Young moms.
There is some anxiety about feeding a newborn.
Babies can't speak.
Moms don't know either.
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Moreover, newborns are more delicate.
I'm afraid I'll hurt him if I'm not careful.
So in the process of feeding the newborn baby.
Mothers have a lot of doubts.
The following health jun will answer for you.
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According to the theory of nutritional programming, the formula and feeding method used in the early years of life have a profound impact on the life of the baby.
All authoritative guidelines, including official guidelines and expert consensus, strongly recommend that exclusive breastfeeding should be initiated immediately after birth, including preterm infants, at least until 6 months of age, and can continue until 2 years of age (with the addition of necessary complementary foods), which has an immeasurable effect on the physical growth and mental development of children and even long-term health.
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Breastfeeding should also be advocated and encouraged in preterm infants, but simple breastfeeding of small preterm infants cannot meet their needs for protein and multiple nutrients for rapid growth, and should be fed in the form of breast milk + breast milk fortifier.
Newborns who have been assessed by a professional physician and are unable to breastfeed can be fed with different formulas (milk) to ensure adequate nutrient intake.
For example, standard general infant formula, preterm infant in-hospital formula, post-discharge preterm infant formula or transitional formula for preterm infants, hydrolyzed protein formula, amino acid formula, lactose-free and lactose-low formula, and other special formulas for children with metabolic diseases.
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Feeding method
Oral feeding is a normal way of feeding for newborns, and those who can eat orally should be encouraged to feed directly, which has great benefits for maintaining the physiological function of the digestive system.
Oral feeding is suitable for newborns at 32 to 34 weeks gestational age, and full-term infants at 37 weeks can receive adequate oral feeding except for patients with serious diseases
34 Newborns at 36+6 weeks are called late preterm infants, which can basically be fed directly by mouth
32 Newborns between 34 weeks of age need to choose a safe and reliable feeding method depending on their vitality and coordination of sucking, swallowing and breathing, and cannot be generalized;
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32-week premature infants have poor sucking and swallowing function in the early postnatal period, insufficient gastrointestinal motility, and are prone to regurgitation, choking, inhalation and even hypoxic bruising, resulting in suffocation.
Newborns who can directly suck breast milk can breastfeed as needed, and those who cannot feed directly can let the mother express or pump the milk and feed it with a dropper or spoonPeople who are breastfeeding can choose to be fed with a variety of formulas.
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Patients who cannot be fed orally but have good gastrointestinal digestion and absorption function, such as premature infants, oropharyngeal malformations, esophageal tracheal fistulas, endotracheal intubation, mechanical ventilation, and patients with frequent convulsions or coma due to central nervous system lesions, can be fed by feeding tube.
What Yangshengjun wants to introduce here is gastric tube feeding, which is inserted into the stomach tube from the mouth or nose cavity, and then injected through the stomach tube. Pay attention to aspirate gastric juice before each milk injection, observe whether there is gastric retention, if there is more gastric retention, the amount of feeding should be reduced or a meal should be stopped, and there are also those who believe that those without obvious abdominal distension do not need to increase the amount of residual milk each time and increase the irritation of the stomach and even cause gastric mucosal damage.
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After feeding, preterm infants can be appropriately elevated at the head of the bed and in the left decubitus position to reduce aspiration due to vomiting or gastroesophageal reflux. If the amount of calories input into the gastric tube does not meet the nutritional needs, some parenteral nutrition can be added.
Indications and contraindications to feeding
Indications] Patients without congenital gastrointestinal malformations, serious diseases, and hemodynamic stability should start nursing restriction as soon as possible after birth
Preterm infants with a birth weight of 100 g can be fed within 12 hours of birth if there are no contraindications to feeding
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For preterm infants of 100g, severe asphyxia at birth (APGAR score of 5 minutes and 4 points), umbilical artery cannulation, etc., the feeding time should be delayed to 24 to 48 hours after birth, and the feeding time should be considered according to the condition, and the feeding time should not be rushed, so as not to cause complications.
Contraindications] Congenital gastrointestinal malformations, gastrointestinal obstruction caused by various causes, high risk of NEC, hypovolemic shock, respiratory and circulatory failure, multi-organ dysfunction, etc., feeding should be suspended until the primary disease is corrected.
