Professor Joseph HADDAD Pediatric Department Saint George Univ Hosp Balamand Univ Beirut Lebanon

Transcription

1 Nutrition & Growth in Premature Infant Professor Joseph HADDAD Pediatric Department Saint George Univ Hosp Balamand Univ Beirut Lebanon

2 PART ONE : THE GROWTH OF THE PREMATURE INFANT ARE WE ON THE RIGHT TRACK?

3 REFERENCE CHART GROWTH FOR PREMATURE

4 REFERENCE CHART GROWTH FOR PREMATURE

5 WHAT ABOUT PREMATURE IN NICU? GROWTH VEL INCREASED FROM 2OO3 TO 2013

6 PERCENTAGE OF INFANT DISCHARGED LESS THAN 10 % PERCENTILE DECREASED FROM 2003 TO 2013 BUT STILL 30 % REMAINED GROWTH RESTRICTED EXTRAUTERINE GROWTH RESTRICTION

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8 AT DISCHARGE

9 AT 4 YEARS

10 AT 23 YEARS

11 TAKE HOME MESSAGE 0NE PREMATURITY + INTRAUTERINE GROWTH RESTRICTION + EXTRAUTERINE GROWTH RESTRICTION GROWTH IMPAIRMENT + NEURODEVELOPMENTAL DELAY + METABOLIC SYNDROM

12 PART TWO : THE OPTIMAL NUTRITION FOR A PREMATURE INFANT TO AVOID EXTRA UTERINE RESTRICTION

13 3 rd PHASE 2 ND PHASE AVOID EUGR 1rst PHASE REGAIN BIRTH WEIGHT

14 1rst PHASE REGAIN BIRTH WEIGHT *DECREASE INSENSIBLE WATER LOSS *DECREASE INSENSIBLE INTRACELLULAR FLUID LOSS *EARLY POSITIVE NITROGEN BALANCE *EARLY PARENTERAL NUTRITION *MINIMAL ENTERAL NUTRITION

15 EARLY PARENTERAL NUTRITION TIME TO REGAIN BIRTH WEIGHT

16 EARLY PARENTERAL NUTRITION NO INCREASES IN MORTALITY OR MORBIDITY

17 EARLY PARENTERAL NUTRITION

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19 MINIMAL ENTERAL NUTRITION

20 MINIMAL ENTERAL NUTRITION

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22 TAKE HOME MESSAGE TWO TO REGAIN BIRTH WEIGHT AS SOON AS POSSIBLE WITHIN 10 TO MAX 15 DAYS *EARLY PARENTERAL NUTRITION *MINIMAL ENTERAL NUTRITION

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27 TAKE HOME MESSAGE TWO BIS TO ENSURE A BETTER BRAIN GROWTH DURING THE FIRST 15 DAYS *EARLY PARENTERAL NUTRITION *MINIMAL ENTERAL NUTRITION *HIGH ENERGY INTAKE *BREAST MILK

28 2 ND PHASE OPTIMIZING ENTERAL NUTRITION Weight 20 g/day Length 1 cm/week HC 0.7 cm /week MEET ENERGY REQUIREMENT FOR GROWTH TO AVOID Extra Uterine Growth Retardation

29 GAIN WEIGHT > 20 G/DAY IS THE BEST FOR A BETTER DEV

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31 3 RD PHASE THE CATCH UP GROWTH POST DISCHARGE NUTRITION TO ENSURE A THOUROUGH FOLLOW UP ON GROWTH

32 FOLLOW UP ON GROWTH CORRECTION FOR GA WEIGHT THROUGH 24 MONTHS HEIGHT THROUGH 40 MONTHS HC THROUGH 18 MONTHS

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36 PART 3 : ENTERAL NUTRITION OF THE PRETERM WHAT IS THE BEST? BREAST FEEDING FORMULA ENRICHED OR NOT

