Nutrition Management for LBW Babies
Nutrition Management for Low Birth Weight Babies
Basic Principles
- Goals of Nutritional Support:
- Achieve growth similar to intrauterine rates
- Prevent postnatal growth restriction
- Support optimal neurodevelopment
- Prevent nutritional deficiencies
- Growth Targets:
- Weight gain: 15-20 g/kg/day
- Length increase: 0.8-1.0 cm/week
- Head circumference: 0.5-0.8 cm/week
Nutritional Requirements
Energy Requirements
- Total Energy:
- 110-135 kcal/kg/day for LBW
- 130-150 kcal/kg/day for VLBW
- 140-160 kcal/kg/day for ELBW
- Components:
- Basal metabolism: 50-60 kcal/kg/day
- Growth requirements: 20-30 kcal/kg/day
- Activity: 15-20 kcal/kg/day
- Thermal regulation: 10-15 kcal/kg/day
Protein Requirements
- Daily Needs:
- 3.5-4.0 g/kg/day for ELBW
- 3.0-3.5 g/kg/day for VLBW
- 2.5-3.0 g/kg/day for LBW
- Protein-to-Energy Ratio: 3.0-4.0 g/100 kcal
Carbohydrate Requirements
- Glucose requirements:
- Initial: 4-6 mg/kg/min
- Maximum: 12-13 mg/kg/min
- Total carbohydrates: 10-14 g/kg/day
Lipid Requirements
- Daily needs: 3.0-4.0 g/kg/day
- Essential fatty acids: 3% of total calories
- DHA and AA supplementation
Feeding Strategies
Initial Assessment
- Risk Factors:
- Gestational age
- Birth weight
- Clinical stability
- Maternal factors
- Feeding Readiness Assessment:
- Respiratory status
- Hemodynamic stability
- GI function
- Neurological status
Feeding Protocols
- Trophic Feeding:
- Starting volume: 10-20 mL/kg/day
- Duration: 3-5 days
- Monitoring tolerance
- Feed Advancement:
- Standard protocol: 20-30 mL/kg/day
- Conservative protocol: 10-20 mL/kg/day
- Target volume: 150-180 mL/kg/day
Parenteral Nutrition Management
Early Parenteral Nutrition
- Initiation:
- Start within first 24 hours
- Amino acids: 2-3 g/kg/day initially
- Lipids: 1-2 g/kg/day initially
- Glucose: 4-6 mg/kg/min
- Advancement:
- Protein: Increase by 0.5-1.0 g/kg/day
- Lipids: Increase by 0.5-1.0 g/kg/day
- Glucose: Increase by 1-2 mg/kg/min daily
Micronutrient Supplementation
- Vitamins:
- Fat-soluble vitamins
- Water-soluble vitamins
- Vitamin K prophylaxis
- Minerals:
- Calcium: 1.5-2.0 mEq/kg/day
- Phosphorus: 1.5-2.0 mmol/kg/day
- Magnesium: 0.3-0.4 mEq/kg/day
- Trace elements
Enteral Nutrition Protocols
Human Milk Feeding
- Benefits:
- Reduced NEC risk
- Improved neurodevelopment
- Enhanced immunity
- Better feed tolerance
- Fortification:
- When to start: 100 mL/kg/day
- Types of fortifiers
- Monitoring protocols
Formula Feeding
- Types of Formula:
- Preterm formula
- Post-discharge formula
- Special formulas
- Selection Criteria:
- Weight category
- Gestational age
- Clinical condition
Nutritional Monitoring
Growth Assessment
- Anthropometric Measurements:
- Daily weight
- Weekly length
- Weekly head circumference
- Growth velocity calculations
- Growth Charts:
- Fenton charts
- WHO growth charts post-term
Biochemical Monitoring
- Regular Assessments:
- Electrolytes
- Blood glucose
- Blood gases
- Calcium/Phosphorus
- Protein/Albumin
- Specific Markers:
- BUN/Creatinine
- Liver function tests
- Alkaline phosphatase
- Vitamin D levels
Nutritional Complications
Common Issues
- Feed Intolerance:
- Gastric residuals
- Abdominal distension
- Vomiting
- Metabolic Complications:
- Hyperglycemia
- Hypoglycemia
- Metabolic bone disease
- Electrolyte imbalances
Prevention Strategies
- Standardized feeding protocols
- Regular monitoring
- Early identification of issues
- Prompt intervention
Disclaimer
The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.
