Feeding Neonates
WHO recommendation: breastfeed exclusively for 1st 6mo
Benefits of breastfeeding
dramatically improves infant's survival in developing countries
environment contaminated
reduces GI infection risk
reduced GI infection
reduced NEC in premies
helps bond
benefits for baby in later life: reduced obesity, DM, HTN
reduced breast ca in mother
Issues with breastfeeding
hard to tell how much milk baby is taking
NB to check weight regularly
harder with twins, impossible to exclusively breastfeed triplets or high order multiples
harder in premies
mother will need to express until infant can suck (35-36 wks CGA)
maintaining supply can be a problem
social class
no break for mum - others can't take charge of baby for any length of time
if mother works can delay return to work + cause financial hardship
lack of facilities in public places
failure can cause emotional distress
Establishing breastfeeding
Colostrum for 1st few d
should do 1st feed asap after birth
frequent suckling enhances lactation
ideal nutrition for first 6mo
also reduces birth rate (lack of other forms of contraception)
Properties of breastmilk
IgA - mucosal protection
Bifidus factor - inhibits GI pathogens
Lysozyme - bacteriolytic
Lactoferrin - inhibits E Coli
Interferon - antiviral
macrophages
lymphocytes
protein
lipids
Ca - prevents hypocalcaemic tetany
Long chain polyunsaturated FAs - retinal development
transmission of infection
CMV
Hep B
HIV
Breast milk jaundice
transmission of drugs + toxins
antimetabolites CIed
nicotine
caffeine
alcohol
Breastfeeding beyond 6mo without introducing solids can lead to poor weight gain + rickets
Vit K deficiency - should use supplements to prevent haemorrhage disease of newborn
Breast pain, engorgement, mastitis, cracked nipples
Cow's milk
unsuitable in infancy
breast/formula for 1st yr, then pasteurised cow's milk can be given
deficient in vits A, C, D + Fe
Children on cow's milk should get full fat until 5 y/o
Specialised infant formula
Used for CMPA, CMPI, lactose intolerance, CF, neonatal cholestatic liver disease, neonatal intestinal resection
Types
hydrolysed cow's milk
AAs
Soya
don't use if >6mo as has high aluminium content + phytoestrogens
Weaning
from 6mo
start with small quantities of pureed fruit, root veg, rice
if starting before 6mo avoid wheat, eggs + fish
avoid honey before 1yr (botulism)
higher protein + Ig content
in developed countries HIV +ve women recommended not to breastfeed
in developing countries safer to breastfeed so give baby ART
can use NG/OG tube