infant

Infant Nutrition and Feeding

  • Weight Changes After Birth

    • Newborns typically lose 5-10% of their birth weight within days of birth.

    • They should regain this weight within 2 weeks.

  • Hunger Cues

    • Look for signs such as:

    • Hand to mouth

    • Sucking behavior

    • Rooting reflex

    • Mouthing

  • Hydration Needs

    • Newborns do not require water, as they receive adequate hydration from breast milk or formula.

Breastfeeding

  • Initiation

    • The first breastfeeding should occur ASAP after birth and should be done on demand.

    • The best time to initiate feeding is immediately post-delivery, ideally during skin-to-skin contact.

  • Benefits of Breastfeeding

    • Reduces risk of infections.

    • Enhances brain growth.

    • Reduces the risk of Sudden Infant Death Syndrome (SIDS).

    • Convenient and cost-effective.

  • Vitamin D Supplementation

    • Infants should receive 400 IU of Vitamin D daily after 6 months.

  • Breastfeeding Positions

    • There are four common positions for breastfeeding:

    • Football hold

    • Cross cradle

    • Cradle hold (across the lap)

    • Side-lying cradle

Formula Feeding

  • Feeding Schedule

    • Formula-fed newborns should be fed every 2-4 hours and on demand, totaling 8-12 feeds in 24 hours.

  • Nutritional Requirements

    • Infants require iron-fortified formula for the first year of life.

Milk Storage

  • Breast Milk

    • Can be stored at room temperature for up to 4 hours.

    • Refrigerated for up to 4 days.

    • Frozen for up to 6 months; deep freezing extends this to 12 months (do not refreeze).

    • Thaw breast milk in the refrigerator or lukewarm water, never microwave.

    • Discard any unused portions.

  • Formula

    • Use powder formula mixed with water from a safe source.

    • Prepared formula can be at room temperature for up to 2 hours.

    • Refrigerate any unused prepared formula for up to 24 hours.

    • Formula should never be microwaved or frozen.

Gastrointestinal System Adaptations

  • Development of the GI system

    • The newborn GI system is immature; full maturation may take 4-6 months.

    • Important developments include:

    • Formation of a mucosal barrier to prevent harmful substances.

    • Initial stomach capacity is small but increases over the first 4 days.

    • Immature cardiac sphincter and stomach control may lead to regurgitation and uncoordinated peristalsis.

  • Nutritional Requirements

    • Newborns should have an intake of 108 kcal/kg/day from birth to 6 months.

  • Stool Characteristics

    • First meconium stool should occur within 24 hours.

    • Normal stool characteristics:

    • Meconium (first stool) is green and dark tarry.

    • Transitional stool is green-brownish-yellow.

    • Breastfed stool is yellow and seedy, while bottle-fed stool can be yellow or brownish.

    • Expect 6-8 wet diapers daily and 3-4 dirty diapers in breastfed/bottle-fed infants.

Infection Control

  • Newborns' Risk for Infection

    • Newborns are at significant risk for infection during their first few months due to an immature immune system.

  • Umbilical Cord Care

    • Apply triple dye or antibacterial ointment to the umbilical cord and leave it alone to dry.

    • Assess for signs of infection: redness, edema or drainage.

    • Keep the diaper folded away from the cord and avoid submersion baths until the cord falls off (usually 10-14 days).

  • Hemorrhage Prevention

    • If the cord clamp falls off too early, apply pressure to prevent hemorrhage.

  • Bonding

    • Encourage family involvement in care and document bonding experiences.

Medications for Newborns

  • Vitamin K Administration

    • Vitamin K is critical to prevent bleeding; it is produced in the colon after feedings commence (day 7-8).

    • Administer 0.5-1 mg IM in the vastus lateralis muscle within 1 hour of birth.

  • Hepatitis B Vaccine

    • Mandated vaccination at birth.

    • Parents must give informed consent for all vaccines.

    • If mothers are Hepatitis B positive, infants receive Hep B IG and the Hep B vaccine within 12 hours.

