Upload
basil-wilkinson
View
218
Download
1
Embed Size (px)
Citation preview
Time-Budgets
Feral Horses
Select highest fiber, lowest protein content
70% of its day foraging
Stabled Horses
10% of their day feeding
Meal fed
Digestion is organ specificStarch digestion
occurs in the stomach and
small intestines
(Stomach: 15 min. Small intestine:
30-90 min.)
Fiber digestion occurs in the cecum/colon (48-72 hours)
Amino acids and fat digested and absorbed in small intestine
Vitamins/minerals absorbed in small intestine
8%
30%
62%
9-15 liters
Trickle feeders
Transit time <2 hr
Cardiac sphincter does not relax to allow regurgitation
Stomach
Small Intestine30% of GIT, ~70 ft. long~contains 24 gallons3 Segments
DuodenumJejunumIleum
Starch digestion occurs in the stomach and small intestinesAmino acids and fat digested
and absorbed in small intestineMany Vitamins/minerals absorbed in small intestine
α-Amylase – low & varies widely between horses
Hindgut – 60% of digestive tract capacityCecum –
25-35 litersLarge muscular mixing vatInitiates fermentationBegins protein degradation & B vitamin synthesis
Large Colon50-60 litersContinuation & completion of microbial digestion, absorption of VFA, B vitaminsConservation of electrolytes (Na, Cl, K), absorption of P
Small Colon18-19 litersPrimary function is to conserve water
Large Intestine
Fiber digesters most active pH of 6.2-6.8Starch digesters prefer pH 5.2 – 6.0
Microbial Fermentation
Fibrous &Non-Fibrous
Carbohydrate
Microbe
Volatile Fatty Acids
Gas
B-vitamins & Vit. K
MetabolizedFor
Energy
WastedEnergy
Protein and Amino Acids?
Aspects of The Foal GI Tract
Small digestive tract
The small intestine does not increase in length from 4 wks of age
Cecum not fully functional until 15-24 mo of age
The large intestine increases with age even up to 20 yrs
Total CHO
Non-FiberCarbohydrates
Neutral DetergentFiber
NonstructuralCarbohydrates
Neutral DetergentSoluble Fiber Hemicellulose
Acid DetergentFiber
Sugars
Starches
Pectins
Fructans
β-Glucans
Cellulose
Lignin
Carbohydrates
How Hindgut Acidosis Can Occur In Hindgut And How It Can Be Attenuated
High Grain or High Fructans
Minimal decrease in pH
Significant decreaseIn pH
Increase in VFA&Lactic Acid of
Hindgut
Time ReleasedBuffer
Optimal VFA absorption
Optimal Energy forWorking & Breeding Horses
Decrease in fiber fermenting OrganismsIncrease in lactate producing organisms
Very low pH
Bacterial lyses
SubclinicalAcidosis
Irritation & damageTo intestinal mucosa
Inhibition of fiber fermentingOrganisms & lactateUtilizing organisms
Off FeedDecreased fiber
digestibilityColic Symptoms
Stereotypic Behaviors
Release of endotoxins
LaminitisPagan, J. 2007. Feedstuffs
Ingredient NSC Sugar StarchPectins
Beta-Glucans
% DM -------------------------- % of NSC ---------------------
Alfalfa hay 23.0 0.0 40.9 33.0
Grass hay 17.2 35.4 15.2 49.4
Barley 61.8 9.1 81.7 9.2
Corn 71.4 20.0 80.0 0.0
Oats 42.4 4.4 95.6 0.0
Wheat 73.8 8.9 80.2 10.9
Distillers 10.3 0.0 100.0 0.0
Corn gluten feed 24.7 3.7 71.2 25.1
Corn gluten meal 17.3 0.0 69.4 30.6
Soyhulls 14.1 18.8 18.8 62.4
Soybean meal, 44% 34.4 25.0 25.0 50.0
Wheat midds 31.2 10.0 90.0 0.0
Starch Comparisons (what’s low, what’s high)
Starch Digestion
Critical capacity for hydrolysable carbohydrate overload ~0.4% of BWMaximizing starch digestion in small intestine
Properties of the starch granuleGrain processingPlant cell wallsTransit time through the small intestineAvailability & concentration of enzymes
Cuddeford, D. 1999; Harris et al. 1999
Comparison of Small Intestinal Starch Digestibility of Processed Corn
Whole corn Crushed corn
Ground corn Popped corn
Starch intake (g/kg BW/meal) Morning:evening
1.9:1.0 1.9:1.1 2.1:2.0 1.3:1.5
Preileal starch digestibility (%)
28.9 29.9 45.6 90.1
Processing affects the site of starch digestion.
