant is completely lip
feeds
 Avoid advancing feed volume/number simultaneously
Neonatal Nutrition & Feeding
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How to feeds con’t

13. Prepared by: PRAK Viroth, BSN
Monitor feeding of gastric residuals
 Residuals with less than feeds volume, baby is general doing well, continue feeds
and monitor for other signs of sepsis, gastro-intestinal pathology, NEC
 Residuals is gradually increases, hold feeds, monitor closely, screen for signs of
sepsis, gastro-intestinal pathology, NEC
 Residuals is serious signs, hold feeds, reassess and screen for signs of sepsis,
gastro-intestinal pathology, NEC
 Residual with Abdomen distention and Blood in stool is signs of intestinal
pathology, stop feeds, immediately reassessment for NEC and sepsis and
treatment
 Metabolic acidosis, hold feeds and immediately reassessment for NEC and sepsis
Neonatal Nutrition & Feeding
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14. Prepared by: PRAK Viroth, BSN
Is (s)he stable?
 Fast breathing (RR>60/min)
 Severe chest in-drawing
 Apnea
 Requirement for oxygen
 Convulsions
 Fever (>37.50C) or low temperature (<35.50C)
 Abnormal state of consciousness
 Abdominal distension
If unstable, start intravenous (IV) fluids
Presence of any one
of these signs = UNSTABLE
Deciding the initial feeding method
Teaching Aids: ENC

15. Prepared by: PRAK Viroth, BSN
Feeding ability
Deciding the initial feeding method
Teaching Aids: ENC
អាយុរបស់គភ៌
(Gestational age)
ដំណ ើរបុ៉ិនប្បសប់ក្ន ុងការច៉ិញ្ច ឹមជីវិ ត
(Maturation of feeding skills)
វិ តីីស្រ្សក្ ក្ន ុងការច៉ិញ្ច ឹមារក្
(Initial feeding method)
< 28 សប្តក្ ហ៍
- ម៉ិនមានការប្បឹងជញ្ជ ក្់ (No proper sucking efforts)
- គ្មា នចលនាណ ោះណិៀន (No gut motility)
បញ្ច ូលណសរ៉ូម (Intravenous fluids)
ផ្ក្ល់តាមសុងប្ក្ពោះ (Gavage)
28-31 សប្តក្ ហ៍
- មានការល៉ូ លាស់ននការជញ្ជ ក្់ (Sucking develop but)
- ម៉ិនណចោះសប្មបសប្មួលក្ន ុងការជញ្ជ ក្់ ណលប ន៉ិង ដក្ដណងហើម
(No coordination between suck/swallow and breathing)
ផ្ក្ល់តាមសុងប្ក្ពោះ ន៉ិងមក្ងមាា លតាមស្រា បប្ ឬណព
ង (OG tube feeding and occasional prove with
spoon/palladia feeding)
32-34 សប្តក្ ហ៍
- ចាប់ណផ្ក្ើមបុ៉ិនប្បសប់ក្ន ុងការជញ្ជ ក្់ (Slightly mature sucking
pattern Coordination begins)
ផ្ក្ល់តាមស្រា បប្ ឬ តាមណពង (Feeding by
spoon/bottle/cup and if the baby is particular
wide awake you can prove with breastfeeding)
>34 សប្តក្ ហ៍
- មានលទ្ធភាពក្ន ុងការជញ្ជ ក្់ណៅ (Mature sucking pattern)
- មានលទ្ធភាពក្ន ុងការសប្មបសប្មួលរវាងការដក្ដណងហើម ន៉ិង
ការណលប (More coordination between breathing and
swallowing)
បំណៅណ ោះមាក្ យ (Breastfeeding)

16. វិ តីីស្រ្សក្ ក្ន ុងការបំណៅារក្
Spoon feeding
Gavage feeding
Teaching Aids: ENC

17. Baby on IV fluids
Assess for stability
If stable
Introduce small amounts
of intra-gastric tube feeds Baby on intra-
Gastric tube feeds
Monitor daily for signs
of feeding readiness
• Offer small amounts of
oral feeds by spoon/paladai
Make him suckle at breast
Put him on breast more
frequently
Baby on
breastfeeding
Continue breastfeeding
Baby on oral feeds
byspoon/paladai/bottle
• Put on breast
Continue till the baby is
on full spoon feeds
Teaching Aids: ENC

18. Prepared by: PRAK Viroth, BSN
Case Discussion
SOK was born at 35 weeks through vaginal delivery. His birth weight was
2.2kg. Next day, no feed since birth, he has referred to NCU. You plan to
feeds after medical procedure. His admission weight is 2 kg.
Q- What is nutrient that you prefer to feeds him?
A- EBM if available
Q-How do you feed him?
A- OGT
Q-How many ml/kg/d will you introduce?
A- 12ml/kg/d
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19. ស៉ូ មអរគុ៣០ ម៉ិថុនា ២០១៧