  • Erythromycin Ointment

    • Administer a 1-2cm ribbon of ointment in each eye to prevent ophthalmia neonatorum caused by N. gonorrhoeae and Chlamydia.

Circumcision

  • Informed Consent

    • Circumcision is a personal choice requiring informed consent from parents.

  • Timing of Procedure

    • Should not be done immediately following birth due to risks of bleeding.

  • Benefits of Circumcision

    • Decreases risk of penile cancer, improves hygiene, and lowers risk of STIs and UTIs.

  • Contraindications

    • Conditions such as hypospadias, epispadias, or family history of bleeding disorders (e.g., hemophilia).

  • Anesthesia

    • Administer a dorsal penile nerve block, topical anesthetic, or oral glucose (sucrose) to manage pain.

  • Pre-Procedure Care

    • No feeding 2-3 hours before the procedure to prevent aspiration.

  • Post-Procedure Care

    • Watch for effective voiding within 6-8 hours.

    • Apply Vaseline gauze to the surgical site to prevent infection.

    • Monitor for complications such as bleeding or infection.

Car Seat Safety

  • Legal Requirements

    • It is required by law to place infants in rear-facing seats in the backseat of the vehicle, preferably in the center position.

  • Weight and Age Guidelines

    • Infants should remain in a rear-facing seat until at least age 2.

    • Upgrade to a booster seat after age 8, provided they meet weight (80 lbs minimum), height (4'9"), and age criteria.

Newborn Complications

  • Neonatal Asphyxia

    • Caused by trauma during labor, leading to respiratory distress and inability to produce surfactant.

    • Signs include respiratory distress, retractions, and cyanosis.

    • Immediate assessment includes the newborn's color, breathing effort, heart rate, temperature, and Apgar scores.

    • Nursing management includes immediate resuscitation, observation, maintaining a neutral thermal environment, and monitoring blood glucose levels.

  • Meconium Aspiration Syndrome

    • Occurs when meconium is inhaled into the lungs, leading to inflammation and decreased surfactant production.

    • Assess for risk factors like late-term infants, hypoxia, and staining of body fluids.

    • Treatment involves suctioning at birth, readiness for resuscitation, ensuring adequate tissue perfusion, and monitoring vital signs.

  • Necrotizing Enterocolitis (NEC)

    • A life-threatening inflammation of the intestines leading to necrosis.

    • Risk factors include prematurity, low birth weight, and hypoxia.

    • Treatment involves NPO status, NG tube, TPN, and possibly bowel resection.

    • Complications may include perforation and sepsis.

  • Birth Trauma

    • Injuries from the delivery process can include fractures, brachial plexus injuries, cranial nerve trauma, and other head traumas.

    • Assessment includes monitoring for bruising, swelling, and other physical abnormalities.

    • Management focuses on supportive care and further assessment for complications.

  • Neonatal Abstinence Syndrome (NAS)

    • Caused by exposure to drugs in utero; can lead to long-term complications such as developmental delays and bonding issues.

    • Symptoms include CNS irritability, poor feeding, and signs of withdrawal.

    • Treatment may involve medications and close monitoring of symptoms.

  • Hypoglycemia

    • Defined as a blood sugar level of less than 40 mg/dL.

    • Common in infants during the first hours of life; can lead to seizures or death if untreated.

    • Symptoms may include jitteriness, weak cry, and cyanosis.

    • Treatment involves feeding, IV fluids if symptomatic, and monitoring blood sugar levels.

  • Respiratory Distress Syndrome (RDS)

    • Caused by surfactant deficiency leading to poor gas exchange.

    • Common in preterm or compromised infants.

    • Signs include tachypnea, nasal flaring, and grunting.

    • Treatment includes oxygen support and administration of surfactant if indicated.

  • Neonatal Sepsis

    • A serious condition arising from infections like PROM or chorioamnionitis.

    • Subtle signs: temperature instability, poor feeding, and respiratory distress are critical for assessment.

    • Treatment involves antibiotics and supportive care to stabilize the infant's condition.