OB ATI: Chapter 25 – Newborn Nutrition – Flashcards

100 to 140 mL/kg/24 hr. - Newborns do not need to be given water because they receive sufficient water from either breast milk or formula.

110 kcal/kg/day. - From 3 to 6 months, the requirement decreases to 100 kcal/kg/day. Both breast milk and formula provide 20 kcal/oz.

40% to 50% of the newborn's total caloric intake. The most abundant carbohydrate in breast milk or formula is lactose.

fat (triglycerides). The fat in breast milk is easier to digest than the fat in cow's milk.

2.25 to 4 g/kg of protein per day.

iron-fortified cereal and other foods rich in iron. Newborns who are formula fed should receive iron-fortified newborn formula until 12 months of age. Mothers who breastfeed their newborns are encouraged to do so for the newborn's first 12 months of life.

6 months of age. If introduced too early, food allergies may develop.

optimal source of nutrition for newborns. - Breastfeeding is recommended exclusively for the first 6 months of age by the American Academy of Pediatrics. - Newborns should be breastfed every 2 to 3 hr. - Parents should awaken the newborn to feed at least every 3 hr during the day and at least every 4 hr during the night until the newborn is feeding well and gaining weight adequately. ● Colostrum is secreted from the mother's breasts during postpartum days 1 to 3. It contains the IgA immunoglobulin that provides passive immunity to the newborn.

Parents should be presented with factual information about the nutritional and immunological needs of their newborn. The nurse should present information about both breastfeeding and bottle feeding in a nonjudgmental manner. The optimal time to provide newborn nutritional information is during pregnancy, so that the parents make a decision prior to hospital admission.

■ Reduces the risk of infection by providing IgA antibodies, lysozymes, leukocytes, macrophages, and lactoferrin that prevents infections. ■ Promotes rapid brain growth due to large amounts of lactose. ■ Provides protein and nitrogen for neurological cell building and improves the newborn's ability to regulate calcium and phosphorus levels. ■ Contains electrolytes and minerals. ■ Breast milk is easy for the newborn to digest. ■ Breastfeeding is convenient and inexpensive. ■ Reduces incidence of sudden infant death syndrome (SIDS), allergies, and childhood obesity. ■ Promotes maternal-infant bonding.

◯ Place the newborn skin-to-skin on the mother's abdomen immediately after birth. Initiate breastfeeding as soon as possible or within the first 30 min following delivery. ◯ Explain breastfeeding techniques to the mother. Have the mother wash her hands, get comfortable, and have caffeine-free, nonalcoholic fluids to drink during breastfeeding. ◯ Explain the let-down reflex (stimulation of maternal nipple releases oxytocin that causes the let-down of milk). ◯ Reassure the mother that uterine cramps are normal during breastfeeding, resulting from oxytocin, which also promote uterine involution. ◯ Express a few drops of colostrum or milk and spread it over the nipple to lubricate the nipple and entice the newborn. ◯ Show the mother the proper latch-on position. Have her support the breast in one hand with the thumb on top and four fingers underneath. With the newborn's mouth in front of the nipple, the newborn can be stimulated to open his mouth by tickling his lower lip with the tip of the nipple. The mother pulls the newborn to the nipple with his mouth covering part of the areola as well as the nipple. ◯ Explain to the mother that when her newborn is latched on correctly, his nose, cheeks, and chin will be touching her breast. ◯ Demonstrate the four basic breastfeeding positions: football, cradle or modified cradle, across the lap, and side-lying. ◯ Encourage the mother to breastfeed at least 15 to 20 min/breast to ensure that her newborn receives adequate fat and protein, which is richest in the breast milk as it empties the breast. ◯ Avoid educating mothers regarding the duration of newborn feedings. Mothers should be instructed to evaluate when the newborn has completed the feeding, including slowing of newborn suckling, a softened breast, or sleeping. ◯ Explain to the mother that newborns will nurse on demand after a pattern is established. ◯ Show the mother how to insert a finger in the side of the newborn's mouth to break the suction from the nipple prior to removing the newborn from the breast to prevent nipple trauma. ◯ Show the mother how to burp the newborn when she alternates breasts. The newborn should be burped either over the shoulder or in an upright position with his chin supported. The mother should gently pat the newborn on his back to elicit a burp. ◯ Tell the mother to begin the newborn's next feeding with the breast she stopped feeding him with in the previous feeding. ◯ Tell the mother how to tell if her newborn is receiving adequate feeding (gaining weight, voiding 6 to 8 diapers a day, and contentedness between feedings). ◯ Explain to the mother that the newborn may have loose, pale, and/or yellow stools during breastfeeding, and that this is normal. ◯ Tell the mother to avoid nipple confusion in the newborn by not offering supplemental formula, pacifier, or soothers. Supplementation can be provided using a small feeding or syringe feeding, if needed. ◯ Tell the mother to always place her newborn on his back after feedings. ◯ Promote rooming-in efforts. ◯ Offer referral to breastfeeding support groups. ◯ Contact a lactation consultant to offer additional recommendations and support, especially to mothers who have concerns about adequate breast milk or mothers who have been unsuccessful with breastfeeding in the past. ◯ Herbal products, such as fenugreek, and prescription medications, such as metoclopramide (Reglan), have been reported to increase breast milk production. There is insufficient data to confirm or deny their effect on lactation. Mothers should check with the provider before taking over-the-counter or prescription medications.

