The document discusses the importance of optimal nutrition for growth and brain development in preterm and low birth weight infants. It notes that the goal of nutrition should be to meet the growth rate of healthy fetuses of the same gestational age. This is critical as brain development is most rapid in the first 1000 days of life. For preterm infants, the brain requires high amounts of nutrients for growth and maturation. Inadequate nutrition can permanently impact brain development and neurodevelopmental outcomes. Human milk is recommended but often requires fortification to provide sufficient nutrients. Different fortification methods aim to optimize growth rates while avoiding risks like necrotizing enterocolitis. New fortifiers containing partially hydrolyzed proteins have shown improved growth outcomes over
NEW Dinner ANU 2023_Nutritional Interventions to Promote Brain Development an...Avianita3
The document discusses the importance of optimal nutrition for brain development in preterm and low birth weight infants. It notes that the brain grows most rapidly in the first 1000 days of life, making adequate nutrition critical during this period. For preterm infants in particular, nutrition must support both catch-up growth to match fetal growth trajectories as well as meet the high metabolic demands of the rapidly developing brain. The document reviews evidence that greater energy and nutrient intake during the initial weeks after birth is associated with larger brain volumes and better neurodevelopmental outcomes in preterm infants. It discusses the use and various methods of fortifying human milk to ensure preterm infants receive sufficient nutrients.
This document discusses best practices for the nutritional support of very low birth weight infants. It covers the following key points:
1) Early initiation of parenteral nutrition within 24 hours of life, including early administration of lipids and amino acids, in order to prevent nutritional deficits and support growth.
2) Rapid advancement of parenteral nutrition to provide adequate amino acids and calories as early as possible.
3) Establishing enteral feedings with human milk as the standard, given its benefits for growth, development and reducing morbidities in preterm infants.
4) Consistent nutritional monitoring and standardized practices to optimize growth outcomes for these high-risk infants.
This document discusses the benefits of breast milk and breastfeeding for infants in the NICU. It begins by outlining the objectives of increasing awareness of the importance of breast milk for preterm infants in the NICU and educating about its benefits. It then covers several key areas in less than 3 sentences each: the positive impact of breast milk on the gastrointestinal tract, lipid and fatty acid composition, anti-microbial components, short and long-term health benefits, limitations for preterm infants, and methods for fortification to meet their nutritional needs.
Agenda
The magnitude of the problem.
Risk factors of growth failure in infants and children.
Effect of good nutrition on growth.
The proper time for an intervention.
What are the management goals?
Important nutrients for optimal growth: Arginine & Vitamin K2.
The role of nutrition in children growth & healthAbdulmoein AlAgha
This document discusses the role of nutrition in children's growth and health. It covers several key points:
1) Nutrition plays a fundamental role in children's growth and development, especially during infancy when growth is most rapid. Adequate nutrition is needed to support appropriate growth, while malnutrition can stunt growth.
2) Several nutrients are particularly important for children's growth, including proteins, carbohydrates, fats, vitamins, minerals, and certain amino acids like arginine.
3) During periods of growth faltering, nutritional interventions can help restore growth and enable "catch-up growth" to achieve a child's full growth potential. Close monitoring of children's nutrition and growth is important
Protective Gut And Nutritional StratigiesPerwin Waly
Early and aggressive nutrition is recommended for preterm infants to support growth and development. This includes starting total parenteral nutrition within the first hours and minimal enteral feeding beginning on the first day using human milk when possible. Human milk provides important immune and nutritional benefits and is preferred over formula when available due to its protection against infection and promotion of development.
A Quasi Experimental Study to Evaluate the Effect of Prefeeding Oral Stimulat...ijtsrd
BackgroundPremature infants are defined as neonates born before 37 weeks gestational age a newborn infant, or neonate, is a baby under 28 days of age. During these first 28 days of life, the baby is at highest risk of dying. It is thus crucial that appropriate feeding and care are provided during this period, both to improve the infant’s chances of survival and to lay the foundations for a healthy life.Objective To evaluate the effect of prefeeding oral stimulation program on oral feeding skills among preterm infants.Material and Methods A quasi experimental approach and pretest posttest control group design was adopted. Purposive sampling technique was used to select 40 preterm infants i.e. 20 in each experimental and control group. In experimental group, intra and peri oral stimulation was given for 3 minutes and 2 minutes on pacifier, 2 times a day at 2 hours intervals for the duration of 4 days and in control group routine care was done. Data collection was done using oral feeding skills assessment scale. The collected data were analyzed by calculating frequency, percentage, mean, standard deviation, chi square, and -‘t’ test.Findings The results revealed that in pre test, there was no statistically significant p 0.05 difference in all levels of feeding skills among preterm infants between experimental and control group but in post test there was statistically significant p 0.05 difference found in mean score of all levels of feeding skills among preterm infants in experimental and control group. The difference between the pre test and post test mean scores of all levels of feeding skills among preterm infants in experimental group was statistically more significant in comparison with control group after provision of 4 days of prefeeding oral stimulation programme. Hence prefeeding oral stimulation programme was found to be effective in improving the oral feeding skills among preterm infants.Conclusion The effect of prefeeding oral stimulation program on oral feeding skills among preterm infants is effective and it helped in the improvement of preterm infants feeding skills. Priya Guleria | Mrs. Poonam Toor | Mrs. Davinder Kaur "A Quasi Experimental Study to Evaluate the Effect of Prefeeding Oral Stimulation Program on Oral Feeding Skills among Preterm Infants in Selected Hospitals, Punjab" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-6 , October 2022, URL: https://www.ijtsrd.com/papers/ijtsrd51975.pdf Paper URL: https://www.ijtsrd.com/medicine/nursing/51975/a-quasi-experimental-study-to-evaluate-the-effect-of-prefeeding-oral-stimulation-program-on-oral-feeding-skills-among-preterm-infants-in-selected-hospitals-punjab/priya-guleria
This document discusses enteral nutrition in preterm neonates. It notes that providing adequate nutrition to preterm infants is challenging due to immaturity of bowel function and inability to suck and swallow. While parenteral nutrition can provide nutrients, lack of enteral intake can impair gut development and function. The document reviews evidence from several Cochrane reviews on different approaches to enteral feeding in preterm infants, finding insufficient evidence to recommend one approach over others and calling for additional large randomized controlled trials to evaluate effects on important outcomes.
