الفهرس 
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Abstract
SUMMARY
The composition of artificial feeds for full-term infant comprises the
following:
• The protein: must be of essential amino acids, and of about 1.5g/1 00
ml of feed.
• Fats: Essential fatty acids are important, and fat content should lie
between 2.3-5 gllOO ml offeed.
• Carbohydrates: mainly lactose and about 4.8-10 gil 00 ml offeed.
• Energy: about 65-75 kcalll 00 ml offeed.
• Water: between 150 & 200 ml/kg/day.
• Macrominerals: Calcium supplementation since birth, and iron after
age of 4 month are particularily important.
• Trace metals: the most important are iodine, ZInC, copper and
manganese.
• Vitamins: supplementation with vitamin A, vito D, vito K, folic acid,
vito C, vito B2 & B6 and vito E are important.
,
Breast milk is of many benefits the most important are:
1- Provision of immunological protection by its immunoglobulins, cells and
effect of gut flora.
2- Provision of nutrients: as follow:
• Proteins: about I gm/IOO ml offeed.
• Fats: high content of essential fatty acids & unsaturated fatty
acids.
Carbohydrates: mainly lactose and about 7 gmll 00 m!’
Minerals: All major minerals are present in high concentration
except iron.
Trace metals: present in good amount including zinc, copper,
iodine and manganese.
• Energy: it provides about 70 kcal/100 m!.
• Vitamins:
- Vit K is low in breast milk.
- Vit D supplementation is needed after age of 16 month for
adequate mineralization of bones.
3- Provision of breast milk hormones and growth factors.
4- Provision of digestive enzymes e.g. milk lipases.
5- Facilitation of mother-infant bonding.
Types of artificial formula:
1- Unmodified cow’s milk.
2- Modern cow’s milk-based formula.
3- Soy formula.
Feeding requirements of preterm & LBW infants comprise the
following:
• Protein: 2-2.25 gm/kg/day apparently well tolerated, where it
comprises about 7-16% of total caloric intake.
• Fats: about 30-55% oftotal calories and about 12% linoleic acid.
• Carbohydrates: about 40% (35-65%) of total calories and mainly
lactose.
• Energy: 120-150 kcal/kg/day to meet and sustain good growth rate.
• Vitamins: preterm infant has higher needs for folic acid, vitoE, vit. D
and other.
• Minerals: preterm require all minerals specially iron which is needed
at 2 mg/kg/day and calcium and phosphorus.
Enteral feeding of preterm baby as regarding:
Method, technique, volume and schedule of feeding and also
tolerance to feeding.
Parenteral nutrition:
It is the parenteral delivery of hyperalimentation solutions containing
the following:
• Water: varies between 60-125 ml/kg/day.
• Carbohydrates: infants < 1000 gm ~ should initially receive no more
than 6 mg/kg/min glucose and 1000-1500g ~ should initially receive no
more than 8 mg/kg/min.
• Proteins: about 2-2.5 gm/kg/day can achieve nitrogen balance but
initial protein load of 0.5-1 gm/kglday is recommended.
• Fats: initial load of 0.5-1 gin/kg/day increased as tolerated to a
maxrmum of 2-3 gm/kglday. And not to exceed 40-50% of the total
calories.
• Electrolytes: Na daily amount 2-4 mEq/kg.
K daily amount 2-3 mEq/kg .
Chloride daily amount 2-3 mEq/kg.
• Minerals: calcium at least 2 mEq/kg/day which IS about 1/3 the
amount that would have been received in utero.
•
• Magnesium requirements 0.25-1 mEq/kg/day.
• Vitamins: the recommended daily dose of MVI-pediatric package
insert differ according to weight as follow:
* Infant weighing less than 1 kg: Not exceed 30% of the vial daily. *
Tnfantweighing 1-3 kg: Not> 65% of the vial daily.
* Infant weighing> 3kg can receive one vial daily. where this
preparation contain multivitamins
Trace elements: the suggested daily intake is
Zinc 300 ug/kg Copper 20 ug/kg
Manganese 2-10 ug/kg Chromium 0.1-0.2 ug/kg
Feeding of High Risk Newborn ”HRN”:
• HRN compnses maternal and foetal related factors, the most
important are preterm & LBW, perinatal asphyxia, infant of diabetic
mother and in born errors of metabolism.
• The nutritional requirements for full term and preterm show
differences based on the route of administration.
• Immediately postnatal he should receive glucose 10% sol. For 24hr-
36hr.
• Enternal nutrition:
* Is advantageous and may be expressed breast milk, or infant
formula with supplementation of preterm & LBW with iron and
multi vitamins.
•
* It may be nipple feeding, or gavage feeding or continuous gastric
feeding Orjejunal feeding.
Parenteral nutrition is needed 111 many circumstances, the most
important are, multiple congenital anomalies in the G.I.T. which interfer
with oral feeding, NEC, postoperative support, some VLBW infants and
severely m,alnourished infant.
Extremely-low-birth weight infants:
* Sodium intake should be restricted.
* Care should be taken against hypertonic dehydration during the lSI
12hr.
* Parenteral nutrition should be initiated within 24-36 hr.
* Minimal trophic feedings does not increase the risk ofNEC, and
may even playa role in its prevention.
Perinatal asphyxia:
* Parenteral nutrition is usually initiated on the second day of life.
* Human milk is preferred or otherwise age-appropriate infant
formula.
* Care is given against aspiration pneumonia specially if brain
damage results.
• Necrotizing enterocolitis:
* Parenteral nutrition plays an important role in the treatment, at least
for 3-5 days in suspected.
* Cases and 7-10 days in proved cases, and 14 days for surgical
intervention.
* Enteral feeding usually fail indicating post-NEC stenosis.
• Preoperative and postoperative care:
* Preoperative nutrition support aims for correction of growth
deficits.
* Postoperative nutrition support should be administered to all
neonates who can’t receive adequate enteral amounts.
* Initiation of enteral feedings should be withheld until paralytic ileus
is resolved.
• Mechanical ventilation:
Lipid emulsions are administered at lower infusion rates and longer
times, usually over a period of 24 hr.
e
* Nasogastric tube feeding are routinely provided either continuous
or intermittent.
• Infant of diabetic mother:
Therapy is mainly preventive by maternal blood glucose control.
Several blood samples obtained after birth and parenteral treatment for
maintenance of carbohydrate homeostasis is required, early administration
of oral feeds at 3 to 4 hours of age may be beneficial guided by blood
glucose measurement before each feed.
• Inborn errors of metabolism:
For each disease management depend on the specific biochemistry
and pathophysiology of the disease .
Thefollowing strategies are required fur nutritional support,
1- Dietary restriction of the precursor for the enzyme block.
2- Replenishing any deficient end product distal to enzyme block.
3- Supplementing compounds that may combine with a toxic metabolite
to promote its excretion.
4- Providing cofactor in therapeutic dose, if possible.
Discharge of the high-risk neonate:
Four categories of high-risk newborn are identified for discharge
planning program which are:
1- Preterm infant
2- Infant who requires technological support.
3-lnfant primarily at risk because offamily issue.
4- Infant with anticipated early death.
The discharge program should have six critical components which are:
1- Parental education.
2- Implementation of primary care.
3- Evaluation of unresolved medical problems.
4- Development of the home care plan.
5- Identification and mobilization of surveillance and support services.
6- Determination and designation of follow-up care.