FEEDING THE LOW BIRTH WEIGHT (LBW) INFANT

FEEDING THE LOW BIRTH WEIGHT (LBW) INFANT

Feeding problems of the LBW Infant

The LBW Infant, known for immunity of the gastrointestinal system, frequently suffers from one or the other feeding problem:

1. Excessive crying because of the need for a higher food intake compared to the normal infant in order to make up the deficit in weight.
2. High frequency of suckling difficulties
3. In coordination between suckling and swallowing.
4. Abdominal distention as he is not capable of holding a large feed in his stomach.
5. Regurgitation since the cardio esophageal sphincter is lax.
6. Poor tolerance for saturated fatty acids

Notably most of the problems are secondary to immaturity of the gastrointestinal system.

Nutritional needs of the LBW Infant

According to estimates, the LBW infant requires on an average 140(120-150) kcal/kg/day. Understandably, about 200 ml of milk is required to meet this demand.

Attempts to attain this target right at the outset often prove futile since the infant is simply unable to cope with this much feed. A realistic and practical approach is to aim at achieving this target by second week. As regards protein, 4-6 g/kg/day is good enough. An intake outside this range is not in the interest of the infant. Higher intake may cause retention of fluid and solute as also high blood urea on account of renal immaturity. Rapid weight gain occurring in this situation is not in the interest of the baby. Low protein intake may cause hypoproteinemic edema and poor weight gain, further worsening the baby’s nutritional status. Over and above this, the infant also needs vitamin K at birth, an multivitamins(especially vitamin A,C,D and E), iron and folic acid, calcium, phosphorus etc. subsequently. Early feeding is the current recommendation within 6-12 hours. Most centers give the first feed at about 3 hours of age. The risk of aspiration in early feeding can be minimized with careful supervision and vigilance.

Risk of delayed feeding include icterus, hypoglycemia, metabolic acidosis and brain damage.