REMEMBER!“The number one cause of deaths from
colic is from starch overload due to
feeding mismanagement.”Dr. John Reagor, PhDChief of ToxicologyTexas Veterinary Medical Diagnostic Laboratory
Building a Horse RationStart with horse needsMaximize forage Add energy if neededAdd protein & minerals if neededConsider adding vitamins & supplementsConsistency is key to good feeding practices
Feed concentrate that makes-up the difference between nutrients needed & nutrients in roughage
2. Know Your Horse & Provide Feed Based on:
Class
Weight
Body Condition Score
Stage of production
Age
Activity level
Growth
Nutrient Requirement Varies With Class of Horse
Adult (no work)
WorkingLight exercise
Moderate exercise
Heavy exercise
Very heavy exercise
Stallions
Pregnant Mares< 5 mo
5th, 6th, 7th, 8th, 9th, 10th, 11th mo
Lactation1st, 2nd, 3rd, 4th, 5th, 6th mo
Growing 4, 6, 12 mo
18 moLight exercise
Moderate exercise
24 moLight exercise
Moderate exercise
Heavy exercise
Very heavy exercise
3. Feed According to Body Wt. Feed intake usually expressed as
% of Body Weight Lbs feed/100 lbs body weight Free Choice
Forages
Provide fiber & energy
At least 1% of body weight (dm basis)
Concentrates
Provide energy
Supplements
Provide protein, minerals and vitamins
How Much Hay & Grain Should an 800 lb. Yearling Foal Receive?Total Intake:
Forage Intake:
Concentrate Intake:
How Much Hay & Grain (800 lb. Yearling)?Total Intake: 20 pounds
800 x .02 = 16 pounds
800 x .03 = 24 pounds
Forage Intake: 10 pounds800 x .01 = 8 pounds
800 x .015 = 12 pounds
Concentrate: 10 pounds (20 total–10 forage)800 x .01 = 8 pounds
800 x .02 = 16 pounds
4. Know Your ForageForage quality depends on:
Pasture vs hay
Legume vs grass
Cool vs warm season species
Plant maturity
Growing conditions
Harvest conditions
Forages are the FoundationPasture, Hay
GrassBromegrassOrchardgrassTall FescueTimothy
Grain HayOat HayWheat hay
Straw
LegumeAlfalfaBirds Foot trefoilCloversLespedeza
5. Maximize Pasture Production
Fertilize grasses
OverseedFrostseed
Interseed
Rotationally graze
Control weeds
Avoid overgrazing
Correct stocking density
8. Evaluate Hay SubstitutesHandout: Hay Substitutes
Note:
Fed as sole part of diet?
Advantages and disadvantages
Special comments
Compare on cost per pound of Digestible Energy (DE)
Hay SubstitutesHay cubes
Haylage
Beet pulp
Rice bran
Wheat barn
By-products from grain harvest
Straw
Complete Feed with >15%
9. Control Loss by Method of Storing Hay
Square Bales
1. Barn or some kind of permanent structure
2. Tarp with hay stacked off the ground
Round Bales
1. Barn
2. Tarp
3. Sleeves or bonnets
4. Plastic wrap
5. Net wrap
6. Twine wrapped, outside
Round Bale, Hay Storage Losses
Storage Conditions Approximate Dry Matter Losses, %
Outside, on ground, without cover 13-30+Outside, on ground, plastic or tarp cover 8-9Outside, on drained surface, without cover 7-8Outside, on ground, net wrapped 6-7Outside, on ground, full plastic ‘sleeve’ 5-6Outside, drained surface, plastic or tarp cover 5-6Inside bale storage 5
10. Control Hay Loss in Feeding
Method of Feeding % Loss
Unprotected round bales fed free choice on the ground
25
Protected round bales fed in a feeder 5
Square bales fed on the ground 25
Square bales fed in a feeder 5
Control Hay Loss in Feeding Use a container for hay
Hay feeder
Feed bunk
Hay net
Limit the amount of time to access round bales
Feeders should be no higher than shoulder level
11. Feed by WeightNOT Volume
Weights vary by:Feed type
Processing method
So, the amount of energy provided varies
Calculating Nutrients3-lb coffee can full of
32 lb/bushel oats = 2 1/2 lbs
34 lb/bushel oats = 4 lbs
corn or pellets = 5 lbs
Oats = 1.46 Mcal/lb
Corn = 1.76 Mcal/lb
2.5 * 1.46 = 3.65 Mcal
5 * 1.76 = 8.8 Mcal
Hay
Bale 40-130 lbs
10 flakes/bale
Avg 4” flake alfalfa 5 lbs
Avg 4” flake grass 3 lbs
Alfalfa = 1.10 Mcal/lb
Grass = .99 Mcal/lb
5 lbs * 1.10 = 5.5 Mcal
3 lbs * .99 = 2.97 Mcal
Forage Isn’t Everything
Most do not have all the minerals &/or vitamins a horse requires. Four ways to add these.