NEW Dinner ANU 2023_Nutritional Interventions to Promote Brain Development an...Avianita3
The document discusses the importance of optimal nutrition for brain development in preterm and low birth weight infants. It notes that the brain grows most rapidly in the first 1000 days of life, making adequate nutrition critical during this period. For preterm infants in particular, nutrition must support both catch-up growth to match fetal growth trajectories as well as meet the high metabolic demands of the rapidly developing brain. The document reviews evidence that greater energy and nutrient intake during the initial weeks after birth is associated with larger brain volumes and better neurodevelopmental outcomes in preterm infants. It discusses the use and various methods of fortifying human milk to ensure preterm infants receive sufficient nutrients.
This document discusses best practices for the nutritional support of very low birth weight infants. It covers the following key points:
1) Early initiation of parenteral nutrition within 24 hours of life, including early administration of lipids and amino acids, in order to prevent nutritional deficits and support growth.
2) Rapid advancement of parenteral nutrition to provide adequate amino acids and calories as early as possible.
3) Establishing enteral feedings with human milk as the standard, given its benefits for growth, development and reducing morbidities in preterm infants.
4) Consistent nutritional monitoring and standardized practices to optimize growth outcomes for these high-risk infants.
This document discusses the benefits of breast milk and breastfeeding for infants in the NICU. It begins by outlining the objectives of increasing awareness of the importance of breast milk for preterm infants in the NICU and educating about its benefits. It then covers several key areas in less than 3 sentences each: the positive impact of breast milk on the gastrointestinal tract, lipid and fatty acid composition, anti-microbial components, short and long-term health benefits, limitations for preterm infants, and methods for fortification to meet their nutritional needs.
Agenda
The magnitude of the problem.
Risk factors of growth failure in infants and children.
Effect of good nutrition on growth.
The proper time for an intervention.
What are the management goals?
Important nutrients for optimal growth: Arginine & Vitamin K2.
The role of nutrition in children growth & healthAbdulmoein AlAgha
This document discusses the role of nutrition in children's growth and health. It covers several key points:
1) Nutrition plays a fundamental role in children's growth and development, especially during infancy when growth is most rapid. Adequate nutrition is needed to support appropriate growth, while malnutrition can stunt growth.
2) Several nutrients are particularly important for children's growth, including proteins, carbohydrates, fats, vitamins, minerals, and certain amino acids like arginine.
3) During periods of growth faltering, nutritional interventions can help restore growth and enable "catch-up growth" to achieve a child's full growth potential. Close monitoring of children's nutrition and growth is important
Protective Gut And Nutritional StratigiesPerwin Waly
Early and aggressive nutrition is recommended for preterm infants to support growth and development. This includes starting total parenteral nutrition within the first hours and minimal enteral feeding beginning on the first day using human milk when possible. Human milk provides important immune and nutritional benefits and is preferred over formula when available due to its protection against infection and promotion of development.
A Quasi Experimental Study to Evaluate the Effect of Prefeeding Oral Stimulat...ijtsrd
BackgroundPremature infants are defined as neonates born before 37 weeks gestational age a newborn infant, or neonate, is a baby under 28 days of age. During these first 28 days of life, the baby is at highest risk of dying. It is thus crucial that appropriate feeding and care are provided during this period, both to improve the infant’s chances of survival and to lay the foundations for a healthy life.Objective To evaluate the effect of prefeeding oral stimulation program on oral feeding skills among preterm infants.Material and Methods A quasi experimental approach and pretest posttest control group design was adopted. Purposive sampling technique was used to select 40 preterm infants i.e. 20 in each experimental and control group. In experimental group, intra and peri oral stimulation was given for 3 minutes and 2 minutes on pacifier, 2 times a day at 2 hours intervals for the duration of 4 days and in control group routine care was done. Data collection was done using oral feeding skills assessment scale. The collected data were analyzed by calculating frequency, percentage, mean, standard deviation, chi square, and -‘t’ test.Findings The results revealed that in pre test, there was no statistically significant p 0.05 difference in all levels of feeding skills among preterm infants between experimental and control group but in post test there was statistically significant p 0.05 difference found in mean score of all levels of feeding skills among preterm infants in experimental and control group. The difference between the pre test and post test mean scores of all levels of feeding skills among preterm infants in experimental group was statistically more significant in comparison with control group after provision of 4 days of prefeeding oral stimulation programme. Hence prefeeding oral stimulation programme was found to be effective in improving the oral feeding skills among preterm infants.Conclusion The effect of prefeeding oral stimulation program on oral feeding skills among preterm infants is effective and it helped in the improvement of preterm infants feeding skills. Priya Guleria | Mrs. Poonam Toor | Mrs. Davinder Kaur "A Quasi Experimental Study to Evaluate the Effect of Prefeeding Oral Stimulation Program on Oral Feeding Skills among Preterm Infants in Selected Hospitals, Punjab" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-6 , October 2022, URL: https://www.ijtsrd.com/papers/ijtsrd51975.pdf Paper URL: https://www.ijtsrd.com/medicine/nursing/51975/a-quasi-experimental-study-to-evaluate-the-effect-of-prefeeding-oral-stimulation-program-on-oral-feeding-skills-among-preterm-infants-in-selected-hospitals-punjab/priya-guleria
This document discusses enteral nutrition in preterm neonates. It notes that providing adequate nutrition to preterm infants is challenging due to immaturity of bowel function and inability to suck and swallow. While parenteral nutrition can provide nutrients, lack of enteral intake can impair gut development and function. The document reviews evidence from several Cochrane reviews on different approaches to enteral feeding in preterm infants, finding insufficient evidence to recommend one approach over others and calling for additional large randomized controlled trials to evaluate effects on important outcomes.
