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Lecture Eleven: Newborn Nutrition


The neonatal diet should include adequate calories and include protein, ... Foremilk is the milk obtained at the beginning of the feeding. ... – PowerPoint PPT presentation

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Title: Lecture Eleven: Newborn Nutrition

Lecture Eleven Newborn Nutrition
  • NURS 2208
  • T. Dennis RNC, MSN

Nutritional Needs of the Newborn (pg 778-779)
  • The neonatal diet should include adequate
    calories and include protein, carbohydrates, fat
    water, vitamins, and minerals.
  • Caloric needs 105 to 108 Kcal/Kg/day or 50 to 55
  • Water requirements are high 140 to 160 ml/Kg/day
    or 64 to 73ml/lb/day.
  • Formula fed babies gain weight faster than
    breastfed babies due to the high protein content
    in commercial formulas and the larger volumes of
    formula needed to deliver adequate nutrition.
  • Bottle fed babies regain their birth weight in 10
    days and gain approximately 30 g (1 oz) per day
    up to 6 months.
  • Breast fed babies regain their birth weight in 14
    days and gain approximately 15 g (1/2 oz) per day
    up to 6 months.
  • Formula fed infants double their weight in 3 ½ to
    4 months.
  • Breast fed infants double their weight by 5

Breast Milk (pg 779)
  • Contains mostly serum and white blood corpuscles
  • Is a yellowish or creamy appearing fluid
  • Is secreted from the breast before the onset of
    true lactation
  • Has a high protein content, provides some immune
  • Cleanses the neonates intestinal tract of mucus
    and meconium
  • Is thicker than milk
  • Production begins early in pregnancy and lasts
    several days after birth

Breast Milk (pg 779)
  • Transitional Milk
  • Breast milk produced from the end of colostrum
    production until about 2 weeks postpartum.
  • Contains more fat, lactose, water soluble
    vitamins and calories than colostrum contains.

Breast Milk (pg 779)
  • Breast milk that contains 10 solids
    (carbohydrates, proteins, fats) for energy and
  • Contains 90 water.
  • Foremilk is the milk obtained at the beginning of
    the feeding.
  • Hindmilk is released after the initial let-down
    or release of milk that is higher in fat
  • May appear watery and bluish in color.
  • Provides approximately 20 kcal per oz.
  • AAP and ACOG recommend breast milk as the optimal
    food for the first 6 to 12 months.
  • Provides newborns and infants with specific
    immunological, nutritional, and psychosocial

Breast Milk (pg 779)
  • Immunologic Advantages
  • Protection from respiratory and gastrointestinal
    infections, otitis media, meningitis, sepsis and
  • Provides coverage during the neonatal period
    until the babys own immunoglobulins become
    active by 18 months of age.
  • Breast milk is non-allergenic.

Breast Milk (pg 779)
  • Nutritional Advantages
  • Breast milk is composed of lactose, lipids, and
    polyunsaturated fatty acids, and amino acids
    (especially taurine) and has a wheycasein
    protein ratio that facilitates its digestion,
    absorption, and full use compared to formula.
  • Considered the ideal first food because its
    composition varies according to gestational age
    and stage of lactation.
  • Provides newborns with minerals in more
    appropriate doses than do formulas.
  • Iron in breast milk is more readily and fully
  • Delivered in an unchanged form (vitamins are not
    lost through processing or heating).

Breast Milk (pg 779)
  • Psychological advantages
  • Affects maternal/infant attachment
  • Oxytocin level increases coincide with more
    even mood responses and increase feeling of
    maternal well-being.
  • Provides the opportunity for frequent, direct
    skin contact between mother and newborn.
  • In twin births, enhances individualization and
    attachment of each newborn.
  • Fathers can be actively involved in providing
    feedings (pumped).

Contraindications and Disadvantages
  • A mother diagnosed with breast cancer
  • A mother diagnosed with AIDS
  • Infants suffering from galactosemia
  • Medications example - Flagyl
  • 9 to 12 feedings a day initially
  • Another pregnancy
  • La Leche League, lactation Consultants

Formula Feeding
  • A nutritious alternative to breastfeeding
  • Both parents may assist in the nurturing process
  • Commercial formulas have been developed to
    minimize the harmful components of cows milk.
  • Three categories cows milk base, soy-protein,
    and specialized or therapeutic.