1. Add 1 to 4 oz mineral or mineral/vitamin supplement per day or
2. Add 1 to 2 lbs ration balancer (mineral plus protein) per day or
3. Feed 5 to 7 lbs fortified grain per day or
4. Feed 12 – 14 lbs complete feed (forage & grain)
12. Evaluate Your Mixed Feed Relative quality of the ingredients
Amount of crude fiber & energy
Price –Cost/pound
Cost/pound of nutrient
Grain Intake Comparison
Energy Sources - Grains
Oatsvariable
crimped vs. whole
Corncracked, steam rolled
Barley
Sorghum & wheatless than 30%
rolled, cracked, flaked,
Fat/Fatty Acids• No gall bladder
Horses can be safely fed up to 20% fat in the total diet Energy from fat is 90% utilizable
Often used to supplement calories for hard-working horses and hard keepers
Reduction in DM intake & bowel weight
Calmer temperament
Protein Muscle & bone growth, milk production, fetal growth, normal metabolismRequirements can be met with good quality hay or pasture forageLow requirements for maintenance Quality = amino acid balance
Very important for young horsesLysine, methionine, tryptophan most limiting for growth & milk production
Minerals Content in the diet
Determined by soil & waterQuality of feed & proportion of grain to hay
Macro-mineralsCa & P - quality forages usually provide adequate amount
This ratio is very important: 1.5:1 to 2:1 Grains are rich in P and low in Ca
NaCl (Salt)Salt block will meet many horse’s needsIf horses sweat a lot - need salt in the ration
Trace MineralsLook for iron, zinc, copper, selenium
MineralsMacro-minerals
– Ca & P - quality forages usually provide adequate amount
This ratio is very important: 1.5:1 to 2:1 Grains are rich in P and low in Ca
– NaCl (Salt)Salt block will meet many horse’s needsIf horses sweat a lot - need salt in the ration
– Trace MineralsLook for iron, zinc, copper, selenium
A guide to the recommended
concentrations of trace elements in
the diet, mg/kg dry matter. (Modified
fromthe NRC 2007).
These will need to be adjusted to suit
individual circumstances, growth rate and
appetite etc.
Vitamins Fat soluble:
- stored in body - A, D, E, K- Toxicity’s can occur if fed in excess
Water soluble: - must be continuously supplied - B-complex; niacin, thiamin, riboflavin
•High quality fresh forages = maintenance for mature horses High quality fresh forages = maintenance for mature horses •Hay is poor in Vit A, supplement Vit A in the rationHay is poor in Vit A, supplement Vit A in the ration•Exposure to sunlight provides Vit DExposure to sunlight provides Vit D•Supplement Vitamin ESupplement Vitamin E
Guide to recommended levels of Fat-soluble vitamins (need to be adjusted according to individual
circumstances).