EAT RIGHT IN PREGNANCY Dr Renu Chawla , Dr Sharda Jain Lifecare Centre
The document discusses the importance of nutrition, especially adequate intake of omega-3 fatty acids like DHA, during pregnancy and the first 1000 days of life. It notes that this period is critical for growth and development. The fetus relies on maternal sources of DHA, which is transferred through the placenta and accumulated rapidly in the brain and eyes during the third trimester. Insufficient DHA intake during pregnancy and breastfeeding can impact the health, development, and future disease risk of both mother and child.
This document summarizes a conference on maternal nutrition and infant feeding practices. The conference was organized to address gaps in understanding how maternal nutrition affects fetal growth, birth outcomes, and infant feeding practices. It covered 3 topics: 1) the effect of maternal nutrition and the placenta on fetal development and birth outcomes, 2) feeding preterm infants, and 3) feeding full-term infants. For topic 1, presentations showed the placenta's role in nutrient transport affects fetal growth and discussed the importance of nutrients like folate and calcium. Research priorities identified included studying nutrient interactions and their effects on different populations. Topic 2 noted a lack of evidence on best practices for preterm infant nutrition. Topic 3 discussed ensuring evidence on human milk
Nutritional planning for growth & development of preterm neonatesArnab Nandy
This document discusses nutritional planning for pre-term neonates. It notes that pre-term neonates have unique nutritional needs due to higher rates of growth and metabolism. These include higher protein, energy, water, electrolyte and fatty acid requirements compared to term infants. The document outlines strategies for nutritional support including parenteral and enteral feeding, the importance of breastmilk and fortification, monitoring growth, and educating families. The overall aim is to ensure normal growth and neurodevelopmental outcomes for pre-term infants.
Proposal Development on Organizing Health Promotion Education Communication T...Mohammad Aslam Shaiekh
Proposal Development on Organizing Health Promotion Education Communication Training Program on Maternal Infant and Young Child Nutrition Practices in Pumdi, Pokhara Municipality 22.
total parental nutrition in neonate guidlinemandar haval
This document discusses total parenteral nutrition (TPN) in neonates. It begins by describing the history and development of TPN, from early experiments in the 19th century to its modern use. It then discusses appropriate use of TPN in neonates, noting specific conditions where enteral feeding is not possible. The document provides details on components of TPN solutions, including fluids, energy and carbohydrate requirements, protein needs, and lipids. It stresses the importance of meticulous care, monitoring, and early transition to enteral feeding to minimize complications of TPN therapy in neonates.
Malnutrition is a major health problem for infants and young children worldwide. Inadequate nutrition during the first two years of life can negatively impact growth, health, and development. The document discusses the importance of breastfeeding and complementary feeding. Exclusive breastfeeding for the first six months meets infant nutritional needs and protects against illness. After six months, other foods should be introduced along with continued breastfeeding to two years or beyond. Improper complementary feeding can impair growth. The study aims to examine awareness of breastfeeding and complementary feeding practices in urban and rural Bangladeshi communities and how malnutrition impacts infection rates in children.
Nutritional management for high risk neonateOlaAlomoush
This document discusses nutritional management for high risk newborns. It outlines that parenteral nutrition (PN) is important for newborns unable to tolerate enteral feeding. PN provides complete nutrition through intravenous administration and should be started within 8 hours of birth. Close monitoring of PN is required to watch for complications like infection or liver issues. Transitioning to enteral nutrition involves gradually increasing milk feeds while decreasing PN. Enteral nutrition with breast milk is preferred when possible due to benefits like improved gastrointestinal function. Proper nutrition management in the NICU can help yield the best outcomes for high risk newborns.
This document discusses nutritional requirements from infancy to old age. It covers general considerations around human nutrient needs and recommended dietary allowances. Specific sections address energy requirements, protein requirements determined through nitrogen balance studies, fat intake recommendations, mineral needs, trace element requirements determined through balance or depletion/repletion studies, and vitamin intake levels established to prevent deficiency diseases. Guidelines are provided for requirements during pregnancy, lactation, and for infants and children based on growth and tissue demands.
Comparison of prolonged low volume milk and routine volume milk onamir mohammad Armanian
This study compared outcomes for very low birth weight neonates who were fed using either a prolonged low volume milk strategy (20 mL/kg/day for 7 days before increasing) or a routine advancing volume strategy (increasing volumes by 20 mL/kg/day). The study found that the incidence of necrotizing enterocolitis was significantly lower in infants fed with the prolonged low volume strategy compared to those fed with advancing volumes. However, infants fed with advancing volumes reached full enteral feeding volumes sooner. Overall hospital stay times and weight gain at 30 days were similar between the two groups. The study suggests prolonged low volume feeding may help reduce NEC risk in very low birth weight neonates.
This document provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
This document discusses the benefits of breastfeeding for both children and mothers. It summarizes that breastfeeding provides optimal nutrition for infant development, protects against infectious diseases, and lowers the risk of obesity and chronic diseases. Breastfeeding also benefits mothers by reducing risks of certain cancers, diabetes, and cardiovascular diseases. The economic analysis finds that increased breastfeeding rates could save billions of dollars annually in healthcare costs.
CLINICAL BRIEF
A Quality Improvement Initiative: Improving Exclusive
Breastfeeding Rates of Preterm Neonates
Amanpreet Sethi1 & Meena Joshi1 & Anu Thukral1 & Jagjit Singh Dalal1 &
Ashok Kumar Deorari1
Received: 7 October 2016 /Accepted: 31 January 2017 /Published online: 24 February 2017
# Dr. K C Chaudhuri Foundation 2017
Abstract This study is a single center quality improve-
ment (QI) initiative in a tertiary care neonatal intensive
care unit which was done with an objective to increase
the proportion of neonates receiving mother’s own milk
(at postnatal age of 7 d) from the current rate of 12.5%
to 30% over a period of six weeks. Additional objec-
tives were to evaluate the proportion of mothers’ ex-
pressing breast milk within 3 h of birth, on day one
and three and the amount of expressed breast milk
(EBM) on day one and day seven. A team was formu-
lated to evaluate the reasons for inadequate breast milk
expression and to plan the steps for promoting the
same. Comprehensive postnatal breast feeding counsel-
ing (CPNC) to promote early breast milk expression
was initiated soon after the birth of a preterm neonate.
