FEEDING LOW BRITH WEIGHT/ PRETERM INFANTS

RACHEL MUSOKE (UON)FLORENCE OGONGO (KNH)

KNH/UON SYMPSIUM 10TH JAN 2013

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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

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MDGs & LBW/preterm feeding

FOCUS ON MDG 1, 4 & 5

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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

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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)

Intervention to improve feeding can have significant impact on all

these factors

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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

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POSTNATAL NUTRITION

Birth of LBW/preterm is a shockPhysiological stressors:• Temperature regulation• Breathing• Elimination• Separation

Decisions to feed at birth

Temp shock at birth require energyReserve as fat• 1000g baby : 100kcal/kg/day• Term 1500-1800kcal/kg/dayReserve as glycogen• Brain metabolism depend on glucose: brain

10% of body wt (adult 2%) need 6mg/kg/min (8.64g/kg/day

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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

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NUTRITION: meeting the nutritional needs

• Simulate intrauterine growth• Higher needs for: Growth Associated stress events• Poor neurodevelopmental outcome if not

adequately fed

Methods of feeding

• Parenteral: Total parenteral nutrition; requires a lot of expertise to include medical, nursing, pharmacy and laboratory monitoring. It is not available in our setting

• At KNH glucose & electrolytes– Risks: hyperglycaemia

• Enteral

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Glucose infusions: Complications

• Hyperglycaemia in the VLBW - Dehydration - Increased CO2 production

• Risk of IVH & death

• Hypoglycaemia

Enteral feeding

When do you start?Larger LBW/late preterm 32-36wks• Well infant• Size at birthSmaller LBW /early preterm <32wks• Sick infant• Respiratory distress

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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.

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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, jigglingor talking to the baby during feeding attempts

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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

What milk?

• Own mother’s milk - unmodified

• Own mother’s milk - fortified

• Preterm formula

• Parenteral

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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?

Family Support

• Having a preterm/LBW baby is traumatic to parents

• Mother needs support to produce enough milk

• Children at home without a mother

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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

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THANKS FOR LISTENING AND PARTICIPATING

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