13. Control Waste in Feeding Grains & Mixes
Use a storage container
Buy a monthly supply
Feed in a containerTrough
Pan
Bucket
14. Do the “Little Things” Feed smaller amounts more often
Feed individually if possible
De-worm regularly
Float the teeth
Provide shelter and bedding
Always have fresh, clean water
Water Essential for all body functions
Temperature regulation
Feed digestion
Amount of water intakeLevel of exercise
Ambient temperature
Quality of feeds in ration
Proportion of diet that is forage
Minimum 1 gallon/100 lbs BW/day
Maintenance Dry matter intake: 1.5-2.0% of the BW
Feed selection
Good quality grass hay → 0.8-0.9 Mcal DE/lb
Alfalfa → 0.9-1.2 Mcal DE/lb
Traditional concentrates (3-3.5% fat) → 1.25 Mcal DE/lb
Fat added (6% Fat) → 1.45 Mcal DE/lb
MaintenancePhysiological Maintenance
2007 NRC
Low Maintenance
DE req. = 30.3 kcal/kg * BW (kg)
CP req. = 1.08 * BW
Average Maintenance
DE req. = 33.3 kcal/kg * BW (kg)
CP req. = 1.26 * BW
High Maintenance
DE req. = 36.3 kcal/kg * BW (kg)
CP req. = 1.44 * BW
Recommended Daily Feed Intakes as % of Body Weights
Class Forage Concentrate Total Example
1,000 lb horse
Mature (Idle) 1.5 - 2.0 0.0 - 0.5 1.5 - 2.0 15-20 lb
Geriatric 0.8 – 2.0 0.5 – 2.0 1.5 – 3.0 15-30 lb
Geriatric Horses Nutrient Considerations
Reduced salivation
CF digestibility ↓
Total fiber < 30%
CP digestibility ↓
12-14% CP
Energy:
Increase soluble carbohydrates, fats, & oils
Caloric Restrictions
Supplement minerals & vitamins including vitamin C
Typical Nutrient Content of some Senior-type Feeds
Crude Protein 12-14%
Crude fat Not less than 5%
Crude fiber Not less than 16%
Lysine 0.6-0.7%
Ca 0.6-1.2%
P 0.4-0.8%
Mg 0.15-0.30%
S 0.15-0.30%
Cu 26-55 ppm
Zn 100-220 ppm
Vit A 1500-3000 IU/lb
Vit E 40-80 IU/lb
Biotin 0.4-0.5 mg/lb
Vitamin B1 (Thiamine) 2.2-2.6 mg/lb
Vitamin C 5-10 g/day
SELECTION OF FEED FOR THE GERIATRIC HORSE
Hay cubes, ground hay, wet down hay
Soft Multiform feed
Moderate fat level - 5% fat
Highly digestible fiber sources
Guaranteed amino acid levels- rebuild muscles
Direct fed microbials & Yeast Cultures
Stabilized high fat rice bran, ground flaxseed, beet pulp
Organic trace mineral complexes – avoid stress from excess mineral intake
Levels of Performance/Work
Light – Recreational riding, beginning of training programs, Show horses (occasional)
Moderate – School horses, Recreational riding, Show horses (frequent), Polo, Ranch
Heavy– Ranch, Polo, Show horses (frequent, strenuous events), Low-medium eventing, Race training (middle stages)
Very Heavy – Racing, Elite 3-day event
Aerobic and Anaerobic Metabolism
During exercise, ATP is generated from breakdown of:
Glucose
Fatty acids
Amino acids
ATP low in muscles; essentially no storageContinuous ATP production vital for athletes
ATP
OxidativeMetabolismLactate
Free Fatty Acids
Creatine Phosphate CO2and
Water
Lipolysis
O2
Simplified Energy for Muscle Contraction
Pyruvate
Blood Glucose
Muscle Glycogen
Energy
Predict substrate used based on type of exercise performed
EnduranceLong term exercise utilizes fatty acids as primary energy source
Needs muscle glycogen as well
RacehorsePredominately uses muscle glycogen stores
Work
ENERGY, ENERGY, ENERGY
Electrolytes & water muscle function and fluid balance
Forage is not enough for 1+ hour/d moderate work. Starch is necessary for replacing glycogen stores.
