Premature Infant Nutrition - Oregon Health Science ：早产儿营养-俄勒冈健康与科学.ppt

Nutrition Management of the Premature Infant Melissa Nash, MPH, RD Washington County Field Team melissa_nash@co.washington.or.us Objectives Describe appropriate growth in premature infants, including growth charts. Describe current practices for feeding and supplementation for premature infants. Understand how to better support the breastfeeding premature infant. Recognize potential feeding problems and solutions in premature infants. Newborn Classifications LBW: Low Birth Weight 2500g (5 1/2 lbs) VLBW: Very Low Birth Weight 1500g (3 1/3 lbs) ELBW: Extremely Low Birth Weight 1000g (2 1/4 lbs) Preterm: 37 weeks GA Late Preterm: 34 0/7 – 36 6/7 weeks GA Typical Feeding Progression Gestational Age (Weeks) 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 Pacifier Sucking (non-nutritive suck) Gag Reflex Rooting Reflex Early Intermediate Mature Coordinate Suck, Nutritive Suck Swallow, Breathe TPN for 1-2 weeks as enteral Gradually start breast/ Infant nippling feeds advance via tube bottle per infant cues all feeds Post-Discharge Premature Infant Nutritional Issues Switch from ‘super-milks’ to standard milk Slower growth in follow-up Neonatal period critical for ‘programming’ of development and health Limited information/research on post- discharge nutrition The Underlying Question… “Do you want a smart, tall, fat adult who will die prematurely of cardiovascular disease or a dumb, short, thin adult who will outlive the other?” Richard Schandler, MD Neonatalogist Developmental Origins of Health Disease “Fetal Programming” Under-nutrition during pg LBW are strongly associated with HTN, obesity, insulin resistance and dyslipidemia later in life Combination of poor growth rapid catch-up weight may increase risk Additional research is needed to determine when catch-up growth is “excess growth” What does the research say? Weight Gain Growth Fee