◯ Inform the mother that breast milk can still be provided to the newborn during periods of separation by using a breast pump. ■ Breast pumps can be manual, electric, or battery-operated and pumped directly into a bottle or freezer bag. ■ One or both breasts can be pumped, and suction is adjustable for comfort. ◯ Teach the parents that breast milk must be stored according to guidelines for proper containers, labeling, refrigerating, and freezing. ■ Breast milk may be stored at room temperature under very clean conditions for up to 8 hr. It may be refrigerated in sterile bottles for use within 8 days, or may be frozen in sterile containers in the freezer compartment of a two-door refrigerator for up to 6 months. Breast milk may be stored in a deep freezer for 12 months. ■ Thawing the milk in the refrigerator for 24 hr is the best way to preserve the immunoglobulins present in it. It also can be thawed by holding the container under running lukewarm water or placing it in a container of lukewarm water. The bottle should be rotated often, but not shaken when thawing in this manner. ■ Thawing by microwave is contraindicated because it destroys some of the immune factors and lysozymes contained in the milk. Microwave thawing also leads to the development of hot spots in the milk because of uneven heating, which can burn the newborn. ■ Do not refreeze thawed milk. ■ Used portions of breast milk must be discarded.

3 to 4 hr. Parents should awaken the newborn to feed at least every 3 hr during the day and at least every 4 hr during the night until the newborn is feeding well and gaining weight adequately. Then, a feed-on-demand schedule may be followed.

◯ Teach the parents how to prepare formula, bottles, and nipples. Review the importance of handwashing prior to formula preparation. ◯ Teach the parents about the different forms of formula (ready-to-feed, concentrated, and powder) and how to prepare each correctly. ◯ Bottles can be put in the dishwasher or washed by hand in hot soapy water using a good bottle and nipple brush. ◯ Teach parents to wash the lid of a can of concentrated formula with hot soapy water before opening it. ◯ Instruct parents to use tap water to mix concentrated or powder formula. If the water source is questionable, tap water should be boiled first. ◯ Instruct parents that prepared formula can be refrigerated for up to 48 hr. ◯ Teach the parents to check the flow of formula from the bottle to ensure it is not coming out too slow or too fast. ◯ Show the parents how to cradle the newborn in their arms in a semi-upright position. The newborn should not be placed in the supine position during bottle feeding because of the danger of aspiration. Newborns who bottle feed do best when held close and at a 45 ̊ angle. ◯ Instruct the mother how to place the nipple on top of the newborn's tongue. ◯ Keep the nipple filled with formula to prevent the newborn from swallowing air. ◯ Always hold the bottle and never prop the bottle for feeding. ◯ Newborns should be burped several times during a feeding, usually after each 1⁄2 to 1 oz of formula or breast milk. ◯ Place the newborn on his back after feedings. ◯ Tell the parents to discard any unused formula remaining in the bottle when the newborn is finished feeding due to the possibility of bacterial contamination. ◯ Teach the parents how to tell if their newborn is being adequately fed (gaining weight; bowel movements are yellow, soft and formed; infant will stool after every feeding, and after a couple of weeks, movements decrease to 1 to 2 per day; voiding 6 to 8 times per day; and satisfaction between feedings).

◯ Newborn factor ■ Inadequate breastfeeding ■ Illness ■ Infection ■ Malabsorption ■ Other conditions that increase the newborn's energy needs ◯ Maternal factor ■ Inadequate or slow milk production ■ Inadequate emptying of the breast ■ Inappropriate timing of feeding ■ Inadequate breast tissue ■ Pain with feeding ■ Maternal hemorrhage ■ Illness ■ Infections

daily in the newborn nursery and then usually at 2 days of age after discharge for newborns who are breastfed and 6 weeks of age for newborns who are formula fed. - Growth is assessed by placing the newborn's weight on a growth chart. - Adequate growth should be within the 10th to 90th percentile. Poor weight gain would be below 10% and too much weight gain would be above 90%.

◯ Hand-to-mouth or hand-to-hand movements ◯ Sucking motions ◯ Rooting ◯ Mouthing

◯ Newborns who are sleepy ■ Unwrap the newborn. ■ Change the newborn's diaper. ■ Hold the newborn upright and turn him from side to side. ■ Talk to the newborn. ■ Massage the newborn's back, and rub his hands and feet. ■ Apply a cool cloth to the newborn's face. ◯ Newborns who are fussy ■ Swaddle the newborn. ■ Hold the newborn close, move, and rock him gently. ■ Reduce the newborn's environmental stimuli. ■ Place the newborn skin to skin. ● Failure to thrive is slow weight gain. A newborn usually falls below the 5th percentile on the growth chart. ◯ Newborns who are breastfeeding ■ Evaluate positioning and latch-on during breastfeeding. ■ Massage the breast during feeding. ■ Determine feeding patterns and length of feedings. ■ If the newborn is spitting up, the newborn may have an allergy to dairy products. Determine the maternal intake of dairy products. The mother may need to eliminate dairy from her diet. Instruct her to consume other food sources high in calcium or calcium supplements. ◯ Newborns who are formula feeding ■ Evaluate how much and how often the newborn is feeding. ■ If the newborn is spitting up or vomiting, he may have an allergy or intolerance to cow milk-based formula and may require a soy-based formula.

D

C

B

C, D, E

D