CPNC was done for next fifteen mothers and their
breast feeding support was streamlined. The effect of
CPNC and teamwork was discussed amongst the team
members every day and adjustments incorporated (Plan-
Do-Study-Act cycle). The proportion of neonates receiv-
ing mother’s only milk (MOM) on day 7 increased to
80% (12/15) after 4 wk of QI. Thus, a simple and
feasible CPNC package lead to improved breast milk
output in mothers.
Keywords Breast milk . Neonate . Quality improvement
Introduction
Exclusive breastfeeding for six months is the most effective
preventive strategy for under-five mortality [1]. Host resis-
tance factors are abundant in fresh breast milk and when prop-
erly collected and stored, it provides the highest quality of
anti-infective properties. [2, 3] However, for various reasons,
mothers of these neonates face multiple challenges in estab-
lishing and maintaining an adequate supply of milk, this phe-
nomenon being more common in preterm neonates [4, 5]. The
gap in current evidence based implementation is the strategy
to reduce the time to first milk expression and to increase
frequency of expression and night time expression of milk in
these mothers. It is also known that mothers of extremely
preterm neonates should be taught early and effective milk
expression techniques [6].
The authors identified problem of delayed breast milk ex-
pression by mothers of preterm neonates whose babies were
admitted in the neonatal intensive care unit (NICU). The fre-
quency of milk expression in these mothers was limited to two
to three times in the entire day leading to most neonates re-
ceiving predominant formula feed for the first one week.
In view of the existing evidence and the identified problem,
the authors formulated an aim to increase the proportion of
breast milk intake in the admitted preterm neonates o.
This quality improvement study conducted in a neonatal intensive care unit aimed to increase exclusive breastfeeding rates of preterm neonates from 12.5% to 30% over 6 weeks. The team implemented comprehensive postnatal breastfeeding counseling for mothers, which focused on early and frequent milk expression. This led to improved breast milk output, with the proportion of neonates receiving mother's own milk increasing from 12.5% to 80%. Sustaining efforts like allocating breast pumps and celebrating successes helped maintain high exclusive breastfeeding rates of over 80% in follow up periods. The simple counseling approach improved breastfeeding outcomes without external funding or additional staffing.
National Guidelines and RecommendationsTim Smitley
This document discusses recommendations from various national organizations for the use of kangaroo care. It begins by reviewing the origins of kangaroo care and discusses how evidence of its benefits has led professional organizations to publish guidelines supporting its use. Some key recommendations mentioned include the WHO, AAP, CDC, and ACOG guidelines supporting kangaroo care for benefits like improved breastfeeding rates, decreased infant mortality and morbidity, and pain and stress reduction. The document then reviews studies demonstrating these benefits. It concludes by discussing how following kangaroo care guidelines can help institutions support parents and improve infant outcomes.
This randomized controlled trial evaluated the effects of high-dose docosahexaenoic acid (DHA) supplementation on neurodevelopmental outcomes in preterm infants. The study found that:
1) Overall, high-DHA supplementation did not significantly improve Bayley Mental Development Index (MDI) scores at 18 months corrected age compared to standard DHA supplementation.
2) However, girls who received high-DHA supplementation had significantly higher MDI scores than girls who received standard supplementation.
3) Infants born weighing less than 1250g who received high-DHA supplementation tended to have higher MDI scores, but the difference was not statistically significant after adjustment for confounders.
This document discusses body composition and fat distribution in the human body. It explains that body fat is stored primarily in adipose tissue, which can be subcutaneous or visceral. Visceral fat around the organs increases health risks more than subcutaneous fat. The document also covers nutritional requirements for different groups, including pregnant and lactating women, infants, and children. It emphasizes the importance of breastfeeding and provides guidelines for optimal breastfeeding and complementary feeding practices.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
EAT RIGHT IN PREGNANCY Dr Renu Chawla , Dr Sharda Jain Lifecare Centre
The document discusses the importance of nutrition, especially adequate intake of omega-3 fatty acids like DHA, during pregnancy and the first 1000 days of life. It notes that this period is critical for growth and development. The fetus relies on maternal sources of DHA, which is transferred through the placenta and accumulated rapidly in the brain and eyes during the third trimester. Insufficient DHA intake during pregnancy and breastfeeding can impact the health, development, and future disease risk of both mother and child.
This document summarizes a conference on maternal nutrition and infant feeding practices. The conference was organized to address gaps in understanding how maternal nutrition affects fetal growth, birth outcomes, and infant feeding practices. It covered 3 topics: 1) the effect of maternal nutrition and the placenta on fetal development and birth outcomes, 2) feeding preterm infants, and 3) feeding full-term infants. For topic 1, presentations showed the placenta's role in nutrient transport affects fetal growth and discussed the importance of nutrients like folate and calcium. Research priorities identified included studying nutrient interactions and their effects on different populations. Topic 2 noted a lack of evidence on best practices for preterm infant nutrition. Topic 3 discussed ensuring evidence on human milk
Nutritional planning for growth & development of preterm neonatesArnab Nandy
This document discusses nutritional planning for pre-term neonates. It notes that pre-term neonates have unique nutritional needs due to higher rates of growth and metabolism. These include higher protein, energy, water, electrolyte and fatty acid requirements compared to term infants. The document outlines strategies for nutritional support including parenteral and enteral feeding, the importance of breastmilk and fortification, monitoring growth, and educating families. The overall aim is to ensure normal growth and neurodevelopmental outcomes for pre-term infants.
