Newborn Nutrition and Family Dynamics PDF

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Newborn NutritionNewborn Nutritional Needs  Needs o Water: 100-150 ml/kg/day o Calories:110-120 cal/kg/day  Breast milk and artificial formula provide 20 cal/oz  Infant stomach capacity varies 30-90 ml“Breastfeeding is Best-Feeding”  Health advantages  Promotes growth and development  Benefits...

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Newborn Nutrition Newborn Nutritional Needs  Needs o Water: 100-150 ml/kg/day o Calories:110-120 cal/kg/day  Breast milk and artificial formula provide 20 cal/oz  Infant stomach capacity varies 30-90 ml “Breastfeeding is Best-Feeding”  Health advantages  Promotes growth and development  Benefits women’s health  Psychosocial advantages  Complements family planning  Saves infant’s lives  Saves money  convenience Breast vs. Bottle Feeding  Recommendations- AAP. Breast milk is optimal food for infants  Only breast milk first 6 months  B/F should continue until 1 year or older Potential Disadvantages  Pain, Leaking milk, Embarrassment, Unequal responsibilities/stress & Diet restrictions Contraindications  HIV/AIDS  Active TB/Varicella  Active herpes on her breast  Illicit drugs  Specific medications  Galactosemia AAP Policy Statement  Initiate in the first hour  Formal evaluation of breastfeeding o First 24-48 hours o Again at 3-5 days and 2-3 weeks of age  Assess o Infant weight, General health

o Breastfeeding o Jaundice o Hydration, Elimination patterns Goal of Initial Feeds  Promote bonding/ Effective feeding technique  Intake meets metabolic needs o Blood sugar >40mg/dl o Temperature stability o Supports respiration and oxygenation o hydration Readiness for feeds  Cues o Rooting o Breast crawl o Hands to mouth  Crying is often a late sign of hunger Breast Milk Composition  Colostrum (thick yellow)  Produced until 2-4 days after birth o High in immunoglobins  Transitional (thinner creamy)  End of colostrum until 2 wks pp  Mature Milk (thinner)  Foremilk, hind milk Pituitary releases prolactin and oxytocin Nipple Position/Latch  Infant latch  Mouth opened wide  Duck bill  Lips are curled out  “LATCH” scoring system  Positioning/comfort Nutrition During Lactation  Generally healthy diet  Drink fluids to thirst  Adequate protein and calories  Calcium & Multivitamin supplement Medications

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Do transfer into milk Very few contraindicated Properties/amt/time/frequency Weigh risk and benefits Five adjustments: o Avoid long -acting forms o Absorption rate/peak levels o Longer intervals o Least tendency to pass into breast milk o Single-symptom drugs

Nipple Pain/Trauma  S&S  yeast/thrush  engorgement  Prevention strategies  Treatment Infant Assessment  Encourage at least 8-12 feedings per day  Alternate the breast that is offered first  Time at the breast  Education sign of dehydration  Weight loss o Average loss 6% over the first 3-4 days o Loss greater than 10% mandates careful evaluation  Weight Gain o 4-5 day's with increased production o Expect gain ½ to 1oz per day Infant Assessment  6-8 pale or colorless voids/ by day 5  Loose, yellow, curd-like stools freq. first month  Constipation, unusual first month  Stool Patterns o Meconium= black o Transitional= green/yellow o Bottle fed= orange tinged brown. o Breast fed = yellow/mustard Lacational Amenorrhea Method

Community Support  Nurses/ Lactation specialist, Hospital support group, La Leche League & WIC Program Employed mothers  Breaks, Clean/private area, storage Storage of Breast Milk and Formula Location Temperature

Duration

Countertop, table

Room temperature (up 4–8 hours to 79°F or 25°C)

Insulated cooler bag

5-39°F or -15-4°C

24 hours

Refrigerator

39°F or 4°C

5-8 days

20 wks  “stillbirth” or fetal demise Intrauterine Fetal Death  Maternal Risks o If passage of fetus is delayed may develop DIC, infection  Medical Management o Confirm with ultrasound o Cervical ripening, induction of labor o If prior caesarean, may repeat o Autopsy of fetus Nursing Plan  Provide accurate information  Support through labor induction  Prepare stillborn  Offer time with stillborn  Discuss plans for funeral/ disposition of remains  Incorporation of religious/ spiritual practices  Provision of remembrances  Facilitate grief process  Referrals to counselors/ community support groups  Postpartum self care/follow‐up