Potential Contraindications (pg 782)
  • Improperly prepared formulas may be detrimental
    to the infant (concentrated may lead to kidney -
    overdiluted leads to a deficit in nutrients).
  • Allergic reactions vomiting, colic, diarrhea,
    colitis, reluctance to feed and eczema.
  • Nutritionists advise against whole cows milk, 2
    cows milk or skim milk for children under 2
    years of age.

Newborn Feeding (pg 783)
  • The initial feeding is determined by the
    physiologic and behavioral cues of the newborn.
  • Assess for active bowel sounds, absence of
    abdominal distention, and a lusty cry which
    quiets and is replaced with rooting and sucking
    behaviors when a stimulus is placed near the
  • First feeding assess suck, swallow and gag
  • Breastfeeding should begin immediately.
  • Bottle feeding infants are offered formula as
    soon as they show an interest.
  • Early feeding stimulates peristalsis, facilitates
    elimination of by products, which decreases the
    risk of jaundice, and enhances maternal-infant
  • Observe closely and position on right side after
    feeding to aid in drainage and facilitate gastric

Establishing a Feeding Pattern (pg 784)
  • Breastfeeding on demand, 1 1/2 to 2 hours
    initially is not uncommon.
  • Early cues include hand to mouth and/or hand
    passing motion, whimpering, sucking, and rooting.
  • Crying may delay adjustment to extrauterine life.
  • Formula feedings are every 3 to 4 hours because
    formula is digested more slowly than breastmilk.
  • Both formula fed and breast fed infants may
    experience growth spurts and require increased

Promotion of Successful Infant care (pg 785)
  • Parents may see the success of feeding their
    newborn as a sign of parental success.
  • Infants may recognize muscular tension from the
  • Consistency in teaching is paramount.
  • The goals of Healthy People 2000are to have 75
    of infants breastfeeding at birth and 50
    continuing to consume at least some human milk
    until 6 months.
  • Position comfortably for success breastfeeding or
  • Couplet care facilitates success at feedings.

Cultural Considerations in Infant Feeding (pg
  • North American and European societies sometimes
    consider it indecent to expose the breast,
    believe too much handling spoils the child, and
    that weaning is a sign of development.
  • In some cultures, colostrum is not offered to the
  • Muslim women may breastfeed for 2 years.

Physiology of the Breasts and Lactation (pg
  • Female breast is divided into 15 to 24 lobes,
    separated by fat and connective tissue.
  • Lobes are subdivided into lobules, composed of
    small units called aveoli where milk is
    synthesized by the aveolar secretory epithelium.
  • The lobules have a system of lactiferous ductiles
    that join larger ducts and eventually open onto
    the nipple surface.

Physiology of the Breasts and Lactation (pg
  • Increased levels of estrogen during pregnancy
    stimulate breast duct proliferation and
  • Elevated progesterone levels promote the
    development of lobules and alveoli in preparation
    for lactation.
  • A rapid drop in estrogen and progesterone and an
    increase in prolactin occur at birth.
  • Prolactin promotes milk production by stimulating
    the aveolar cells of the breasts.
  • The release of oxytocin from the pituitary is
    stimulated by the infants sucking.
  • Oxytocin increases the contractility of the
    myoepitheleal cells lining the mammary duct walls
    and milk flow occurs resulting in the let-down

Physiology of the Breasts and Lactation (pg
  • The let-down reflex causes milk ejection.
  • A tingling or prickling sensation is felt at
  • Uterine cramps, increased lochia, milk from the
    other breast, and a feeling of relaxation occur
    with let-down.
  • A lack of self confidence, fear or embarrassment
    about or pain connected with breastfeeding may
    prevent milk ejection.
  • Milk production is decreased with repeated
    inhibition of the milk ejection reflex.
  • Failure to empty the breasts frequently and
    completely also decreases production due to
    pressure on the aveoli from accumulated milk.

Breastfeeding Process (pg 788)
  • The objectives of breastfeeding are 1) to provide
    adequate nutrition, 2) to facilitate
    maternal/infant attachment, and 3) to prevent
    trauma to the nipples.
  • Arrange for privacy.
  • Assist mother to find a comfortable position.
  • Mother should use C- hold or scissors hold.
  • The gums surround the areola so the jaws compress
    the milk ducts when the baby suckles.
  • The baby should be facing the mother (tummy to
    tummy, chest to chest) with the ear, shoulder and
    hip aligned.
  • As long as feeds are offered frequently, whatever
    the duration the newborn wishes are appropriate.
  • DO NOT watch the clock.

