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NutritionPeek2007_final

NutritionPeek2007_final - Neonatal and Infant Nutrition Dr...

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Neonatal and Infant Nutrition Dr Russell Peek Paediatric HST Core Training Day Gloucester, 4 th October 2007
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Introduction What does ‘nutrition’ mean to you?
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The OED definition Nutrition (noun) 1. the process of taking in and assimilating nutrients. 2. the branch of science concerned with this process. DERIVATIVES nutritional adj. nutritionist noun. ORIGIN Latin, from nutrire ‘nourish’.
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Textbook answer Nelson’s Textbook of Paediatrics achievement of satisfactory growth and avoidance of deficiency states.
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Aims To explore the knowledge base behind key competencies in nutrition for paediatricians Reference: A Framework of Competences for Core Higher Specialist Training in Paediatrics (RCPCH, 2005.)
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Objectives By the end of this morning, you will understand the effects of fetal growth restriction on short- and long-term health understand the principles and importance of nutrition in the neonatal period including assessment of nutritional status be able to make appropriate recommendations to address feeding problems and faltering growth
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‘Normal’ Nutrition
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Fetal nutrition Parenteral (mostly!) Stores are laid late in gestation At 28 weeks, a fetus has: 20% of term calcium and phosphorus stores 20% of term fat stores About a quarter of term glycogen stores
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Adaptation to nutrition after birth Gut adaptation is regulated by Endocrine factors Intraluminal factors Breast milk hormones and growth factors Bacteria
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Breast is best
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Feeding the term infant Breast feeding achieves Nutrition Immunological and antimicrobial protection Passage of breast milk hormones and growth factors Provision of digestive enzymes Facilitation of mother-infant bonding
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Supplementing breast milk Should be unnecessary, but Vitamin K levels are low Vitamin D levels are low in areas of little sunlight Iron levels are low (but very well absorbed)
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Artificial Feeds Term formulas are broadly similar May be whey or casein based International agreed standards for constituents
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Artificial feeding Practical considerations for making up feeds Water softeners increase sodium content Repeated or prolonged boiling can increase sodium content of water Bottled water can contain high levels of carbon dioxide, sodium, nitrate and fluoride.
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Monitoring feeding Maternal sensation of engorgement and emptying Frequency of feeding Wet nappies Stools Jaundice Weight
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Normal output Daily stool and urine output guidance Day 0 1 wet nappy and meconium at least once a day Day 1 2 wet nappies and meconium at least once a day Day 2 & 3 3 or 4 wet nappies and changing stools at least once a day Day 4+ 5 or 6 heavy wet nappies and yellow stools at least once daily A baby who is passing meconium at 3 or 4 days old may not be getting enough milk.
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