Question

Premature Infant Case Study

Nutrition Assessment of Preterm Infant

Patient History: A 980-gram female infant was born at 27 weeks gestation and classified as an appropriate for gestational age premature infant on a premature growth chart. Length was 36 cm, and head circumference was 25 cm. Today, the patient is 21 days old or 30 weeks postmenstral age (PMA) Patient had respiratory distress syndrome, which required intubation and surfactant therapy. Patient is now on room air.

Nutrition History: Patient was on parenteral nutrition, but is now on total enteral feedings of human milk from her mother at 160mL/kg.

Anthropometrics

Weight: 1085g

Length: 38cm

Head Circumference: 27 cm

Nutrition Problem

Nutrient intake is inadequate for the premature infant.

Nutrition Interventions

As discussed on team rounds, human milk fortifier will be added to human milk to provide 24kcal/oz milk. At 160mL/kg, the infant will receive 128 kcal/kg and 3g protein/kg. The fortifier will bring the nutrient content up to meet the guidelines for prematurity.

Questions

How did weight, length, and head circumference plot at birth and at 3 weeks or 30 weeks gestation on the Lubchenco growth chart?

At the 30 weeks gestation the child is just over the 90^th percentile, for length he’s at the 50^th percentile, 25^th percentile for head circumference.

What are the kilocalorie and protein goals per kg for this infant?

1.09kg x 128 = 139.52 kcals

1.09kg x 3g = 3.27 g

What milk is recommended for the premature infant?

Breast milk

What would the feed volume be per feed for feeding every 3 hours at 160mL/kg?

Write one PES for this case study.

Calculate energy and protein intake son fortified human milk with powdered bovine fortified at 160mL/kg.

What should be monitored on a weekly basis in this infant before discharge?

Answer 1

calculation for feed volume

Total amount of feed required per kg = 160ml× 1.085 kg

Total no.of feeds= 24÷ 3

   = 8

volume of feed = 160×1.085÷8

   =21.7ml

PES

Imbalanced nutrition less than body requirements related to

Small stomach capacity and prematurity

Decreased nutrient deposits

Weak reflexes.

Energy in human breast milk along with bovine fortifier is

1oz of fortified milk contains 24 kcal energy

So, 160ml will give 160× 24÷ 30 (1oz)

128kcal

Protein 3.6 g 1 oz

= 160× 3.6÷30(1oz)

19.2 g protein

Weekly monitoring should include

Assessment of Thermoregulation
Control of breathing
Respiratory stability
Feeding skills and weight gain

Protein

160×3=