Newborn Newborn NutritionNutrition

Dr Varsha atul Shah Dr Varsha atul Shah

Department of Department of NeonatologyNeonatology

Singapore General Singapore General HospitalHospital

Newborn nutritionNewborn nutrition

Newborns adapt rapidly from a relatively Newborns adapt rapidly from a relatively constant intrauterine supply of nutrients constant intrauterine supply of nutrients to intermittent feeding of milkto intermittent feeding of milk

Normal, full-term newborns double their Normal, full-term newborns double their birth-weight by about 5 months of life and birth-weight by about 5 months of life and triple their birth-weight by 1 year of lifetriple their birth-weight by 1 year of life

Principles of nutritional supportPrinciples of nutritional support From 24/52 to 39/52 gestation fetal growth increases at a From 24/52 to 39/52 gestation fetal growth increases at a

rate of approximately 15 g/kg/D rate of approximately 15 g/kg/D

Term neonates loss about 5 to 10% of their birth-weight Term neonates loss about 5 to 10% of their birth-weight in the first 10 days to 2weeks of lifein the first 10 days to 2weeks of life

Preterm infant loss 10 to 20% of their birth-weight Preterm infant loss 10 to 20% of their birth-weight because of their immature skin and kidneys, regain BW because of their immature skin and kidneys, regain BW by 7-14 daysby 7-14 days

Term infants have sufficient glycogen and fat store to Term infants have sufficient glycogen and fat store to meet energy demands while preterm infants rapidly meet energy demands while preterm infants rapidly deplete their limited endogenous nutrient store and hence deplete their limited endogenous nutrient store and hence become hypoglycaemic and catabolicbecome hypoglycaemic and catabolic

How to assess nutrient How to assess nutrient requirement requirement

in preterm infants?in preterm infants?

Use intrauterine growth chartsUse intrauterine growth charts

Use nutrient accretion rate dataUse nutrient accretion rate data

Nutritional GoalNutritional Goal

To achieve normal growth and To achieve normal growth and developmentdevelopment

Nutrient requirementsNutrient requirements

Energy (EEnergy (Eintakeintake = E = E storedstored + E + Eexpendedexpended + E + Eexcreted excreted ))

Healthy term babies grow well with intake of Healthy term babies grow well with intake of 90-120 90-120

kcal/kg/Dkcal/kg/D

125 - 140 kcal/kg/D125 - 140 kcal/kg/D is the energy required by preterm is the energy required by preterm

infants to achieve a growth rateinfants to achieve a growth rate of 15 g/kg/Dof 15 g/kg/D

Conditions that result in increased energy requirements Conditions that result in increased energy requirements

include; CLD, steroid therapy and infection etcinclude; CLD, steroid therapy and infection etc

Nutrient requirementsNutrient requirements

WaterWater

Infant’s water requirements depend on Infant’s water requirements depend on gestational age, postnatal age and gestational age, postnatal age and environmental conditions (phototherapy, environmental conditions (phototherapy, radiant warmer)radiant warmer)

Term infants ingest Term infants ingest 140-180 mls/kg/D140-180 mls/kg/D of fluid of fluid

Preterm infants may require fluid intake of up to Preterm infants may require fluid intake of up to 200 ml/kg/D in the first week of life. Conversely 200 ml/kg/D in the first week of life. Conversely fluid restriction may be necessary for infants fluid restriction may be necessary for infants with RDS, CLD CHF, PDA or renal insufficiencywith RDS, CLD CHF, PDA or renal insufficiency

ProteinProtein

Recommended allowance:15-20 % of daily caloriesRecommended allowance:15-20 % of daily calories

If energy intake is low, dietary protein cannot be utilized If energy intake is low, dietary protein cannot be utilized

fully for tissue synthesis hence azotemia can occurfully for tissue synthesis hence azotemia can occur

Term infants : 2.2 g/kg/DTerm infants : 2.2 g/kg/D can be achieved can be achieved

through through

VLBW infants: 3-3.5 g/kg/DVLBW infants: 3-3.5 g/kg/D protein supplementprotein supplement

ELBW infants: 3.6-3.8 g/kg/DELBW infants: 3.6-3.8 g/kg/D eg. Promodeg. Promod

FatFat Recommended daily intake: 50% of daily calories for Recommended daily intake: 50% of daily calories for

preterm infants <1750 grams, 30-40% for term and more preterm infants <1750 grams, 30-40% for term and more mature infantsmature infants

Fat intake of > 60% of total calories may lead to ketosisFat intake of > 60% of total calories may lead to ketosis

