Gi Diseases Of The Newborn
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Pediatrics II GI Diseases of the Newborn – Intro Dra. Alabastro shar, maqui, viki 2nd Shifting/September 8, 2008 PHYSIOLOGY OF SWALLOWING
• •
•
Swallowing movement in fetus as early as the 12th week
Gestational or postnatal age
2.
Clinical status
3.
Extrauterine adaptation
Coordination of swallowing, epiglottal and uvular closure of the larynx and nasal passages and normal esophageal motility attained after 34 weeks AOG
•
Digestive enzymes mature after inadequate amount of bile salts
Supplementary parenteral fluids for small premature infants during the first 24-72 hours
•
Partial or total parenteral nutrition for the very sick or the very small infants
28
weeks
AOG;
•
Gastric capacity of newborn is 10-20mL
•
No excretion by way of GIT unless the anal sphincter relaxes (relaxes only when there is oxygen deprivation)
•
Fluid requirements vary according to gestational age
•
1st stools passed within 24 hours; 1-6 stools per day for premature
CRITERIA FOR INITIATING NORMAL INFANT FEEDING • Normal bowel sounds, soft abdomen •
1.
BABIES AT RISK FOR DEVELOPING FEEDING PROBLEMS • Preterm: <32-34 weeks AOG •
Very low birth weight (VLBW) regardless of gestational age: <1500g
•
Depressed/asphyxiated infants
•
Infants with respiratory distress
•
GI anomalies
•
METHODS OF FEEDING Breastfeeding (PO)
Should have passed meconium
•
Infant should be stable (HR, CR)
•
Absence of abdominal distension or peritonitis
•
No billous aspirates or emesis
•
-
Attempted only in infants 34 weeks AOG or older
-
Sucking and gagging attempting first feeding
Serum electrolytes normal
-
First PO feeding 10-15cc consists of breast milk
•
At least 6 hours after extubation
-
Breastfeeding started if tolerated
•
Respiratory rate < 60/min
•
Umbilical catheters – remove 24 hours before feeding
•
•
•
CONSIDERATIONS IN FEEDING THE NEWBORN Nutritional care of all newborns demand that calories be provided either enterally or IV to meet metabolic demands in the first 6-12 hours 1.
Provide adequate nutrition
2.
Supply energy
3.
Stimulate maturation of gut
4.
Provide weight gain
Method of feeding is individualized
•
reflexes
checked
before
Intermittent orogastric (IOG)/nasogastric (ING) -
Used for infants on ventilation or acutely distending stomach
-
Begin with 3cc/kg every 2 hours; increase by 12cc/kg every other feeding until desired volume is reached
-
Allowable gastric residuals 50% of feeding volume
-
Change to every 3 hours when further volume is desired
Continuous orogastric (COG)/nasogastric (CNG) -
Started at 1cc/kg/h
MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY KC JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU RACHE ESTHER JOEL GLENN TONI
Surgical Pathology Salivary Glands Page 2 of 2
•
-
Increased by 1-2cc every 4-24 as infant tolerates
-
Gastric residuals checked every 2-4 hours not to exceed 5 mL of volume infused
Continuous nasojejunal (CNJ)/orojejunal (COJ) -
Used in very low birth weight infants with poor gastric motility or gastroesophageal reflux or reserved for infants unable to feed by other methods
-
Main difficulty is placement of tube in small intestine
-
Complications are rare: perforation of the small intestine
CONSIDERATION IN ASSESSING FLUID REQUIREMENTS • Insensible water loss •
Urine/fecal loss
•
Caloric expenditure
•
Use of modality of procedure: phototherapy, drainage, radiant warmer, higher ambient temperatures, higher environmental humidity, ventilators with highly humidified air, plastic heat shields
•
SUPPLEMENTARY IVF Start with 10% dextrose in water if enteral feeding is < 150 mL/kg/day
•
Slowly decrease IVF as enteric feeding is increased
•
Discontinue IVF once enteric feeding is equal to at least 100 mL/kg/day
•
If unable to feed by the 3rd day, start parenteral alimentation
•
MONITORING FEEDING Growth: weigh daily, monitor and record length and head circumference daily
•
Tolerance: -
No blood in stools
-
No significant residuals
-
No vomiting or regurgitation
-
No apneic episodes with feeding
-
No abdominal distension
• •
•
Swallowing movement in fetus as early as the 12th week
Gestational or postnatal age
2.