37 BREAST MILK IS THE BEST FOR NUTRITION OF PREMATURE INFANT IMMUNITY COGNITION

38 BREAST MILK IS THE BEST FOR NUTRITION OF PREMATURE INFANT IMMUNITY

39 BREAST MILK IS A MUST IMMUNITY

40 IMMUNITY

41 L A C T O S E HMO > 200 STRUCTURES SYNTHETHIZED IN MAMMARY GLANDS ONLY DURING LACTATION IMMUNITY

42 Human Milk OligoSaccharides = Natural PREBIOTIC

43 IMMUNITY HMOS 43

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45 BREAST MILK IS THE BEST FOR NUTRITION OF PREMATURE INFANT COGNITION

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53 BREAST MILK IS THE BEST FOR NUTRITION OF PREMATURE INFANT IS THERE A NEED FOR PHM FORTIFICATION? FOR A BETTER GROWTH

54 IS THERE A NEED FOR PHM FORTIFICATION? PROTEIN VIT D DHA IRON

55 Nutrient Requirement of Premature & Protein (+ kcals) is the principal determinant of growth Aim is to support intrauterine rate of weight gain Digestion, absorption and metabolism limited by immaturity of organs ESPGHAN 2010 Recommendation of two different protein intakes Preterm babies <1000 g g/100 kcal g/kg/day Preterm babies g g/100 kcal g/kg/day LBW FOR PROTEIN

56 IS THERE A NEED FOR PHM FORTIFICATION? PROTEIN

57 IS THERE A NEED FOR PHM FORTIFICATION? PROTEIN

58 IS THERE A NEED FOR PHM FORTIFICATION? PROTEIN

59 EFFECT ON WEIGHT GAIN

60 EFFECT ON LENGTH GAIN

61 EFFECT ON HEAD GROWTH

62 NO EFFECTS ON

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64 IS THERE A NEED FOR PHM FORTIFICATION? Wide Variation in Human DHA % Total FA Milk DHA Due to Diet Median 0.32%* Canada US Australia UK Mexico China Chile Philippines Japan Yuhas R, et al. Lipids. 2006;41: *Brenna JT et al. Am J Clin Nutr. 2007;85:

65 IS THERE A NEED FOR PHM FORTIFICATION? DHA

66 IS THERE A NEED FOR PHM FORTIFICATION? DHA

67 RISK OF OSTEOPENIA TERM FORMULA ENRICHED POST DISCH FORMULA

68 If a baby was born prematurely they may not have had enough time to get iron from their mother during the last few weeks of pregnancy IRON SHOULD BE SUPPLEMENTED WHEN PREMATURE ARE FED BREAST MILK

69 TAKE HOME MESSAGE THREE TO ENSURE AN APPROPRIATE GROWTH IN THE SECOND PHASE THE USE OF BREAST MILK FORTIFIED BY PROTEINS AND DHA AND VIT D IS RECOMMENDED along with IRON SUPPLEMENTATION

70 3 RD PHASE THE CATCH UP GROWTH POST DISCHARGE NUTRITION IF BREAST MILK MILK IS NOT AVAILABLE

71 ENTERAL NUTRITION OF THE PRETERM FORMULA ENRICHED OR NOT? THE DEBATE! STANDARD FORMULA PRETERM FORMULA POST DISCHARGE FORMULA

72 PROTEINS ENERGY STANDARD FORMULA PRETERM FORMULA POST DISCHARGE FORMULA g/100 ml Kcal /100ml g/100 ml 80 K cal /100ml g/100 ml 74 K cal /100ml

73 POST DISCHARGE FORMULA WEIGHT 9 months 18 months STANDARD FORMULA 2016

74 POST DISCHARGE FORMULA LENGTH 9 months 18 months STANDARD FORMULA 2016

75 PRETERM FORMULA WEIGHT LENGTH 12 & 18 M 18 M STANDARD FORMULA H C 6 to 18 M 2016

76 CONCERNS ABOUT RAPID GROWTH AND CATCH UP EARLY GROWTH & LATER MORBIDITIES BARKER THE THRIFTY PHENOTYPE HYPOTHESIS TWO SCENARIOS PREGNANCY NEONATAL & POST LUCAS -SINGHAL THE GROWTH ACCELERATION HYPOTHESIS THE METABOLIC SYNDROME

77 NUTRITION &DEVELOPMENT UNDERNUTRITION FIRST WINDOW OF OPPORTUNITY 1000 DAYS OVER NUTRITION

78 Dysbiosis