EFA must be provided in the dietEFA must be provided in the diet

Preterm infants vulnerable to EFA deficiency because of Preterm infants vulnerable to EFA deficiency because of insufficient fat absorption, increased fat requirement and insufficient fat absorption, increased fat requirement and rapid brain growth and myelinization and limited adipose rapid brain growth and myelinization and limited adipose reservesreserves

Fat digestion and absorption is limited in preterm infants Fat digestion and absorption is limited in preterm infants because of bile salt deficiency secondary to reduced because of bile salt deficiency secondary to reduced synthesis and ineffective ileal resorption of bile acidssynthesis and ineffective ileal resorption of bile acids

CarbohydratesCarbohydrates

Carbohydrate constitute 40-50% of total daily caloriesCarbohydrate constitute 40-50% of total daily calories

Almost all the CHO in the human milk and infant Almost all the CHO in the human milk and infant

formula is lactoseformula is lactose

Preterm formula contains 50% lactose and 50% glucosePreterm formula contains 50% lactose and 50% glucose

Intestinal mucosal lactase activity is active by the 28th Intestinal mucosal lactase activity is active by the 28th

week. Glycosidase activity is also active in preterm week. Glycosidase activity is also active in preterm

infants hence these infants tolerate preterm formula infants hence these infants tolerate preterm formula

Minerals Minerals

Accretion of Ca, Phosphorus, Mg and iron is maximal Accretion of Ca, Phosphorus, Mg and iron is maximal at the third trimester of pregnancy. Preterm infants at the third trimester of pregnancy. Preterm infants are prone to mineral deficiency because of this as are prone to mineral deficiency because of this as well as difficulty in estabilizing aedquate enteral well as difficulty in estabilizing aedquate enteral intake of the early weeks of life. The intake of the early weeks of life. The daily daily recommended allowancerecommended allowance for preterm infants : for preterm infants :

Sodium/PotassiumSodium/Potassium : 2-3 mEq/kg/D: 2-3 mEq/kg/D

CaCa : 210 mg/kg/D: 210 mg/kg/D

PhorphorusPhorphorus : 140 mg/kg/D: 140 mg/kg/D

MagnesiumMagnesium : 10 mg/kg/D: 10 mg/kg/D

The quantity of iron in the breast milk is

less compared to infant formula.

VitaminsVitamins

Are essential metabolic cofactorsAre essential metabolic cofactors

Toxicity can occur with fat-soluble vitamin Toxicity can occur with fat-soluble vitamin because it can be stored in the tissuesbecause it can be stored in the tissues

Toxicity with water-soluble vitamin is unusual Toxicity with water-soluble vitamin is unusual because of high renal clearance and low storage because of high renal clearance and low storage capacitycapacity

Vitamin content in breast milk changes with Vitamin content in breast milk changes with course of lactationcourse of lactation

Preterm infants have no reserve for vitamins, Preterm infants have no reserve for vitamins, hence prone to deficiencyhence prone to deficiency

VitaminsVitamins

Daily recommended intake:Daily recommended intake:

Vitamin AVitamin A : 1500 iu/kg/D: 1500 iu/kg/D

Vitamin DVitamin D : 400 iu/kg/D: 400 iu/kg/D

Vitamin EVitamin E : 6-12 iu/kg/D: 6-12 iu/kg/D

Vitamin KVitamin K : 0.5-1 mg: 0.5-1 mg

Trace elementsTrace elements

Are accumulated during the third Are accumulated during the third trimester, hence preterm infants are trimester, hence preterm infants are prone to deficiency statesprone to deficiency states

Most preterm formula have adequate Most preterm formula have adequate amount of trace elements.amount of trace elements.

Types of enteral feedsTypes of enteral feeds Human milk (provides 67 kcal/100 ml)Human milk (provides 67 kcal/100 ml)

Infant formula (provides 67 kcal/100ml)Infant formula (provides 67 kcal/100ml)

Preterm formula (provides 81 kcal/100 Preterm formula (provides 81 kcal/100 ml)ml)

Transitional formulaTransitional formula

Specialized formula eg. PregestimilSpecialized formula eg. Pregestimil

Anti-reflux formulaAnti-reflux formula

Soy formulaSoy formula

Lactose free formulaLactose free formula

Soy protein-based formula is Soy protein-based formula is NOT indicated in:NOT indicated in:

baby <1800gbaby <1800g

Additives to Infant FormulaAdditives to Infant Formula

NucleotidesNucleotides LCPUFAsLCPUFAs TaurineTaurine IronIron PrebioticsPrebiotics Probiotics (bifidobacteria, Probiotics (bifidobacteria,

lactobacillus, saccharomyces, lactobacillus, saccharomyces, streptococcus thermophilus)streptococcus thermophilus)

