FEEDING OF LBW

1. R E F E R E N C E : A I I M S P R O T O C O L A N D J I P M E R P R O T O C O L
P R E S E N T A T I O N B Y : D R . M A H E S H Y A D A V
FEEDING OF LOW BIRTH WEIGHT
NEONATES

2. INTRODUCTION
 Low birth weight – (<2500 gms )
 Accounts for 60 – 80 % of neonatal deaths .
 Simple interventions such as early initiation of breast feeding
and avoidance of pre lacteal feeding have been shown to
improve their survival .

3. HOW IS IT DIFFERENT ?
 Inadequate feeding skills
 Prone to illness-prematurity
 Higher fluid requirements--- higher feed volumes
 Gut immaturity
 Low body stores of micronutrients

4. OTHER PROBLEMS
 Birth asphyxia
 Hypothermia
 Infections
 Respiratory distress
 Apneic spells
 Intraventricular hemorrhage
 Hypoglycemia
 Metabolic acidosis
 Hyperbilirubinemia

5. PROTOCOL FOR FEEDING IN LBW INFANTS
 How to decide the initial method of feeding in a given LBW infant ?
 For infants initiated on modes other than breastfeeding :
How to progress to breast feeding ?
What milk to be given ?
How much milk to be given ?
 What supplements are required ?
 How to assess the feeding adequacy and monitor the growth ?
 How to identify and manage feed intolerance ?

6. GESTATIONAL
AGE
MATURATION OF FEEDING
SKILLS
INITIAL FEEDING METHOD
<28 WEEKS No proper sucking efforts .
No propulsive motility in the gut .
I.V.fluids
28-31 WEEKS Sucking bursts develop .
No coordination b/w suck /swallow and
breathing .
Oro gastric or naso gastric tube
feeding with occasional spoon
/paladai feeding
32- 34 WEEKS Slightly mature sucking pattern
Coordination b/w breathing and
swallowing begins .
Feeding by spoon /paladai /cup
>34 WEEKS Mature sucking pattern .
More coordination b/w breathing and
swallowing .
Breastfeeding

7. Is stable?
 Fast breathing (RR>60/min)
 Severe chest in-drawing
 Apnea
 Requirement for oxygen
 Convulsions
 Abnormal state of consciousness
 Abdominal distension
 Shock
If unstable, start intravenous (IV) fluids
Presence of any one
of these signs = UNSTABLE
Deciding the initial feeding method

8.  Mothers own milk best for all LBW
infants/Expressed breast milk.
 Donor breast milk
 Infant formula
 Animal milk
What to feed
•Standard infant formula
•Preterm formula < 1500 gms & up to
2000 gms achieved

9. Steps in progression feeding
How to decide the
initial feeding
method

10. Progression of
feeding low birth wt

11. Summary

12.  NUTRIENT SUPPLEMENTATION ...IN PRETERM VLBW
INFANTS UNTIL 40 WEEKS PMA

13. Supplementation
NUTRIENTS ONLY EBM EBM FORTIFIED WIH
LACTODEX- HMF
EBM FORTIFIED
WITH PRE TERM
FORMULA
CALCIUM START supplementation
(140-160mg/kg/day)
Once the infant is on 100
ml/kg/day
NOT NEEDED START
SUPPLIMENTATION TO
MEET RDA
Once the infant is
on 100 ml/kg/day
PHOSPORUS START supplementation
(70-80mg/kg/day)
Once the infant is on 100
ml/kg/day
NOT NEEDED START
SUPPLIMENTATION TO
MEET RDA
Once the infant is
on 100 ml/kg/day
ZINC AND
VITAMINS A , B6
ETC
START MULTIVITAMINS
supplementation
Once the infant is
on 100 ml/kg/day
START MULTIVITAMINS
SUPPLIMENTATION
Once the infant is
on 100 ml/kg/day
START MULTIVITAMINS
SUPPLIMENTATION
Once the infant is
on 100 ml/kg/day

14. Supplementation
NUTRIENTS ONLY EBM EBM FORTIFIED WIH
LACTODEX- HMF
EBM FORTIFIED
WITH PRE TERM
FORMULA
VITAMIN D USUALLY OBTAINED
FROM MULTIVITAMIN
DROPS AND CALCIUM
SUPPLIMENTS THAT
CONTAIN VITAMIN D
START VITAMIN D3 DROPS
Once the infant is
on 100 ml/kg/day
START VITAMIN D3
DROPS IF THE TOTAL
INTAKE IS LESS THAN
RDA
FOLIC ACID START
SUPPLIMENTATION
Once the infant is
on 100 ml/kg/day
NOT NEEDED START
SUPPLIMENTATION
Once the infant is
on 100 ml/kg/day
IRON START IRON (2mg/kg/day
) at 4 weeks of life
START IRON (2mg/kg/day ) at 4
weeks of life
start IRON (2mg/kg/day ) at
4 weeks of life