Proposal Development on Organizing Health Promotion Education Communication T...Mohammad Aslam Shaiekh
Proposal Development on Organizing Health Promotion Education Communication Training Program on Maternal Infant and Young Child Nutrition Practices in Pumdi, Pokhara Municipality 22.
total parental nutrition in neonate guidlinemandar haval
This document discusses total parenteral nutrition (TPN) in neonates. It begins by describing the history and development of TPN, from early experiments in the 19th century to its modern use. It then discusses appropriate use of TPN in neonates, noting specific conditions where enteral feeding is not possible. The document provides details on components of TPN solutions, including fluids, energy and carbohydrate requirements, protein needs, and lipids. It stresses the importance of meticulous care, monitoring, and early transition to enteral feeding to minimize complications of TPN therapy in neonates.
Malnutrition is a major health problem for infants and young children worldwide. Inadequate nutrition during the first two years of life can negatively impact growth, health, and development. The document discusses the importance of breastfeeding and complementary feeding. Exclusive breastfeeding for the first six months meets infant nutritional needs and protects against illness. After six months, other foods should be introduced along with continued breastfeeding to two years or beyond. Improper complementary feeding can impair growth. The study aims to examine awareness of breastfeeding and complementary feeding practices in urban and rural Bangladeshi communities and how malnutrition impacts infection rates in children.
Nutritional management for high risk neonateOlaAlomoush
This document discusses nutritional management for high risk newborns. It outlines that parenteral nutrition (PN) is important for newborns unable to tolerate enteral feeding. PN provides complete nutrition through intravenous administration and should be started within 8 hours of birth. Close monitoring of PN is required to watch for complications like infection or liver issues. Transitioning to enteral nutrition involves gradually increasing milk feeds while decreasing PN. Enteral nutrition with breast milk is preferred when possible due to benefits like improved gastrointestinal function. Proper nutrition management in the NICU can help yield the best outcomes for high risk newborns.
This document discusses nutritional requirements from infancy to old age. It covers general considerations around human nutrient needs and recommended dietary allowances. Specific sections address energy requirements, protein requirements determined through nitrogen balance studies, fat intake recommendations, mineral needs, trace element requirements determined through balance or depletion/repletion studies, and vitamin intake levels established to prevent deficiency diseases. Guidelines are provided for requirements during pregnancy, lactation, and for infants and children based on growth and tissue demands.
Comparison of prolonged low volume milk and routine volume milk onamir mohammad Armanian
This study compared outcomes for very low birth weight neonates who were fed using either a prolonged low volume milk strategy (20 mL/kg/day for 7 days before increasing) or a routine advancing volume strategy (increasing volumes by 20 mL/kg/day). The study found that the incidence of necrotizing enterocolitis was significantly lower in infants fed with the prolonged low volume strategy compared to those fed with advancing volumes. However, infants fed with advancing volumes reached full enteral feeding volumes sooner. Overall hospital stay times and weight gain at 30 days were similar between the two groups. The study suggests prolonged low volume feeding may help reduce NEC risk in very low birth weight neonates.
This document provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
This document discusses the benefits of breastfeeding for both children and mothers. It summarizes that breastfeeding provides optimal nutrition for infant development, protects against infectious diseases, and lowers the risk of obesity and chronic diseases. Breastfeeding also benefits mothers by reducing risks of certain cancers, diabetes, and cardiovascular diseases. The economic analysis finds that increased breastfeeding rates could save billions of dollars annually in healthcare costs.
CLINICAL BRIEF
A Quality Improvement Initiative: Improving Exclusive
Breastfeeding Rates of Preterm Neonates
Amanpreet Sethi1 & Meena Joshi1 & Anu Thukral1 & Jagjit Singh Dalal1 &
Ashok Kumar Deorari1
Received: 7 October 2016 /Accepted: 31 January 2017 /Published online: 24 February 2017
# Dr. K C Chaudhuri Foundation 2017
Abstract This study is a single center quality improve-
ment (QI) initiative in a tertiary care neonatal intensive
care unit which was done with an objective to increase
the proportion of neonates receiving mother’s own milk
(at postnatal age of 7 d) from the current rate of 12.5%
to 30% over a period of six weeks. Additional objec-
tives were to evaluate the proportion of mothers’ ex-
pressing breast milk within 3 h of birth, on day one
and three and the amount of expressed breast milk
(EBM) on day one and day seven. A team was formu-
lated to evaluate the reasons for inadequate breast milk
expression and to plan the steps for promoting the
same. Comprehensive postnatal breast feeding counsel-
ing (CPNC) to promote early breast milk expression
was initiated soon after the birth of a preterm neonate.
CPNC was done for next fifteen mothers and their
breast feeding support was streamlined. The effect of
CPNC and teamwork was discussed amongst the team
members every day and adjustments incorporated (Plan-
Do-Study-Act cycle). The proportion of neonates receiv-
ing mother’s only milk (MOM) on day 7 increased to
80% (12/15) after 4 wk of QI. Thus, a simple and
feasible CPNC package lead to improved breast milk
output in mothers.
Keywords Breast milk . Neonate . Quality improvement
Introduction
Exclusive breastfeeding for six months is the most effective
preventive strategy for under-five mortality [1]. Host resis-
tance factors are abundant in fresh breast milk and when prop-
erly collected and stored, it provides the highest quality of
anti-infective properties. [2, 3] However, for various reasons,
mothers of these neonates face multiple challenges in estab-
lishing and maintaining an adequate supply of milk, this phe-
nomenon being more common in preterm neonates [4, 5]. The
gap in current evidence based implementation is the strategy
to reduce the time to first milk expression and to increase
frequency of expression and night time expression of milk in
these mothers. It is also known that mothers of extremely
preterm neonates should be taught early and effective milk
expression techniques [6].
The authors identified problem of delayed breast milk ex-
pression by mothers of preterm neonates whose babies were
admitted in the neonatal intensive care unit (NICU). The fre-
quency of milk expression in these mothers was limited to two
to three times in the entire day leading to most neonates re-
ceiving predominant formula feed for the first one week.