Enteral feeding methodEnteral feeding method

Breast feedingBreast feeding

Bottle feedingBottle feeding

Oral gastric feedingOral gastric feeding

Naso-gastric feedingNaso-gastric feeding

Transpyloric feedingTranspyloric feeding

Human milkHuman milk It is the preferred milk for term infant It is the preferred milk for term infant

When fortified, it is also the nutritionally optimal When fortified, it is also the nutritionally optimal diet for preterm infantsdiet for preterm infants

Milk produced by women who delivered Milk produced by women who delivered prematurely contains increased amount of protein, prematurely contains increased amount of protein, sodium and zinc but decreased amount of Vitamin sodium and zinc but decreased amount of Vitamin A. The composition changes to approach that of A. The composition changes to approach that of term milk after a few weeksterm milk after a few weeks

Human milk contain factors protective of infection – Human milk contain factors protective of infection – leucocytes, immunoglobulins, lactoferrin, lysozymes leucocytes, immunoglobulins, lactoferrin, lysozymes and complementand complement

Human milkHuman milk Human milk has growth and differentiation factors that may Human milk has growth and differentiation factors that may

promote intestinal maturation (epidermal growth factor)promote intestinal maturation (epidermal growth factor)

Human milk also contain enzymes eg bile salt-stimulated Human milk also contain enzymes eg bile salt-stimulated lipaselipase

Composition of breast milk varies with mother’s health and Composition of breast milk varies with mother’s health and nutritional statusnutritional status

Protein, sodium, mineral and immunoglobulin contents are Protein, sodium, mineral and immunoglobulin contents are highest in colostrum, intermediate in transitional milk and highest in colostrum, intermediate in transitional milk and lowest in the mature milklowest in the mature milk

‘‘Hindmilk’ (milk expressed at the end of a feeding) has the Hindmilk’ (milk expressed at the end of a feeding) has the

highest fathighest fat

AAP Recommendations AAP Recommendations for Breastfeedingfor Breastfeeding

Human milk for all infants from 0-6 monthsHuman milk for all infants from 0-6 months Breastfeeding to begin within 1 hour of Breastfeeding to begin within 1 hour of

deliverydelivery Frequent nursing 8-12x/dayFrequent nursing 8-12x/day No supplements unless medically indicatedNo supplements unless medically indicated Start weaning after 4-6 monthsStart weaning after 4-6 months Introduce each food type graduallyIntroduce each food type gradually Human milk plus solid food from 6-12 monthsHuman milk plus solid food from 6-12 months Reduce milk feeds correspondinglyReduce milk feeds correspondingly

Benefits of BreastfeedingBenefits of Breastfeeding Infant Infant

Nutritional composition-less obesityNutritional composition-less obesity Growth and development-improves cognitive Growth and development-improves cognitive

functionfunction Acute illness-reduces diarrhoea,otitis media, Acute illness-reduces diarrhoea,otitis media,

pneumoniapneumonia Chronic diseases-reduces atopy, allergiesChronic diseases-reduces atopy, allergies

Maternal effectsMaternal effects Body composition and metabolismBody composition and metabolism Reduces breast and ovarian cancerReduces breast and ovarian cancer Reduces perimenopausal osteoporosis and Reduces perimenopausal osteoporosis and

fracturefracture Child spacingChild spacing

Economic factorsEconomic factors

Psychosocial aspects-skin to skin contact, bondingPsychosocial aspects-skin to skin contact, bonding

Contraindications to Contraindications to BreastfeedingBreastfeeding

Miliary TBMiliary TB

Cancer of breastCancer of breast

GalactosemiaGalactosemia

Maternal drug abuseMaternal drug abuse

Maternal medication eg. Maternal medication eg.

chemotherapychemotherapy

Maternal HIV infectionMaternal HIV infection

Problems associated with Problems associated with BreastfeedingBreastfeeding

UnderfeedingUnderfeeding

Vitamin K low- higher incidence of Vitamin K low- higher incidence of hemorrhagic disease of the newbornhemorrhagic disease of the newborn

Iron low- need to supplement if still Iron low- need to supplement if still on full breastfeeding after 6 months on full breastfeeding after 6 months

Prolonged unconjugated Prolonged unconjugated hyperbilirubinemiahyperbilirubinemia

Recognised benefits of breastfeeding include all of

the following EXCEPT:

Lesser risk of haemorrhagic disease of the

newborn.

