Question

Premature Infant Case Study

Nutrition Assessment of Preterm Infant

Patient History: A 980-gram female infant was born at 27 weeks gestation and classified as an appropriate for gestational age premature infant on a premature growth chart. Length was 36 cm, and head circumference was 25 cm. Today, the patient is 21 days old or 30 weeks postmenstral age (PMA) Patient had respiratory distress syndrome, which required intubation and surfactant therapy. Patient is now on room air.

Nutrition History: Patient was on parenteral nutrition, but is now on total enteral feedings of human milk from her mother at 160mL/kg.

Anthropometrics

Weight: 1085g

Length: 38cm

Head Circumference: 27 cm

Nutrition Problem

Nutrient intake is inadequate for the premature infant.

Nutrition Interventions

As discussed on team rounds, human milk fortifier will be added to human milk to provide 24kcal/oz milk. At 160mL/kg, the infant will receive 128 kcal/kg and 3g protein/kg. The fortifier will bring the nutrient content up to meet the guidelines for prematurity.

Questions

How did weight, length, and head circumference plot at birth and at 3 weeks or 30 weeks gestation on the Lubchenco growth chart?

What are the kilocalorie and protein goals per kg for this infant?

What milk is recommended for the premature infant?

What would the feed volume be per feed for feeding every 3 hours at 160mL/kg?

Write one PES for this case study.

Calculate energy and protein intake son fortified human milk with powdered bovine fortified at 160mL/kg.

What should be monitored on a weekly basis in this infant before discharge?

Answer 1

According to the lubencheco chart

At birth he was appropriate for gestational age as he fell between 25 the and 50 the percentile.

Similarly at 30 weeks he had a steady growth was still appropriate for gestational age as his anthropometric measurement fell between 25 the and 60 the percentile.

2) Requirements for normal growth:

Energy( kcal) = 105-130 per kg/day

Protein(g)= 3.5-4 per kg /day

3) Mother's milk is initially recommended for the preterm babies because :

a) The nutrients are readily absorbed

b) Less chances of NEC or sepsis

C) The composition of the milk is unique thereby easily digestible.

d)Its easy to achieve full enteral feeds compared to formula feeds

e) Though weight gain is slow babies can be discharged early.

But nowadays fortified human milk feeds are recommended for these babies because necessary vitamins and minerals are too low too meet their needs and the amount of milk available can also hamper the daily need of the baby. The formula contains:

Higher carbohydrates and protein content along with added vitamin like A,D etc are more . Electrolytes like sodium, potassium , chloride is added to meet the needs of the baby.Calcium and phosphorus are added in higher concentration to prevent osteopenia in babies.

Feed volume:

Total weight × required fluid(ml) /kg÷ No. Of total feeds

Total weight = 1085 g or 1.085 kg

Req.fluid= 160 ml/kg

Total no.of feeds per day= 24÷3= 8 so,

1.085× 160× 8= 21.7 ml every three hours.

PES

Imbalanced nutrition less than body requirements related to

Decreased nutrient deposits.

Immaturity.

Weak digestive tract and reflexes.

High rate of metabolism.