Breastfeeding Process (pg 788)
  • Breastfeeding assessment infant cues, latch on,
    position, let down, nipple condition, infant
    response, and maternal response.
  • Leaking initial supply increased, stimuli of
    infant crying, thinking of infant.
  • Pads or cups are used to avoid irritation.
  • As milk supply is established, leaking decreases.
  • Direct pressure applied to the breast also
    decreases leaking.
  • Client places a finger inside the infants mouth
    to break suction so the newborn releases the

Breastfeeding Process (pg 788)
  • Supplementary feedings
  • May weaken or confuse the suckling reflex or
    decrease the infants interest in nursing.
  • Artificial nipples should not be introduced until
    breastfeeding is well established.
  • Milk transfer signs, audible swallowing, milk in
    the babys mouth, moms breast soft after a feed,
    leaking from the opposing breast.
  • Infant weight gain and six or more wet diapers a
    day indicate adequate intake.

Breastfeeding Process (pg 791)
  • Expression of Milk
  • Choice of methods depends on mothers
    capabilities and personal preference.
  • Electric breast pump may be used 8 times in a 24
    hr period during the early postpartum.
  • Manual expression.
  • Battery pumps and cylinder pumps are available.

Breastfeeding Process (pg 791)
  • Storing Breast Milk
  • Breast milk can be stored for up to six hours at
    room temperature.
  • Breast milk can be stored up to eight days in the
  • Breast milk should be stored in plastic
    containers (wbcs adhere to glass).
  • Breast milk may be stored in the refrigerator
    freezer for up to 2 weeks and a deep freezer for
    6 months at 0 degrees.

Breastfeeding Process (pg 791)
  • External Supports
  • Father or partner.
  • Mothers, grandmothers and sisters.
  • Nurses, dieticians, childbirth educators, CNMs.
  • Lactation consultants, breastfeeding support
    groups, La Leche League.
  • Breastfeeding mothers who work outside the home
    and receive support tend to breastfeed for longer
    periods of time.

Breastfeeding Process (pg 791)
  • Drugs and breastfeeding
  • Most drugs pass into breast milk.
  • Almost all medications appear in small amounts in
    human milk (usually less than 1 of the maternal
  • Very few drugs are contraindicated for the
    breastfeeding woman.
  • Drug characteristics that influence the amount of
    a medication in breast milk area degree of
    protein binding, degree of ionization, molecular
    weight, degree of solubility in fat and water,
    mechanism of transport, the pH, half life and
    Milk/plasma ratio.

Breastfeeding Process (pg 791)
  • Potential Problems in Breastfeeding
  • Nipple soreness position at breast is one of the
    most critical factors in nipple soreness. Breast
    milk on the nipples after feeding helps heal sore
    nipples. Thrush may occur.
  • Flat or inverted nipples cups or shields may
    help. Exercises may help. Latex shield may be
    used as last resort.
  • Cracked nipples Breast milk for healing. Avoid
    lanolin, masse cream and/or ointments.
  • Breast engorgement Are hard, painful and appear
    taut and shiny. Infant may not be able to latch
    on. Nursing more frequently, pumping and support
    may relieve.
  • Plugged ducts heat massage relieve.
  • Breastfeeding and working refrigerated milk,
  • Weaning personal choice, substitute 1 cup
    feeding for nursing.

Bottle-Feeding (pg 799-800)
  • Infant is held for all feedings to prevent otitis
  • Nipples should have a hole big enough to allow
    milk to flow in drops when the bottle is
  • Nipples vary in size and shape.
  • Infant is burped at intervals.
  • Regurgitation may occur initially or with a
    feeding that is too fast.
  • Formula preparation ready to feed, concentrated
    and powder.
  • Never add honey as a sweetener…may cause

Nutritional Assessment of the Infant (pg 800)
  • Nutritional history from the parent
  • Weight gain since the last visit
  • Growth chart percentiles
  • Physical examination

Medical Blooper for … A Chuckle A Day…from the
medical community
  • An ill-prepared nursing student sat in my
    classroom, staring at a question on the final
    exam. The question directed Give four advantages
    of breast milk.
  • What to write? He sighed and began to scribble
    whatever came into his head, hoping for the best.
  • No need to boil
  • Never goes sour
  • Available whenever necessary.
  • So far so good maybe. But the exam demanded a
    fourth answer. Again, what to write? Once more he
    sighed. He frowned. He scowled, then sighed
    again. Suddenly he brightened and grabbed his
    pen, and triumphantly, he scribbled his
    definitive answer
  • 4. Available in attractive containers of
    varying sizes.
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