Nursing Feeding GuidelinesNursing Feeding Guidelines

Choice of nutrition for newborn is in Choice of nutrition for newborn is in accordance to the parent’s wishesaccordance to the parent’s wishes

Breastfeeding should always be Breastfeeding should always be encouragedencouraged

Consult mother before offering Consult mother before offering formula milk to infantformula milk to infant

Feeding of Healthy NewbornFeeding of Healthy Newborn

Full term healthy baby Full term healthy baby requiredrequired

90 – 120 kcal / kg / day90 – 120 kcal / kg / day

Intake of fluid targeted atIntake of fluid targeted at 140 – 180 ml / kg / day140 – 180 ml / kg / day

Benefits of breast milk to the Benefits of breast milk to the babybaby

Breast milk and human colostrum are made for babies Breast milk and human colostrum are made for babies and is the best first foodand is the best first food

Easily digested and well absorbedEasily digested and well absorbed Contains essential amino acids Contains essential amino acids Rich in polyunsaturated essential fatty acidsRich in polyunsaturated essential fatty acids Carbohydrate content in human milk is higher than Carbohydrate content in human milk is higher than

cow’s milkcow’s milk.. Better bioavailability of iron and calciumBetter bioavailability of iron and calcium Lesser risk of haemorrhagic disease of the newbornLesser risk of haemorrhagic disease of the newborn The quantity of iron in the breast milk is less comparedThe quantity of iron in the breast milk is less compared

cow’s milk formulacow’s milk formula..

Problems associated with Problems associated with BreastfeedingBreastfeeding

UnderfeedingUnderfeeding

Vitamin K low- higher incidence of Vitamin K low- higher incidence of hemorrhagic disease of the newbornhemorrhagic disease of the newborn

Iron low- need to supplement if still Iron low- need to supplement if still on full breastfeeding after 6 months on full breastfeeding after 6 months

Prolonged unconjugated Prolonged unconjugated hyperbilirubinemiahyperbilirubinemia

Contraindications to Contraindications to BreastfeedingBreastfeeding

Miliary TBMiliary TB

GalactosemiaGalactosemia

Maternal drug abuseMaternal drug abuse

Maternal medication eg. Maternal medication eg.

chemotherapychemotherapy

Maternal HIV infectionMaternal HIV infection

Nursing Feeding GuidelinesNursing Feeding Guidelines

Choice of nutrition for newborn is in Choice of nutrition for newborn is in accordance to the parent’s wishesaccordance to the parent’s wishes

Breastfeeding should always be Breastfeeding should always be encouragedencouraged

Consult mother before offering Consult mother before offering formula milk to infantformula milk to infant

Benefits of breast milk Benefits of breast milk (contd.)(contd.)

Protects against infectionProtects against infection Prevents allergiesPrevents allergies Better intelligence Better intelligence Promotes emotional bondingPromotes emotional bonding Less heart disease, diabetes and Less heart disease, diabetes and

lymphoma lymphoma

1. Mother infected

4. Antibody to mother’s infection secreted in milk to protect baby

2. WBC in mother’s body make antibodies to protect mother

3. Some WBCs go to breast and make antibodies there

Protection against Protection against infectioninfection

Benefits to motherBenefits to mother

Helps in involution of uterusHelps in involution of uterus Delays pregnancyDelays pregnancy Decreases mother’s workload, saves Decreases mother’s workload, saves

time and energytime and energy Lowers risk of breast and ovarian Lowers risk of breast and ovarian

cancercancer Helps regain figure faster Helps regain figure faster

Benefits to familyBenefits to family

Contributes to child survivalContributes to child survival

Saves moneySaves money

Promotes family planningPromotes family planning

Environment friendlyEnvironment friendly

Anatomy of breastAnatomy of breastMyoepithelial cells

Epithelial cells

ducts

Lactiferous sinus

Areola

Montgomery gland

AlveoliSupporting tissue and fat

Nipple

Physiology of lactation Physiology of lactation

Hormonal secretions in the motherHormonal secretions in the mother Prolactin helps in production of milkProlactin helps in production of milk