In view of the existing evidence and the identified problem,
the authors formulated an aim to increase the proportion of
breast milk intake in the admitted preterm neonates o.
This quality improvement study conducted in a neonatal intensive care unit aimed to increase exclusive breastfeeding rates of preterm neonates from 12.5% to 30% over 6 weeks. The team implemented comprehensive postnatal breastfeeding counseling for mothers, which focused on early and frequent milk expression. This led to improved breast milk output, with the proportion of neonates receiving mother's own milk increasing from 12.5% to 80%. Sustaining efforts like allocating breast pumps and celebrating successes helped maintain high exclusive breastfeeding rates of over 80% in follow up periods. The simple counseling approach improved breastfeeding outcomes without external funding or additional staffing.
National Guidelines and RecommendationsTim Smitley
This document discusses recommendations from various national organizations for the use of kangaroo care. It begins by reviewing the origins of kangaroo care and discusses how evidence of its benefits has led professional organizations to publish guidelines supporting its use. Some key recommendations mentioned include the WHO, AAP, CDC, and ACOG guidelines supporting kangaroo care for benefits like improved breastfeeding rates, decreased infant mortality and morbidity, and pain and stress reduction. The document then reviews studies demonstrating these benefits. It concludes by discussing how following kangaroo care guidelines can help institutions support parents and improve infant outcomes.
This randomized controlled trial evaluated the effects of high-dose docosahexaenoic acid (DHA) supplementation on neurodevelopmental outcomes in preterm infants. The study found that:
1) Overall, high-DHA supplementation did not significantly improve Bayley Mental Development Index (MDI) scores at 18 months corrected age compared to standard DHA supplementation.
2) However, girls who received high-DHA supplementation had significantly higher MDI scores than girls who received standard supplementation.
3) Infants born weighing less than 1250g who received high-DHA supplementation tended to have higher MDI scores, but the difference was not statistically significant after adjustment for confounders.
This document discusses body composition and fat distribution in the human body. It explains that body fat is stored primarily in adipose tissue, which can be subcutaneous or visceral. Visceral fat around the organs increases health risks more than subcutaneous fat. The document also covers nutritional requirements for different groups, including pregnant and lactating women, infants, and children. It emphasizes the importance of breastfeeding and provides guidelines for optimal breastfeeding and complementary feeding practices.
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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Prof
1. Nutritional Support to Optimize
Growth and Brain Development of
Premature & Low Birth Weight Infants
Rinawati Rohsiswatmo
2.
3.
4.
5. The Goal of Growth in Preterm Infants
● From return to birth weight through discharge,
the goal of enteral nutritional management should
include requirements for catch-up growth and
should be set for weight gain >18 g/kg/ day and
HC >0.9 cm/week
● This growth rate was associated with better
neurodevelopmental and growth outcomes
● If the growth rate falters → focus on protein
content and the protein/energy ratio (P/E ratio)
William WH Jr. Optimizing Nutrition of The Preterm Infant. Zhongguo Dang Dai Er Ke Za Zhi. 2017 Jan 25;19(1):1–21.
Su BH. Optimizing Nutrition in Preterm infants. Pediatrics & Neonatology. 2014 Feb 1;55(1):5-13.
The goal of nutrition of the preterm infant is to meet the growth rate of the healthy fetus
of the same gestational age and to produce the same body composition of the healthy
fetus in terms of organ growth,tissue components, cell number and structure
6. A Structural MRI Study of Human Brain Development from Birth to 2 Years. J Neurosci. November 19, 2008 • 28(47):12176 –12182.
Early Childhood Brain Development. Todd Twogood, MD, FAAP
(TBV)
Brain Development is Most Rapid in
The First 1000 Days of Life
IntrauterineGrowth in The Last Trimester TBV at 2 years is ~ 83% of adult volume
50 cm
800 g 30 cm 75 g
5600 mg
BW
3500 g
375 g
Body calcium
BL Brain Weight
28000 mg
25 40 25 40 25 40
25 40
7. The Importance of Nutrition for
Brain Development
• In preterm infant, the brain is the most metabolically demanding organ and
consumes the largest amount of energy and nutrients for its function and
programmed growth and maturation
• The number of cell replication cycles in the CNS is decreased in malnutrition →
thereby reducing total brain DNA and leading to reduction in the connections
between neurons
• Alterations in dietary precursors → may affect neurotransmitter levels
The resulting CNS impairment, caused by these nutrient deficiencies,involves motor and cognitive
development and social abilities
Skinner AM, Narchi H. Preterm nutrition and neurodevelopmental outcomes. World J Methodol. 2021 Nov 20;11(6):278-293.
8. The Importance of Nutrition for Brain Development
● Inadequate nutrition during the critical periods of brain development alters the
growth trajectory of the brain and can have permanent negative consequences
● The most critical period of brain growth and development for humans
corresponds to the 3rd trimester of pregnancy and VLBW infants
○ Infantsborn early in the 3rd
trimester miss the placental transfer of nutrientswhich would
create stores for use in the postnatal period
Better linear growth and early gains in fat-free body mass have been found to be associated with improved
neurodevelopment inVLBW preterm infants
Arslanoglu S, Boquien CY, King C, Lamireau D, Tonetto P, Barnett D, et al. Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk
Fortification.
Front Pediatr. 2019;7:76.
9. • 49 preterm neonates → 3 serial MRI scans
• Nutritional intake from age 1-14 days was monitored & clinical factors were collected
• Greater energy and lipid intake predicted increased total brain and basal nuclei volumes over the course of
neonatal care to term-equivalentage
• The association of ventilation duration with smaller brain volumes was attenuated by higher energy intake.
Brain growth predicted psychomotor outcome at 18 months’ corrected age
• Conclusions:In preterm neonates,greater energy and enteral feeding during the first 2 weeks of life
predicted more robustbrain growth and accelerated white matter maturation
• The long-lasting effect of early nutrition on neurodevelopmentmay be mediated by enhanced brain growth
• Optimizing nutrition in preterm neonates may representa potential avenue to mitigate the adverse brain
health consequences of critical illness
Schneider J, Fischer Fumeaux CJ, Duerden EG, Guo T, Foong J, Graz MB, Hagmann P, et al. Nutrient Intake in the First Two Weeks of Life and Brain Growth in Preterm Neonates. Pediatrics. 2018 Mar;141(3):e2
0172169.