For early gastrointestinal nutrition of newborns, especially premature infants, the amount of milk per feeding, the amount of residual milk withdrawn, the characteristics of gastric juice, whether there is vomiting, abdominal distention, apnea or bruising, if necessary, fecal occult blood test, strong positive patients should be suspended feeding 1 2 times.
In the event of gastrointestinal bleeding or necrotizing enterocolitis, gastrointestinal nutrition should be discontinued immediately and total parenteral nutrition should be switched to.
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Some preterm infants will have symptoms similar to feeding intolerance in the process of adding milk to a certain amount, including vomiting, abdominal distention, obvious gastric retention, and even bloody stool and intestinal type of NEC.
Management of feeding intolerance
Clinical manifestations of feeding intolerance and feeding intolerance (FI) are common diseases in the neonatal period, with clinical manifestations such as vomiting, abdominal distension, gastric retention, etc., which seriously affect the nutritional intake of children and can lead to growth retardation, which in turn affects neurodevelopment and intellectual motor function.
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The incidence of feeding intolerance in preterm infants is significantly higher than that of full-term infants due to the immaturity of gastrointestinal structure and hormone regulation mechanism, which is a high-risk factor for extrauterine growth retardation (EUGR).
Feeding intolerance means that the intake of energy calories through the gastrointestinal tract is insufficient, resulting in prolonged parenteral nutrition, i.e., intravenous nutrition, and long-term parenteral nutrition can cause serious and sometimes fatal complications, including cholestasis, liver and kidney damage, essential nutrient deficiencies, and catheter-related infection.
Therefore, it is clinically necessary to explore effective methods to improve feeding intolerance in preterm infants.
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The main reasons why preterm infants are prone to FI are divided into two aspects: physiological and pathological
The physiological causes are mainly the immaturity of gastrointestinal function and hormone regulation mechanisms in preterm infantsThere are many pathological causes, and various comorbidities of preterm infants can affect the structure and function of the gastrointestinal tract and lead to the occurrence of FI, such as infection sepsis, severe hypoxia, recurrent apnea, RDS, BPD, NEC, PDA, HIBD, etc., all of which significantly hinder the establishment of enteral feeding, or delay the time to full gastrointestinal feeding.
Principles for the management of feeding intolerance
Assess the child's ** and degree of risk].
The analysis of children diagnosed with FI includes subjective decision-making and objective evaluation based on clinical symptoms, the latter of which can use advanced examination methods such as electrogastrogram, endovascular manometry to understand gastrointestinal motility, far-infrared spectroscopy to monitor gastrointestinal hemodynamics, abdominal ultrasound exploration, etc., which can help guide clinical decision-making.
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General treatment] 1. Adjust the position.
After feeding in the NICU, a left lateral decubitus position with a head elevation of 30° can be taken to reduce regurgitation and aspiration
Rooming-in babies may be pat on the back (burp) after feeding to expel air that may have been brought in during feeding.
2. Abdominal massage.
It can increase gastrointestinal motility and should be performed by an experienced health care provider and the caregiver should be taught to gently massage the abdomen in a clockwise direction with the lubricated palm of the lube, centered on the umbilicus, about 1 hour after feeding, to help meconium pass and enhance gastrointestinal peristalsis.
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3. Prevent medical measures that can cause FI.
If NCPAP is prone to cause abdominal distension and gastric retention, change to hhhfnc as soon as possible
Various drugs such as anesthetic sedatives (benzodiazepines, muscle relaxants) and respiratory stimulants (aminophylline, caffeine) have the effect of relaxing the smooth muscles of the digestive tract, and the dose and duration of the drugs should be controlled.
4. Change the feeding plan.
Breastfeeding or donor milk should be used as much as possible to feed newborns, especially preterm infants, some preterm infants who need to be supplemented with breast milk fortification (HFN) should be used only after the feeding dose reaches 50 total gastrointestinal RDI (recommended intake), and follow the gradual transition from 1 4 to half fortification to full fortification, because adding HFN too early and too quickly is also prone to FI and regression of feeding.
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When human milk is not available, formula milk should be fed close to the composition of breast milk, and the use of low-lactose formulations or hydrolyzed protein formulations has been reported to reduce the occurrence or severity of FI.
5. Drugs**.
Advised to follow medical advice**.
Reference: Neonatal Health