Mf2 Infant Nutrition

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infant weight gain per day

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~30g (1oz) per day for first 3 months once birth weight is regained

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concerns with feeding preterm infants

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Difficulty feeding
- sucking (no reflex until 32 wks fetal age)
- small stomach
- low V/high hz feeding

Increased nutrient needs

Limited Fat absorption

Unstable Electrolyte Balance

Impaired Intestinal Barrier

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necrotizing enterocolitis

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dangerous inflammation of colon causing intestinal bacterial leak thru mucosal barrier, systemic infection!

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sepsis

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bacterial infection of the blood stream

indication of systemic infection

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retrolental hyperplasia

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XS build up connective tissue behind lens of eye

often in response to very high O2 concentrations

can cause loss of eyesight if proceeds unchecked

give Vit E to decrease this risk in preterm infants

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at birth, enteral feeding promotes:

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1) expression of brush boarder enzymes (ie lactase, although this begins in 3rd tri)

2) establishment of normal intestinal flora

3) better intestinal integrity (barrier fn)

** preterm considerations: low lactase so difficulty w milk digestion; also more prone to infection

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Human Milk Composition

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Macro:
Carbs- *lactose
Fat: 1* TG (more in hindmilk)
Protein: Casein (30%), Whey (70%)

Minerals: Na+, K+, Cl, Ca++, Mg++, etc

Water (87.5%)
Anti-infective agents
Leukocytes
Anti-inflam
Enzymes
Growth factors
Hormones

** same osmostic pressure as human blood

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Whey

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Soluble milk protein
70% breast milk protein
includes proteins:
- lactoferrin
- secretory IgA
- alpha-lactalbumin

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Phases of milk

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Colostrum (1-5 days)

Transitional

Mature (day 15)

Partial/Full Weaning

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Colostrum

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Milk produced 1-5days (2-10mL per feeding day 1, 5-15mL day 2)
~67 kcal/100mL

thick
yellowish (high beta-carotene)
rich in proteins and Igs
Low fat, lactose
High vit A, E

facilitates passage of meconium
Promotes establishment of bifidus flora

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transitional milk

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up to 15 days

increasing fat, lactose and water-soluble vitamins

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Mature milk

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~15 days on
~75 kcal/100mL

Stable composition

600-800 mL/day produced if breastfeeding full-time

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binding proteins

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increase absorption of important minerals

serum albumin - Zn, Cu
alpha-lactalbumin - Ca
Lactoferrin - Fe
Vit-binding proteins - folic acid, B12, D

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a.a. required in preterm infants

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cysteine

taurine

tyrosine

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DHA

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docosahexaenoic acid

22 C: 6 =

found in fish oils, egg lipids

can be converted in body from alpha-linolenic acid, BUT insufficient in newborns, amount in breast milk depends on diet of mom

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Major protective factors in breast milk

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Igs

Lactoferrin (prevents bacterial rep via Fe deprivation)

bifidus factor (supports growth of lactobacillus bifidus)

oligosaccharides (prevent Ag from attaching to epithelium, promote L. bifidus growth)

Lysozyme (digests cell walls of some pathogens)

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Lactobacillus bifidus

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beneficial bacteria

increases intestinal acidity and reduces pathogenic bacteria

bifidus factor in breast milk supports growth

oligosaccharides promote growth

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taurine in breast milk

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role in early brain and eye maturation

may promote intestinal growth and bile acid conjugation

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anti-inflam factors in breast milk

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lactoferrin

lysozyme

sIgA

Antioxidants

Prostaglandins

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charts available for monitoring infant growth

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length-for-age: may reflect chronic energy deficits if short stature (<5th percentile)

weight-for-age: used in early infancy, but doesn't account for length

weight-for-length: used to classify underweight (<5th percentile); indicates acute energy deficit, address immediately

**should remain at ~ same percentile for first year of life

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Less-than-appropriate weight gain in infants can be caused by:

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**- inadequate intake of E, protein, essential nutrients (poor breastfeeding or bottle feeding techniques; infection/illness causing increased E needs or reduced consumption)

- continued effects of intrauterine deprivation

- infections and other organic illnesses

- genetic diseases impairing nutrient assimilation

- inborn errors of metabolism

Note - weight gain slows first

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criteria for failure to thrive

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<5th percentile on std charts

weight less than 80-90% of the median weight-for-age

drop in weight or stature across 2 or more major percentile lines

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signs of unabsorbed sugars in distal small intestine in infants

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- flatuence
- colics (bacterial fermentation)
- diarrhea

low lactase activity often due to enteral infection

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most common cause fat malabsorption in infants

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insufficient secretion of lipase or bile (pancreatic insufficiency from cystic fibrosis)

contributes to multiple deficiencies:
triglycerides
Vit A (vision, cell diff)
vit D (Ca absorption, bone health)
vit E (free radical defense)
vit K (blood clotting, bone health)
carotenoids (free radical defense)

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problems with cows milk compared to human

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1) protein: mostly casein, harder to digest; high protein content (21% vs 6%)
2) Carbs: inadequate
3) Fat: diff fa profile, poorly absorbed
4) allergenic poential
5) lower bioavailability Fe Ca
6) high renal solute load
7) cause GI blood loss

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consequences of protein overload

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1) interferes w digestion (colic, diarrhea)

2) metabolism (acidosis, ^ blood ammonia and urea levels)

3) fluid balance (dehydration)

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micronutrients of most concern in infants

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Fe
Folate
B12
D
K
Fluoride (XS)

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important nutrients for brain development:

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DHA: membranes, photoreceptor rods
Choline: precursor phospolipids, NTs
Taurine: osmoregulation, neuroprotection, neuromodulation
Folate: one-carbon transfers, DNA synthesis
Iron: E metabolism, mRNA synthesis regulation, myelin synthesis (deficiency can delay speech, cognitive devel)