Required Energy
Activity DE (Mcal/d)
Maintenance 16
Light 20.0
Moderate 23.3
Heavy 26.6
Very Heavy 34.5
• Non-Structural CHO’s•Sugars & starches•↓ intestinal pH & risk of colic
•Fiber•Beet pulp or soy hulls•↓ glycogen usage
•Fat•Protein (minimal usage)
Feeding Guidelines for Performance Horses
Starch is necessary for replacing glycogen stores.Hay
Feed at least 50% of total ration as forage (pasture &/or hay)Preferably high quality grass hay or alfalfa/grass mix
Exercising horses do not need high levels of proteinMore important – quality of protein
Horses should be fed to meet their immediate needsCut grain on rest days
Feeding Guidelines for Performance Horses
Hay requirementFeed at least 50% of total ration as forage (pasture &/or hay)Preferably high quality grass hay or alfalfa/grass mix
Exercising horses do not need high levels of protein
More important – quality of proteinHorses should be fed to meet their immediate needs
Cut grain on rest days
FAT SUPPLEMENTATION• No gall bladder
Max ~20% in total diet Energy from fat is 90% utilizable
Reduction in DM intake & bowel weight
↓ metabolic heat production Improvement of acidemia during
high-intensity exercise Calmer temperament
FAT SUPPLEMENTATIONEnhanced stamina
capacity for uptake & oxidation of fatty acids in muscle Dose dependent in activity of
lipoprotein lipase & skeletal muscle citrate synthase & β-hydroxy acyl-coA dehydrogenase
Concomitant decrease in use of endogenous carbohydrate stores - Muscle glycogen sparing
Min. 3 weeks for responseAdd 6-10 weeks before performance
Open & Barren MaresFlushing- Increasing energy intake 20-25% ~3 wks prior to breeding.
Maintain optimum body condition
Late PregnancyLast 3 months - Unborn foal growth averages 1 lb/day
During the 10th month, the largest amount of mineral retention occurs in the unborn foal
“In the last trimester of pregnancy, the mare should be on a ‘growth- type’ feed formula,”
A balanced feed will decrease severity of orthopedic problems in foals
Feed Consumption (% BW)Mare status
Forage Concentrate Total
Early pregnancy
1.5-2.0 0-0.5 1.5-2.0
Late pregnancy
1.0-1.5 0.5-1.0 1.5-2.0
•Adding concentrate to late pregnancy mares accounts for limited energy & acclimates microbes
•Allow 1 wk to 10 d for mares to adjust to intake changes
Lactating MareMares produce average of 24 lbs (3 gallons) milk/day
High producing mares give as much as 32 lbs (4 gallons) milk/day
Low producing mares often produce 21 lbs (2.5 gallons)
21
22
23
24
25
26
27
28
15 30 45 60 90 120 150
Time (days)
Dai
ly M
ilk P
rodu
ctio
n (lb
s)
Y = a x (d0.0953)x c(-0.0043d)
Y= daily milk yield in kg; a=0.0274287x mature wt in kg & d = day of lactation
Feed Consumption (% BW)Mare status
Forage Concentrate Total
Early lactation
1.0-2.0 1.0-2.0 2.0-3.0
Late lactation
1.0-2.0 0.5-1.5 2.0-2.5
Heavy milkers may require as much as 1.75-2.0% (17.5-20 lbs for a 1000 lb mare) of BW in concentrate feed/day
Approximate Amounts of Grain (lb) Needed with Hay for Broodmares
1100 lb mare 1300 lb mare
DE Req (per lb of feed)
Mcal
Avg Hay lb
Good Hay lb
Avg HayLb
Good HayLb
Barren Mare & 1st 2/3 of pregnancy (maintenance)
1.00 3.0 - 4.0 -
Pregnancy (last 90 days)
1.10 7.0 5.0 8.0 5.0
Lactation (1st 3 months)
1.20 14.0 12.0 16.0 14.0
Lactation (3 months to weaning)
1.10 9.0 6.0 10.0 6.0
Nutrition of the Broodmare. KY Cooperative Extension
Body Condition ScoreReason: Standardized scale for estimating and comparing body fatDeveloped in 1983 by Dr. Don HennekeSystem for assessing subcutaneous fatNine levels of body conditionSix body areas of fat storageUses
ResearchFeed managementHealth management
Body Condition Scoring
1-3 Poor-Thin4 Can see ribs,
vertebra ridge evident5 Back flat, can’t see
ribs, but can feel them6 Crease down back, fat
deposits7-9 Fleshy - Extremely fat
Time & Additional Grain Required To Improve
BCS by 1 level
Improving 1 Condition Score
Days Needed Daily Gain Additional Grain Needed
60 0.75 lbs/day 4.5 lbs/day
90 0.50 lbs/day 3.0 lbs/day
120 0.40 lbs/day 2.3 lbs/day
Body Condition Affects Reproductive Performance
Mare managers should monitor body condition on a regular basis
Mares should be optimum condition for breeding
Body Condition ScoreReproductive performance of mares in varying body condition
Body Condition Cycles per Conception Conception Rate (%)
<4.5 2.8 71
5.0-6.5 1.4 93
>7.0 1.4 96
From Nutrition & Feeding Management of Broodmares
Body Condition ScoreCondition score of 5 or less in milking mares - do not have enough stored fat to support efficient reproductive performance
Mares with BCS of 5 or less
More likely to skip a breeding season
Incidence of embryo loss increase
Body Condition ScoreWeight loss by pregnant mares does not affect foal’s birth weight, but may decrease mare’s colostrum and milk production.