15. NUTRITIONAL SUPPLEMENTATION IN PRE TERM INFANTS AFTER
40 WEEKS
NUTRIENTS METHOD OF
Supplementation
DOSE TILL WHEN ?
VITAMIN D VITAMIN D3
DROPS
800-
1000IU/DAY
TILL 1 YEAR OF
AGE
IRON IRON DROPS /
SYRUPS
2mg/kg/day TILL 1 YEAR OF
AGE

16. NUTRIONAL SUPPLEMENTS FOR INFANTS WITH BIRTH
WEIGHTS OF 1500-2499 g
NUTRIENTS METHOD OF
SUPPLEMENTS
DOSE WHEN TO
START AND
TILL WHEN TO
CONTINUE ?
VITAMIN D MULTIVITAMIN
DROPS /SYRUP
1ml/day (so as to provide
400IU/day )
2 weeks of age to 1 year of
age
IRON IRON DROPS/ SYRUP 2mg/kg/day 4 weeks of age to 1 year of
age

17.  For breast feeding
Assessment of feeding adequacy
•Observe
•attachment/suckling/
•tiredness of infants
•Look for sore
nipple/engorgement
Ask mother
•How many times in
24 hours feeds
•Any problems
experienced by her

18. Assessment of feeding adequacy of
alternating methods
Ask
•Volume/freq in 24
hrs/spills/splutters of
milk
Or
•Baby take too long time
to feed
Observe
Spluttering/spitting the
milk
Or
Tiring of infants to take
required amount

19. Sign of inadequate feeding
Breast feeding
•<8 times in 24 hrs
•Poor attachment/ineffective
suckling
•Baby tired/take him off before
completion of feeds
•Mother having engorged /sore
nipple
By alternative methods
•Feed vol less than
indicated
•Less freq/excessive
spilling
•Take long time top
finish

20.  Wt loss not more than 10% of birth wt at 1 week of life .
 Start wt gaining after 2 wks
 Average daily wt gain of LBW in initial 3 -4 months
Identification of poor wt gain
Birth wt -<1500gms:
13.5 to 16 gm/kg/d
If > 1500gms – 10- 13
gm /kg/d

21. Causes of inadequate weight gain

22. Management of inadequate weight gain
 Proper counselling of mothers and ensuring adequate support for breastfeeding their infants .
 Assessment of positioning/attachment, managing sore/flat nipple .
 Explaining the frequency and timing of breastfeeding and spoon/ paladai feeds .
 Infrequent feeding is one of the commonest ,m others should be properly counselled regarding the
frequency and the importance of night feed .
 A time-table where mother can fill the timing and amount of feeding .
 Giving EBM by spoon/paladai feeds after breastfeeding also helps in preterm infants who tire out easily
while sucking from the breast.

23. • Energy (calorie) content of milk by adding MCT oil, corn starch.
• Infants on formula feeds given concentrated feeds (by reconstituting 1 scoop in 25 mL of
water) .
OR
Feed volume – to 200 mL/kg/day.
 Proper demonstration of the correct method of expression of milk and paladai feeding: observe
how the mother gives paladai feeds; the technique and amount of spillage
 followed by a practical demonstration of the proper procedure.
 Initiating fortification of breast milk when indicated
 Management of the underlying conditions such as anaemia, feed intolerance,etc.
 If these measures are not successful-

24. Symptoms:
1. Vomiting (altered milk/bile or blood-stained)*
2. Systemic features: lethargy, apnoea
Signs:
1. Abdominal distension (with or without visible bowel loops)*
2. Increased gastric residuals: >2mL/kg or any change from previous pattern
3. Abdominal tenderness
4. Reduced or absent bowel sounds
5. Systemic signs: cyanosis, bradycardia, etc.
Indicators of feed
intolerance

27. Replacement feeds
 Process of feeding a child who is not breastfeeding with a
diet that provides all the nutrients the child needs, until the
child is fully fed on family food.
 Could be formula based or heat treated breast milk.

28.  Chronological age-From date of birth
 Post –conception/post menstrual age - gestation at birth in wks +
chronological age
 Corrected Gestational Age – chronological age in wks - no of wks the
infant born early(40 wks)
 Growth monitoring for infants up to 40 wks done by UK CHARTS.
After that by WHO CHARTS
GROWTH MONITORING

29.  THANK U ....