11. Human Milk Fortification
● Unfortified HM doesn't provide sufficient amounts of nutrients to tiny preterm infants when
fed at usual feeding volumes
● To prevent EUGR which is associated with poor neurocognitive outcome and to avoid
specific nutrient deficiencies, nutrient fortification of HM is necessary
Arslanoglu S, Boquien CY, King C, Lamireau D, Tonetto P, Barnett D, et al. Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk
Fortification.
Front Pediatr. 2019;7:76.
WHO recommendations for care of the preterm or low birth weight infant. Geneva: World Health Organization; 2022.
12. Human Milk Fortification
● HMF (Human Milk Fortifier) may be used only when the infant reaches a
feed of 100 mL/kg/day
○ One sachet (1 g) of HMF may be used for 20 or 25 mL of expressed
or donor pasteurized human milk, depending on the product
guideline
○ The calorie requirement of a preterm infant is usually met with the
addition of HMF, which provides about 4 g/kg/day of protein and
3.5–4 g/kg/day of fats
Kumar RK, Singhal A, Vaidya U, Banerjee S, Anwar F, Rao S. Optimizing Nutrition in Preterm Low Birth Weight Infants—Consensus Summary. Front Nutr 2017;4
Thoene MK, Anderson-Berry AL. A review of Best Evidenced-based Enteral and Parenteral Nutrition Support Practices for Preterm Infants Born <1,500 Grams. Pediatric Medicine. 2018 Oct 23];1(0).
13. Formula Composition (per 100 mL)
Standard
Formula
Standard
Preterm
Formula
Amino Acid
Formula
HMF
(per 4 sachet)
Energy (kcal) 67 81 67 14
Protein (g) 1.45 2.3 1.8 1.1
Calcium (mg) 35 99 65.6 90 (42)*
Phosphorus (mg) 29 54 47.1 50 (23)*
Magnesium (mg) 5.2 8.0 7.0 1
Vitamin D (ug) 1.0 2 1.2 3.75
Zinc (mg) 0.5 1.6 0.73 0.72
*Premature human milk (3rd week)
14. Types of Human Milk Fortifier (HMF)
Multi-Nutrient Fortifiers
• Contain protein, energy,minerals, trace elements,vitamins, and electrolytes
Single-Nutrient Supplements
• Contain protein, lipids, or carbohydrates
Arslanoglu S, Boquien CY, King C, Lamireau D, Tonetto P, Barnett D, et al. Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk
Fortification. Front Pediatr. 2019 Mar 22;7:76.
There are a number of products available for fortifying human milk for preterm babies
which differ by the origin of milk used (bovine, human or donkey), and by nutrient
composition (multi-nutrient fortifiers or supplements of protein, lipids, carbohydrates)
15. The Fortification Methods
Arslanoglu S, Boquien CY, King C, Lamireau D, Tonetto P, Barnett D, et al. Fortification of Human Milk for Preterm Infants: Update and Recommendations of the European Milk Bank Association (EMBA) Working Group on Human Milk
Fortification. Front Pediatr. 2019 Mar 22;7:76.
Standard (STD) Fortification
• A fixed amount of fortifier is added to a fixed volume of HM according to the
manufacturers’ instructions
• Fortification method currently in use in most of the neonatal units
Individualized HM Fortification Methods
• Adjustable (ADJ) Fortification
• Protein adequacy is monitored by BUN twice weekly, cut-off levels of BUN are 10-16 mg/dl*
• If the level is < 10 mg/dl extra protein is added to the STD fortification
• Targeted Fortification
• Macronutrient concentrations in HM are analyzed and based on the results milk is
supplemented with extra protein and/or fat
16. ● 18 small trials totalling 1456 preterm infants ➔ multi‐nutrient fortified human breast milk vs
unfortified breast milk
● Multi‐nutrient fortification of human milk increases in‐hospital rate of weight gain, body length
or head circumference among preterm infants
● The data do not suggest other benefits or harms and provide low‐certainty evidence
suggesting effects of multi‐nutrient fortification on the risk of necrotizing enterocolitis (NEC)
in preterm infants
● Authors’ conclusion: feeding preterm infants with multi-nutrient fortified human breast
milk compared with unfortified human breast milk is associated with modest increases in in-
hospital growth rates. Evidence is insufficient to show whether multi-nutrient fortification has
any effect on long term growth or neurodevelopment
Brown JV, Lin L, Embleton ND, Harding JE, McGuire W. Multi-nutrient fortification of human milk for preterm infants. Cochrane Database Syst Rev. 2020 Jun 3;6(6):CD000343.
17. Controlled, multicenter, double-blind study, a sample
of preterm infants ≤32 weeks or ≤1500g were
randomized to receive nHMF (n=77) or cHMF (n=76)
for a minimum of 21 days
Weight gain rate between study days 1 and 21
(g/kg/day)
18.3
16.8
16
16.5
17
17.5
18
18.5
nHMF cHMF
The
difference: 1.5
g/kg/day
nHMF: new powdered HM fortifier
cHMF: control HM fortifier
A new human milk fortifier containing partially
hydrolyzed
protein, fat, and carbohydrate provides a higher
protein : energy ratio → improves weight gain and
reduces postnatal growth restriction compared to
the current fortifier
Rigo J, Hascoët JM, Billeaud C, Picaud JC, Mosca F, Rubio A, et al. Growth and Nutritional Biomarkers of Preterm Infants Fed a New Powdered Human Milk Fortifier: A Randomized Trial. J Pediatr Gastroenterol Nutr. 2017 Oct;65(4):e83-e93.