Body Condition ScoreMaximize Reproductive Efficiency
Moderately fleshy to fat mares can be expected toCycle earlier in the year
Have fewer cycles per conception
Have a higher pregnancy rate
Maintain pregnancy more easily
Mare prior to breeding should have a BCS of 6 or greater and fed to maintain weight.
BCS of 5.0 is marginal especially for lactating mare.
Lactating MaresEarly lactation weight loss in mares that foal in thin condition
lengthen rebreeding time
lower conception rates
threaten the subsequent pregnancy
Body Condition ScoreExcess obesity (BCS 8 or <) doesn’t appear to affect pregnancy, foaling ease, foal’s birth weight, or reproductive efficiency.May decrease milk production
Feeding The Growing HorseGoals
Maximize genetic potential for growth
Sound musculoskeletal system
•Nutrient Balance is important•Requires higher quality feeds•Growth rate & age determines requirements•Growing till reach 30 months
Average Daily Gain
0
0.5
1
1.5
2
2.5
3
3.5
0 2 4 6 8 10 12 14 16 18 20 22 24
Month of Age
Avg
. Dai
ly G
ain
, lb
s/d
Rations should be balanced to promote a consistent growth curve
Requires periodic updating of the ration
Nutritional Strategies Aimed at Minimizing DOD
www.Foalcare.com
Amount of Feed Recommended for Growing Horses
Lb grain mix/day/mo of age
Horse Age (mo) Grain mix % in total diet
Lb Grain Mix/100 lbs body wt/d
Ponies Others
Nursing foals
0-4 100 0.5-0.75 .25 1.0
Weanlings 4-12 70 1.7-2.0 0.5 1.5
Yearlings 12-18 60 1.3-1.7 For all age horses feed grain only up to a max. of 0.9 lb/100 lb of anticipated mature wt/day
Long Yearlings
18-24 50 1.0-1.25
Two-year olds
24-36 50 1.0-1.25
Nutritional Strategies Aimed at Minimizing DODFeed selection
High quality forage is a must
Grain mix concentrates formulated specifically for growing horses
Improper use of supplements
Feed amounts
Forage
Minimum of 1 lb / 100 lb BW / d
Fed to appetite is best
Concentrate
~ 1 lb / 100 lb BW / d
Max. 8 to 10 lbs /d
Monitor The Growth Process
Daily Intakes
Body Weight
Average daily gain
Signs of Skeletal Abnormalities
Physitis
Joint effusion
Lameness
Consider..Body condition
Stage of production
Quality of feeds available
Feeding Guidelines & Strategies To Minimize Risk Of Hind Gut Dysfunction
Check for Refusals Change type &
amount of feed gradually. 7-10 d period
Provide Salt
Feeding Guidelines & Strategies To Minimize Risk Of Hind Gut Dysfunction
Feeding Guidelines & Strategies To Minimize Risk
Of Hind Gut Dysfunction
Control amount of NSC (sugar, starch & fructan) the horse consumes. Minimize the flow of fermentable polysaccharide to the large intestine
Feed starch sources little and often i.e., less than 5g oats/(2g starch)/kg body weight/mealPre-feed forages
Feeding Guidelines & Strategies To Minimize Risk
Of Hind Gut Dysfunction
Minimize the flow of fermentable polysaccharide to the large intestine
Limit rate of concentrate intake through physical obstructionMaximize substrate (glucose) availability to the performance horse
Ensure good occlusion of teeth through regular dentistry
Group Feeding Should Account for Dominance Hierarchies
Recognize Feeding-Related Behavior Problems
Feeding Guidelines & Strategies To Minimize Risk Of Hind Gut Dysfunction