Clinical status
3.
Extrauterine adaptation
Coordination of swallowing, epiglottal and uvular closure of the larynx and nasal passages and normal esophageal motility attained after 34 weeks AOG
•
Digestive enzymes mature after inadequate amount of bile salts
Supplementary parenteral fluids for small premature infants during the first 24-72 hours
•
Partial or total parenteral nutrition for the very sick or the very small infants
28
weeks
AOG;
•
Gastric capacity of newborn is 10-20mL
•
No excretion by way of GIT unless the anal sphincter relaxes (relaxes only when there is oxygen deprivation)
•
Fluid requirements vary according to gestational age
•
1st stools passed within 24 hours; 1-6 stools per day for premature
CRITERIA FOR INITIATING NORMAL INFANT FEEDING • Normal bowel sounds, soft abdomen •
1.
BABIES AT RISK FOR DEVELOPING FEEDING PROBLEMS • Preterm: <32-34 weeks AOG •
Very low birth weight (VLBW) regardless of gestational age: <1500g
•
Depressed/asphyxiated infants
•
Infants with respiratory distress
•
GI anomalies
•
METHODS OF FEEDING Breastfeeding (PO)
Should have passed meconium
•
Infant should be stable (HR, CR)
•
Absence of abdominal distension or peritonitis
•
No billous aspirates or emesis
•
-
Attempted only in infants 34 weeks AOG or older
-
Sucking and gagging attempting first feeding
Serum electrolytes normal
-
First PO feeding 10-15cc consists of breast milk
•
At least 6 hours after extubation
-
Breastfeeding started if tolerated
•
Respiratory rate < 60/min
•
Umbilical catheters – remove 24 hours before feeding
•
•
•
CONSIDERATIONS IN FEEDING THE NEWBORN Nutritional care of all newborns demand that calories be provided either enterally or IV to meet metabolic demands in the first 6-12 hours 1.
Provide adequate nutrition
2.
Supply energy
3.
Stimulate maturation of gut
4.
Provide weight gain
Method of feeding is individualized
•
reflexes
checked
before
Intermittent orogastric (IOG)/nasogastric (ING) -
Used for infants on ventilation or acutely distending stomach
-
Begin with 3cc/kg every 2 hours; increase by 12cc/kg every other feeding until desired volume is reached
-
Allowable gastric residuals 50% of feeding volume
-
Change to every 3 hours when further volume is desired
Continuous orogastric (COG)/nasogastric (CNG) -
Started at 1cc/kg/h
MARY YVETTE ALLAIN TINA RALPH SHERYL BART HEINRICH PIPOY KC JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC PENG KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MACKY VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU RACHE ESTHER JOEL GLENN TONI
Surgical Pathology Salivary Glands Page 2 of 2
•
-
Increased by 1-2cc every 4-24 as infant tolerates
-
Gastric residuals checked every 2-4 hours not to exceed 5 mL of volume infused
Continuous nasojejunal (CNJ)/orojejunal (COJ) -
Used in very low birth weight infants with poor gastric motility or gastroesophageal reflux or reserved for infants unable to feed by other methods
-
Main difficulty is placement of tube in small intestine
-
Complications are rare: perforation of the small intestine
CONSIDERATION IN ASSESSING FLUID REQUIREMENTS • Insensible water loss •
Urine/fecal loss
•
Caloric expenditure
•
Use of modality of procedure: phototherapy, drainage, radiant warmer, higher ambient temperatures, higher environmental humidity, ventilators with highly humidified air, plastic heat shields
•
SUPPLEMENTARY IVF Start with 10% dextrose in water if enteral feeding is < 150 mL/kg/day
•
Slowly decrease IVF as enteric feeding is increased
•
Discontinue IVF once enteric feeding is equal to at least 100 mL/kg/day
•
If unable to feed by the 3rd day, start parenteral alimentation
•
MONITORING FEEDING Growth: weigh daily, monitor and record length and head circumference daily
•
Tolerance: -
No blood in stools
-
No significant residuals
-
No vomiting or regurgitation
-
No apneic episodes with feeding
-
No abdominal distension
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