Question

A baby born to a cocaine-addicted mother at 30 weeks gestation had a LBW, at 2.91# and 15.71".

a) Calculate this infant’s calorie and protein needs.

b) Identify potential developmental feeding problems in early infancy, including what appropriate hunger cues might be missing.

c) Identify two programs the infant would be eligible to participate in.

Answer 1

a)Nutrition Requirements calculation:

baby's weight = 2.91#

Length = 15.71 "

We know the formula,1 pound = 0.454 kilogram.

Hence, 2.91 pounds= 0.454× 2.91 kilogram

Therefore the baby's weight = 1.32 kilogram.

According to Nutrient and Energy Recommendations for Preterm and Term Infants,

The calorie requirement of preterm infant = 110-150 kcal/kg body weight

Hence, the calorie requirement is 150× 1.32

= 198 kcal/day

According to Nutrient and Energy Recommendations for Preterm and Term Infants,

The protein requirement of preterm infant = 3.4 - 4.4 g/kg body weight

=4.4× 1.32

= 5.8 g/ day

b) FEEDING PROBLEMS OF PRETERM INFANT

A baby born before the 37th week of pregnancy is considered premature. Premature babies often have difficulty feeding, for a variety of reasons. The more premature the baby, the more problems he's likely to develop; a baby born before 34 weeks probably will need tube feedings until he develops both the strength to suck well and the ability to coordinate the suck and swallow reflexes. Preemie feeding problems can last for many months and are often interrelated.

Slow Feeding

      A preemie doesn't have the muscle strength that a full-term baby does; he can't suck for as long without tiring, especially if he also has breathing difficulties. Eating takes more effort and coordination than it might seem. A preemie often tires before he takes in enough food for optimal growth. If he repeatedly tires too soon, he might need to take part of his feeding via a tube that goes directly into his stomach. Preemies often lack the ability to coordinate their sucking and swallowing with their breathing, which makes them choke or gag frequently unless they eat slowly.

Oral Aversion

        Premature babies often have tubes placed in their mouth or noses. This can be uncomfortable and sets them up for a long-term feeding problem called oral aversion or oral defensiveness. A baby with oral aversion doesn't like anything near his mouth or face, because experience has taught him that objects that come near his face often hurt him.

        Familiarizing the baby with being touched on the face and then around the mouth is often the first step in overcoming oral aversion, but it can take time and patience to overcome months of negative experiences in the neonatal intensive care unit. Speech therapists, occupational therapists and lactation consultants often work with growing preemies, who can remain orally defensive for months, to teach them to eat normally.

Reflux

       Gastrointestinal reflux occurs when the sphincter muscle between the esophagus and stomach doesn't close tightly, a common problem in preemies. Acid from the stomach travels up into the esophagus, causing pain that often occurs after eating. The baby begins to associate eating with discomfort and may refuse to eat. Reflux can also cause vomiting that interferes with good nutrition and growth. A preemie with breathing issues is also at increased risk for reflux. Most babies outgrow reflux around 1 year. To counteract reflux, the nurse educate to hold or keep the baby upright for as much of the day as possible to help keep food down in the stomach where it belongs. Placing blocks under the head of the crib to keep his head elevated when he's lying down might also help. Acid blockers and neutralizers might also help.

Aspiration

        When a baby can't effectively suck, swallow and breathe, he's at risk for aspirating his food. Many preemies already have compromised airways and breathing problems, which can worsen significantly if food enters their lungs. Aspiration can cause pneumonia or chronic respiratory infection. When bottle feeding, never forcibly squeeze milk into your baby's mouth by pressing the nipple against the roof or side of his mouth. If his skin turns dusky or blue while he eats, or if he chokes, has milk come out of his nose or vomits, he might be aspirating milk. Reflux and a decreased gag reflex also increase his risk for aspiration.

Sluggish Bowels

    

       The intestines of a preemie baby are like the rest of his body, immature. Because his immature intestines move food more slowly through the intestines, your preemie is more likely to become constipated or to develop gas and stomach upset. Food also empties from the stomach more slowly, which can cause nausea and decreased interest in eating.

Hunger cues that will be missing for a preterm baby

         Premature babies do not always cry, but may move around and become restless if it has been 2-3 hours since they last ate.

   A normal baby cries and shows other signs of hunger, is fed, eats his fill, is satisfied, and the crying stops. As the baby grows, he learns to feed himself based on his own hunger cues. But preterm babies, are different. They do not exhibit cues of hunger which does not let them eat on demand.

       The reason preemies can’t feed on demand is that hunger cues are not well developed before 37 weeks and hence many babies will not eat enough calories. Crying with preemies is actually a very late sign of hunger.

Many normal processes are affected when the nervous system is exposed to our environment too soon for these babies. Altered hunger cues are only one consequence as his hunger cues are not developed.

c) TWO PROGRAMS THAT THE INFANT WILL BE ABLE TO PARTICIPATE:

USAID's maternal and child nutrition programs set the direction and ensure technical excellence of diverse nutrition programs. Maternal and child nutrition programs improve health outcomes by implementing nutrition-specific interventions, or those that address the immediate, health-related determinants of malnutrition.. USAID's maternal and child nutrition programs have a greater impact on improving health of women and children and this infant can get benefitted out of it.

       PATH (Program for Appropriate Technology in Health) is an international, nonprofit global health organization based in Seattle. PATH focuses on five platforms vaccines, drugs, diagnostics, devices, and system and service innovations, to develop innovations and implement solutions that save lives and improve health, especially among women and children.

PATH led the United States Agency for International Development’s flagship program in nutrition for infants and children, the Infant & Young Child Nutrition (IYCN) Project. This has built a strong foundation for worldwide efforts to reduce malnutrition among mothers and children. These two programs can help to meet the nutritional and other health needs of the infant and help him grow healthy.