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Nutrition Through the Life Cycle (...

6th Edition
Judith E. Brown
ISBN: 9781305628007

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Nutrition Through the Life Cycle (...

6th Edition
Judith E. Brown
ISBN: 9781305628007
Textbook Problem

Premature Birth in an At-Risk Family

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Erica is a former 27-week female, birthweight 1.14 kg, and birth length 38.0 cm; his weight, length, and head circumference measurements were appropriate for age. She was born to a 32-year-old woman with hypercholesterolemia and a pre-pregnant BMI of 18. This was her second pregnancy; she and her husband also have an 20-month-old daughter.

Respiratory support and parenteral feeds of amino acids and dextrose were initiated on the day of delivery. The day after birth, small volumes of mother’s own breast milk were introduced via orogastric tube but were discontinued because of suspected intolerance. Breast milk was reintroduced three days later and Erica’s mother had a very good milk supply.

There were multiple occurrences of abdominal distension and periods when enteral feeds were put on hold. Erica’s tolerance to fortified breast milk feeds slowly improved, and fortified feeds of breast milk were initiated at 18 days of age. Erica received parenteral nutrition for a total of 20 days. She was diagnosed with anemia of prematurity, and received two blood transfusions during her stay.

Throughout this time, Erica’s weight and length progressed appropriately. Her head circumference showed minimal growth over a 3-week period. The concentration of her feeds was increased to 26 calories per ounce. Because of suspected gastroesophageal reflux, the volume of her feeds were decreased and feeding concentration increased to 28 calories per ounce. Mom continued to provide breast milk for all of Erica’s feedings.

Breastfeeding was initiated when Erica was 33 weeks postmenstrual age. Respiratory support was discontinued at 36 weeks postmenstrual age. At 37 weeks postmenstrual age, she was bottle feeding and breastfeeding well and no longer needed tube feedings.

Erica had a 105-day stay in the NICU. She remained anemic, and iron and multivitamin supplements were continued at discharge. The recommended discharge feeding plan was comprised of ad lib breastfeeding/expressed breast milk and supplemental feeds of 22 caloric post-discharge formula daily. At time of discharge, Erica’s weight, length and head circumference were at the 50th percentile on the Fenton growth chart for preterm infant girls. Her mom’s milk supply continued to be very adequate; and Erica was breastfeeding well. She was enrolled in the Early Intervention Program and was achieving appropriate developmental skills for her corrected age. Complementary foods were introduced at 6 months corrected age. At 9 months corrected age she transitioned off supplemental feeds of post-discharge formula to exclusive feeds of breast milk and breastfeeding. Erica continued to meet nutrition and growth goals. At 15 months of age, Erica’s corrected age was 12 months and all of her growth measurements were above the 50th percentile for corrected age.

What effects did Erica's preterm birth have on her nutrition and feedings? On her growth?

Summary Introduction

To determine: The effects of preterm birth of Person E on her nutrition and feeding.

Introduction: Preterm birth is defined as birth of infants before 37 weeks of pregnancy. The preterm birth can be subcategorizing based on gestational age such as extremely preterm (> than 28 weeks), very preterm birth (28-32 weeks), moderate-late (32-37 weeks). Preterm birth occurs due to multiple pregnancies, chronic conditions, and infections.

Explanation

Person E is a former 27-week female infant, weighed 1.14 kg, birth length 38 cm, and other body measurement were appropriate for age. Her mother was 32-year-old women with pre-pregnant BMI of 18 and hypercholesterolemia. Person E’s mother have a 20-month-old daughter and this was her second pregnancy.

Because of Person E’s preterm birth, medical assistance was given to her including respiratory support, parenteral feeds on the day of delivery. It was followed by breast milk supply through orogastric tube which was discontinued due to suspected intolerance. She received blood transfusions due to the anemia of prematurity. Her mom continued to provide breast milk and her weight and length increased progressively. Her feed concentration was increased up to 26 calories per ounce. Due to the suspected gastroesophageal reflex, the feed volume was decreased and feeding concentration was increased up to 28 calories per ounce. Around 37th week, she was bottle feeding and breast feeding well and milk supply was continued. For her development for corrected age, she was enrolled in Early Intervention Program. At six months of corrected age, complementary foods were introduced and at nine months of her corrected age she transitioned off to exclusive feeds of breast milk and breast feeding. At 15 months, her corrected age was 12 months with all her growth measurements above 50th percentile for corrected age.

Nutrition and infant feeding plays a key role in growth, neurodevelopment, conditioning, and survival of neonates for long-term health. The effects of preterm birth of Person E on her nutrition and feeding are as follows:

  • • Breast milk of mother or donor is needed to be fortified to meet the nutritional need of very and extremely preterm baby.
  • • Certain gastrointestinal conditions of neonates such as decreased gut motility, gastrointestinal reflux, and impaired absorption interferes with feeding preterm infants.
  • • The coordination of suck-swallow-breathe pattern in preterm infants does not occur until 32-34 weeks of postmenstrual age. So different feeding methods like gavage feeding are selected until they achieve successful bottle or breast feeding.
Summary Introduction

To determine: The effects of preterm birth of Person E on her growth.

Introduction: Preterm birth is defined as birth of infants before 37 weeks of pregnancy. The preterm birth can be subcategorizing based on gestational age such as extremely preterm (> than 28 weeks), very preterm birth (28-32 weeks), moderate-late (32-37 weeks). Preterm birth occurs due to multiple pregnancies, chronic conditions, and infections.

Explanation

Person E is a former 27-week female infant, weighed 1.14 kg, birth length 38 cm, and other body measurement were appropriate for age. Her mother was 32-year-old women with pre-pregnant BMI of 18 and hypercholesterolemia. Person E’s mother have a 20-month-old daughter and this was her second pregnancy.

Because of Person E’s preterm birth, medical assistance was given to her including respiratory support, parenteral feeds on the day of delivery. It was followed by breast milk supply through orogastric tube which was discontinued due to suspected intolerance. She received blood transfusions due to the anemia of prematurity. Her mom continued to provide breast milk and her weight and length increased progressively. Her feed concentration was increased up to 26 calories per ounce. Due to the suspected gastroesophageal reflex, the feed volume was decreased and feeding concentration was increased up to 28 calories per ounce. Around 37th week, she was bottle feeding and breast feeding well and milk supply was continued. For her development for corrected age, she was enrolled in Early Intervention Program. At six months of corrected age, complementary foods were introduced and at nine months of her corrected age she transitioned off to exclusive feeds of breast milk and breast feeding. At 15 months, her corrected age was 12 months with all her growth measurements above 50th percentile for corrected age.

The effects of preterm birth of Person E on her growth are as follows:

  • • Preterm birth causes decreased feeding and slower nutritional uptake, which in turn leads to the slower growth rate of preterm infants.
  • • The growth would be slower but should be steady increase. The growth charts should be used to access the growth rates of infants.

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