Table 23.2 page-864  Before the newborn’s death  Respect variations in the family’s spiritual needs and readiness.  Assess cultural beliefs and practices that may bring comfort; respect culturally appropriate requests for truth telling and informed refusal.  Initiate spiritual comfort by calling the hospital clergy if appropriate; offer to pray with the family if appropriate.  Encourage the parents to take photographs, make memory boxes, and record their thoughts in a journal.  Explore with family members how they dealt with previous losses.  Discuss techniques to reduce stress, such as meditation and relaxation.  Recommend that family members maintain a healthy diet and get adequate rest and exercise to preserve their health.  Participate in early and repeated care conferencing to reduce family stress.  Allow family to be present at both medical rounds and resuscitation; provide explanations of all procedures, treatments, and findings; answer questions honestly and as completely as possible.  Provide opportunities for the family to hold the newborn if they so choose.  Assess the family’s support network.  Provide suggestions as to how friends can be helpful to the family  After the newborn’s death  Help the family to accept the reality of death by using the word “died.”  Acknowledge their grief and the fact that their newborn has died.  Help the family to work through their grief by validating and listening.  Provide the family with realistic information about the causes of death.  Offer condolences to the family in a sincere manner.  Encourage the father to cry and grieve with his partner.  Provide opportunities for the family to hold the newborn if they desire.  At the time of the release of the newborn’s body  Reassure the family that their feelings and grieving responses are normal.  Encourage the parents to have a funeral or memorial service to bring closure.  Suggest that the parents plant a tree or flowers to remember the infant.  Address attachment issues concerning subsequent pregnancies.  Provide information about local support groups.  Provide anticipatory guidance regarding the grieving process.  Present information about any impact on future childbearing, and refer the parents to appropriate specialists or genetic resources.

Postpartum Depression  Definition:  Serious depression  Often begins > 2‐3 wks. Can last for mos to > 1yr  Incidence:  About 10% ‐ 15% of new mothers  Possible causes:  Hormonal changes  Hx depression, pp depression/ other mental illnesses  Lack of social support Postpartum Depression  Findings:  Sadness, frequent crying  Insomnia, appetite changes  Difficulty concentrating/ decision making  Feelings worthlessness, guilt  Lack interest activities, sex  Anxiety, irritability, hostility  No concern for appearance  Risk of suicide  Impact on attachment/family Dynamics  Management:  Antidepressant medications  Sertraline (Zoloft, Lustral) for breastfeeding mothers  Paroxetine ( Seroxat, Deroxat)  Individual or group psychotherapy  Postpartum support groups  Prophylactic medications with future births Postpartum Psychosis  Definition:  Severely impaired mental condition  Begins in 1st 4 weeks  Incidence:  Affects ~ 1 in 1,000  Possible causes:  Hormonal changes  Previous history/family history  History bipolar disorder  Obsessive personality  Lack stable relationships

 Lack social support, isolation Postpartum Psychosis  Findings:  Paranoia, mood shifts  Hallucinations, delusions  May feel compelled to hurt self and/or infant  Agitation, hyperactivity  Insomnia  Confusion  Irrational, poor judgment  Out of touch w reality  Risk of suicide  Impact on attachment/family Dynamics  Management:  Psychiatric emergency  Antipsychotic medications  Haldol  Clozaril  Hospitalization  Psychotherapy  Removal of infant may be necessary  95% of women improve within 2‐3 mos. Nursing Care Management Postpartum Psychiatric Disorders  Prenatal assessment for risk factors  Education prenatally  Postpartum assessment  Objective signs depression  Discharge instructions  Home follow‐up; referrals  Postpartum support groups Infant of Substance Abusing Mother (ISAM)  Presents special challenges in family Dynamics  Drug/alcohol use may result in teratogenic/congenital anomalies with long term consequences  With birth many infants suffer withdrawal; neurobehavioral changes may impact bonding/attachment/family Dynamics  Referrals to drug/alcohol treatment centers/intervention programs/ social services to protect health and well‐ being of newborn/family

Alcohol Use During Pregnancy Maternal effects:  Malnutrition (folic acid and thiamine deficiencies)  Bone marrow suppression  Increased infections  Liver disease  Withdrawal seizures in intrapartum/postpartum periods Fetal/neonatal effects:  Fetal alcohol syndrome (FAS)  Fetal alcohol effects (FAE)  Feeding difficulties, CNS abnormalities common  Most common cause of preventable mental retardation Drug Exposed  Fetal risks  Intrauterine asphyxia  Intrauterine infection  Altered birth weight (most SGA, LGA with methadone)  Low Apgar scores  Neonatal risks  Respiratory distress/ increased SIDS risk  Jaundice  Congenital anomalies/growth restriction  Behavioral abnormalities/difficulties with attachment Medical Management  Drug screen of meconium  Drugs to control withdrawal symptoms  Phenobarbital  Paregoric  Tincture of opium  Oral morphine solution  Oral methadone  Diazepam  Nutrition/fluid support needed due to increased energy expenditure due to withdrawal  Home apnea monitoring

Nursing Care Management  Nonjudgmental history taking/interview  Assessing newborn for malformations/withdrawal symptoms  Check glucose/calcium levels  Neonatal Abstinence Score Sheet (p. 897-898)  Reducing withdrawal symptoms  Promote stable VS/ prevent hypothermia  Small frequent feedings allowing for extra time/nonnutritive sucking  Medications as ordered  Swaddling with hands near mouth to help organize behavior  Reduce stimuli in nursery  Discharge teaching/use of home apnea monitor...