18. HMF Composition
HMF - A
(per sachet 1 g) +
Breastmilk
HMF - B
(Per Sachet 0.71 g) +
Breastmilk
HMF - C
(Per 1 g)
Energy 4.35 kcal 3.5 kcal Not mentioned
Protein 0.36 g 0.28 g 0.27 g
Omega 3 4.17 mg Not mentioned Not mentioned
Omega 6 9.58 mg Not mentioned Not mentioned
DHA 1.57 mg Not mentioned Not mentioned
ARA 0.12 mg Not mentioned Not mentioned
Iron 0.44 mg 0.36 mg 0.0972 mg
Nutritionalvalue informationon the labels of some HMF.
19. New Powdered Human Milk Fortifier
FSI1=fortification strength increase day 1; W40CA=week 40 corrected age; z scores calculated using Fenton preterm growth char t
*P=0.013 vs cHMF (by analysis of covariance, adjusting for value at D1, sex, and center); †P=0.007 vs day 1 (by t test); **P=0.003 vs cHMF (by analysis of covariance, adjusting for value at D1, sex, and center)
Mean±SD weight-for-age
• Weight for-age z score (at D21) was significantly higher in nHMF compared to cHMF (0.12 [95% CI: 0.03, 0.22])
• Head circumference-for-age z scores (at W40CA)were significantly higher in nHMF compared to cHMF
(0.41 [95% CI: 0.14,0.68])
Mean±SD head circumference-for-age
nHMF = new powdered HM fortifier
cHMF = controlHM fortifier
Rigo J, Hascoët JM, Billeaud C, Picaud JC, Mosca F, Rubio A, et al. Growth and Nutritional Biomarkers of Preterm Infants Fed a New Powdered Human Milk Fortifier: A Randomized Trial. J Pediatr Gastroenterol Nutr. 2017 Oct;65(4):e83-e93.
20. Fortification of Feeding
● If maternal or donor human milk is not utilized or sufficient to meet required
feeding volumes → formula feedings can be initiated
● It is important to monitor the growth velocity of the infant, along with
monitoring for osteopenia of prematurity
Kumar RK, Singhal A, Vaidya U, Banerjee S, Anwar F, Rao S. Optimizing Nutrition in Preterm Low Birth Weight Infants—Consensus Summary. Front Nutr 2017;4
Thoene MK, Anderson-Berry AL. A review of Best Evidenced-based Enteral and Parenteral Nutrition Support Practices for Preterm Infants Born <1,500 Grams. Pediatric Medicine. 2018 Oct 23];1(0).
21. Preterm Formula Composition
ESPGHAN 2010
Recommendation
Unit Preterm
Formula A
Preterm
Formula B
Preterm
Formula C
Preterm
Formula D
Energy 110 – 135 kcal/kg/day Kcal/100 ml 83 80 83 74
Protein Body weight 1 -1.8 kg =
3.2 – 3.6 g/100 kcal
g/100 kcal 3.4 3.3 3.4 2.5
Omega 6 /
LA
350 – 1400 mg/100 kcal mg/100 kcal 889.7 740 698 601.2
Omega 3 /
ALA
> 50 mg/100 kcal mg/100 kcal 65.1 74 56 64.5
DHA 11 – 27 mg/100 kcal mg/100 kcal 19.8 17 20 8.25
AA 16 – 39 mg/100 kcal mg/100 kcal 20.8 34 21 18.8
Iron 1.8 – 2.7 mg/100 kcal mg/100 kcal 2.2 1.8 1.8 1.4
Osmolarity mOsm/L 317 320 374.5 N/A
Agostoni C,Buonocore G, Carnielli VP,De Curtis M, Darmaun D,Decsi T,et al. Enteralnutrient supply forpreterminfants:commentary fromthe EuropeanSociety of Paediatric Gastroenterology,Hepatology and
Nutrition Committee on Nutrition.J Pediatr Gastroenterol Nutr.2010Jan;50(1):85-91.
Nutritionalvalue informationon the labels of some premature formula.
22. Anthropometry
Anthropometry
Parameter
Should be Measure Until
Weight 24 month
Length 42 month
Head circumference 18 month
INTERGROWTH-21st. International Fetal and Newborn Growth Standards for the 21st Century: Anthropometry handbook. The Internation al Fetal and Newborn Growth Consortium; 2012.
25. 0 = does not apply; + to +++ reflects relative importance; +/− = of dubious value. w = weeks; m = months; y = years;
CVS = cardiovascular system; UR = unreliable. *prior to school entry; †1-2 years after starting school; ‡growth 12–14
years includes normal pubertal development; §overweight/obesity an ongoing issue; ¶ongoing life learning; ^relevant to
early presentation of autism spectrum disorder. Shaded areas represent a suggested minimal checklist for busy clinicians.
High Risk Children Follow Up
Doyle LW, Anderson PJ, Battin M, Bowen JR, Brown N, Callanan C, et al.
Long term follow up of high risk children: who, why and how? BMC Pediatr. 2014 Dec;14(1):279.
High-risk children who are
destined to have higher than
expected rates of health or
developmental problems
→ need more structured &
specialised follow-up
programs
26. 0 = does not apply; + to +++ reflects relative importance; +/− = of dubious value. w = weeks; m = months; y = years; CVS
= cardiovascular system; UR = unreliable. *prior to school entry; †1-2 years after starting school; ‡growth 12–14 years
includes normal pubertal development; §overweight/obesity an ongoing issue; ¶ongoing life learning; ^relevant to early
presentation of autism spectrum disorder. Shaded areas represent a suggested minimal checklist for busy clinicians.
Doyle LW, Anderson PJ, Battin M, Bowen JR, Brown N, Callanan C, et al.
Long term follow up of high risk children: who, why and how? BMC Pediatr. 2014 Dec;14(1):279.
High Risk Children Follow Up (cont)
27. Take Home Message
Optimization of the nutritional care for the preterm infants has a key role in
improving neurodevelopmental outcomes and has become a priority.
Fortification of human milk is necessary to prevent EUGR which is associated with
poor neurocognitive outcome and to avoid specific nutrient deficiencies.