Neonatal Nutrition

Nutrition Requirement in Neonates

  1. Initial weight loss up 10% normal
  1. Begin to regain weight by day 5
  1. Up to 2wks to regain birth weight
  1. Double birth weight by 6 months
  1. Monitor growth using centile charts
  1. Require 100kcal/kg/day to grow

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Centile charts

Skin to Skins 5B's

  1. Breathing (and heart rate)
  1. Blood glucose
  1. Bonding
  1. Bacteria
  1. Breastfeeding

Positive impact on cardiorespiratory stability

Associated with oxytocin release, also of benefit to non-birthing partner

Acquisition of microbiome

More likely to initiate maintain breastfeeding

Temporarily 0.6mmol/L higher

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Anatomy of Breast

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Glandular tissue

Appox 20 lobes

Lobe Contents

Alveoli

Lactiferous tubules

Milk ducts

Grape like clusters whihc produce milk

Small ducts, connect alveoli

Extend from tubule, open onto the nipple

Lactogenesis

Lactogenesis I

After 16wk lactation occurs colostrum accumulates and alveoli become distended

Lactogenesis II

Triggered by placental expulsion, falling progesterone and oestrogen levels and presence of prolactin

Colostrum → Transitional milk → mature breastmilk

Hormonal control

  1. Oxytocin from post pituitary: Milk ejection relfex - contractnio of the myoepithelial cells
  1. Prolactin: Anterior Pituitary gland inhibited by progesteron
  1. Galactopoiesis / Lactogenesis III

Switches to autocrine (hypothalamic) control
Prolactin released with nipple stimulation and removal of mil
Min 8 feed per 24 required to prevent decline of prolactin

  • Early frequent feeding stimulates faster increase in milk output because it stimulatesreceptors to prolactin in the mammary glands
  • Removal of mil facilitates continued production
  • Milk contains whey protein - Feedback inhibitor of lactation (FIL)
  • Rate of milk synthesis speeds up when mil remove and less FIL

Preparing to Breast Feed

Antenatal education

Link with voluntary groups

IBCLC

Discuss with medical team / pharmacy

Identification of risk factors

Consider antenatal expression of milk

Risk Factors for Suboptimal Lactogenesis

  1. Diabetes
  1. Hypothyroid
  1. Obesity
  1. Assisted reproduction
  1. PCOS
  1. PReterm labour
  1. LSCS
  1. Retained placenta
  1. Post partum haeorrhage
  1. Primiparous
  1. Previous delayed / failed lactogenesis
  1. Delay in initiation of feeding
  1. Infrequent feeding
  1. Breast surgery
  1. Insufficienct mammary gland tissue

Advantages of Breastfeeding

Baby

Protects against infx

Less constipation

Less SIDS

More varied diet

Protection against atopic disease

Better brain growth and development

Microbiome

Less obesity and CV disease

Breastfeeder

Uterine involution

Bonding

Reduce risk of breast and ovarian cancer

Reduced risk of diabetes

REduced osteoporosis

More convient

Better quality sleep

500kcal a day

Term breast milk Composition

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Micorobes

10,000-1,000,000 microbes

Approx 50% microbial diversity from 9 core types

50% other types of microbes

Microbial make-up could be unique

Human Milk Oligosaccharides

3rd largest solif component of human milk (lactose and lipids)

200 known types

Minimally digested - metabolsied in colon or excreted

Vaginal brith seesds gut - HMO acts as anti adhesives

Legal Protection of Breastfeeding

Equal Status Act 2000-15

Prohibition of direct and indirect discrimination, victimisation or harassment

1hr per working day to epxress / feed

Up to age of 2years

WHO International Code of Marketing of Breast Milk Substitutes 1981

Modulate cell response - allergy

How to Help

No advertising of formula milk, bottles, teats or solid food for babies under 6 months

Restrict influence of commercial interest

Do not restrict provision of factual info

Impartiality

Supportive language

Any breastfeeding is beneficial

Formula may be necessary

Improve breastfeeding

Position

Frequent feeding

Improving latch

Breast compressions

Reverse tissue softening

Nipple shield

Appropiate help and advice

Refer to physio if torticollis / plagiocephaly

Frenotomy may be beneficial - not without lactation support

Using pumo to exoress milk may help increase supply - baby not latching

Encourage skin to skin time

Additional milk

Expressed breast milk

Via syringe for small amount

Paced bottle feeding

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