Oxytocin causes ejection of milkOxytocin causes ejection of milk

Reflexes in the baby – rooting, sucking Reflexes in the baby – rooting, sucking

& swallowing & swallowing

Prolactin productionProlactin production

Enhanced byEnhanced by How early the baby is put to the breastHow early the baby is put to the breast How often and how long baby feeds at How often and how long baby feeds at

breastbreast How well the baby is attached to the How well the baby is attached to the

breast breast

Prolactin reflexProlactin reflex

Hindered byHindered by Delayed initiation of breastfeedsDelayed initiation of breastfeeds Prelacteal feedsPrelacteal feeds Making the baby wait for feedsMaking the baby wait for feeds Dummies, pacifiers, bottlesDummies, pacifiers, bottles Certain medication given to mothersCertain medication given to mothers Painful breast conditions Painful breast conditions

Enhancing factors Hindering factors

Emptying of breast

Sucking

Expression of milk

Night feeds

Bottle feeding,Incorrect positioning,

Painful breast

Sensory impulse from nipple

Prolactin in blood

Prolactin “milk secretion” Prolactin “milk secretion” reflexreflex

Baby sucking

Sensory impulse from nipple to brain

Oxytocin contracts myoepithelial cells

Oxytocin “milk ejection” reflexOxytocin “milk ejection” reflex

•Thinks lovingly of baby

•Sound of the baby

•Sight of the baby

•CONFIDENCE

•Worry

•Stress

•Pain

•Doubt

Stimulated by Inhibited by

Oxytocin reflexOxytocin reflex

Mother learns to position baby

Baby learns to take breast

Rooting reflex

Swallowing reflex

Sucking reflex

Feeding reflexes in the babyFeeding reflexes in the baby

Composition of preterm and full Composition of preterm and full term milk (g/dl)term milk (g/dl)

3.5

1.0

7.0

Fat

Protein

Lactose

3.5

2.0

6.0

Full Term Preterm

How breast milk composition varies

Colostrum Foremilk Hindmilk

Fat

Protein

Lactose

For successful breastfeedingFor successful breastfeeding

A willing and motivated motherA willing and motivated mother

An active and sucking newbornAn active and sucking newborn

A motivator who can bring both mother and A motivator who can bring both mother and

newborn together ( health professional or newborn together ( health professional or

relative )relative )

Successful breastfeedingSuccessful breastfeeding

Have a written breastfeeding policyHave a written breastfeeding policy

Motivate mother from antenatal periodMotivate mother from antenatal period

Put to breast within 30 minutes of birthPut to breast within 30 minutes of birth

Promote rooming -in of mother and babyPromote rooming -in of mother and baby

Promote frequent breastfeedingPromote frequent breastfeeding

Successful breastfeeding Successful breastfeeding (contd.)(contd.)

Don’t give prelacteal feedsDon’t give prelacteal feeds

Don’t use bottle to feedDon’t use bottle to feed

Support mother in breastfeeding the babySupport mother in breastfeeding the baby

Arrange mother craft classes in health facilitiesArrange mother craft classes in health facilities

Treat breastfeeding problems earlyTreat breastfeeding problems early

Exclusive breastfeeding till 6 monthsExclusive breastfeeding till 6 months

Addition of home-based semisolids after 6 monthsAddition of home-based semisolids after 6 months

Position of baby in relation to Position of baby in relation to the motherthe mother

The baby’s whole body should face the The baby’s whole body should face the mother and be close to hermother and be close to her

The baby’s head and neck should be The baby’s head and neck should be supported, in a straight line with his body, to supported, in a straight line with his body, to face the breastface the breast

Baby’s abdomen should touch mother’s Baby’s abdomen should touch mother’s abdomen, to be as close as possible to his abdomen, to be as close as possible to his mothermother

Signs that a baby is attached Signs that a baby is attached well at the breast well at the breast

The baby’s mouth is wide openThe baby’s mouth is wide open The baby’s chin touches the breastThe baby’s chin touches the breast The baby’s lower lip is curled outwardThe baby’s lower lip is curled outward Usually the lower portion of the Usually the lower portion of the

areola is not visibleareola is not visible

Signs that a baby is attached well at Signs that a baby is attached well at the breast the breast

baby’s mouth is wide openlower lip is curled outward

lower portion of the areola is not visible

chin touches the breast

Treatment of inverted nippleTreatment of inverted nipple

Treatment should begin after Treatment should begin after birthbirth

Syringe suction methodSyringe suction method Manually stretch and roll Manually stretch and roll

the nipple between the the nipple between the thumb and finger several thumb and finger several times a daytimes a day

Teach the mother to grasp Teach the mother to grasp the breast tissue so that the breast tissue so that areola forms a teat, and areola forms a teat, and allows the baby to feedallows the baby to feed

Sore nippleSore nipple

CausesCauses Incorrect attachment : Nipple Incorrect attachment : Nipple

sucklingsuckling Frequent use of soap and waterFrequent use of soap and water Candida (fungal) infectionCandida (fungal) infection

Treatment Treatment Continue breastfeeding and Continue breastfeeding and

correct the position & attachment correct the position & attachment Apply hind milk to the nipple after Apply hind milk to the nipple after

a breastfeed a breastfeed Expose the nipple to air between Expose the nipple to air between

feedsfeeds

Breast engorgement Breast engorgement CausesCauses Delayed and infrequent Delayed and infrequent

breastfeedsbreastfeeds

Incorrect latching of the babyIncorrect latching of the baby

Treatment Treatment Give analgesics to relieve painGive analgesics to relieve pain

Apply warm packs locallyApply warm packs locally

Gently express milk prior to feedGently express milk prior to feed

Put the baby frequently to the Put the baby frequently to the

breastbreast

Causes of “Not enough Causes of “Not enough milk”milk”

Not breastfeeding often enoughNot breastfeeding often enough Too short or hurried breastfeedingToo short or hurried breastfeeding Night feeds stopped earlyNight feeds stopped early Poor suckling positionPoor suckling position Poor oxytocin reflex (anxiety, lack of Poor oxytocin reflex (anxiety, lack of

confidence)confidence) Engorgement or mastitisEngorgement or mastitis

Management of “Not enough Management of “Not enough milk”milk”

Put baby to breast frequentlyPut baby to breast frequently Baby to be correctly attached to breastBaby to be correctly attached to breast Build mother’s confidenceBuild mother’s confidence Use galactogogues judiciously Use galactogogues judiciously

Adequate weight gain and urine frequency 5-6 Adequate weight gain and urine frequency 5-6 times a day are reliable signs of enough milk times a day are reliable signs of enough milk intake intake

Expressed breast milkExpressed breast milkIndicationsIndications Sick mother, local breast problems Sick mother, local breast problems Preterm / sick babyPreterm / sick baby Working motherWorking mother

StorageStorage Clean wide-mouthed container with tight lidClean wide-mouthed container with tight lid At room temperature 8-10 hrsAt room temperature 8-10 hrs Refrigerator – 24 hours, Freezer - 20° C – for Refrigerator – 24 hours, Freezer - 20° C – for

3 months 3 months

Ten steps to successful Ten steps to successful breastfeeding breastfeeding

Every facility providing maternity services and Every facility providing maternity services and care for newborn infants shouldcare for newborn infants should

Have a written breastfeeding policy that is Have a written breastfeeding policy that is

routinely communicated to all health care staffroutinely communicated to all health care staff

Train all health care staff in skills necessary to Train all health care staff in skills necessary to

implement this policyimplement this policy

Inform all pregnant women about the benefits and Inform all pregnant women about the benefits and

management of breastfeeding management of breastfeeding

Ten steps to successful Ten steps to successful breastfeeding breastfeeding

(contd….)(contd….) Help mothers initiate breastfeeding within half Help mothers initiate breastfeeding within half

hour of birthhour of birth Show mothers how to breastfeed, and how to Show mothers how to breastfeed, and how to

maintain lactation even if they are separated maintain lactation even if they are separated

from their infantsfrom their infants Give no food or drink, unless medically Give no food or drink, unless medically

indicatedindicated Practice rooming-in : allow mothers and infants Practice rooming-in : allow mothers and infants

to remain together 24 hrs a dayto remain together 24 hrs a day

Encourage breastfeeding on demandEncourage breastfeeding on demand Give no artificial teats or pacifiers (also Give no artificial teats or pacifiers (also

called dummies or soothers) to called dummies or soothers) to breastfeeding infantsbreastfeeding infants

Foster the establishment of Foster the establishment of breastfeeding support groups and refer breastfeeding support groups and refer mothers to them on discharge from the mothers to them on discharge from the hospital.hospital.

Ten steps to successful Ten steps to successful breastfeeding breastfeeding

(contd….)(contd….)

Bottle FeedingBottle Feeding

Parents can share caring for newbornHigher incidence of allergic reaction(cow)Problem with powder concentrationCow milk not acceptable for infant feeding.Too much protein,calcium,phosphate, sodium, potassium

Parenteral Nutrition (PN)Parenteral Nutrition (PN)

Infused via peripheral or central vein

Indication:When extended period >7days of inability to take enteral feedings