Pediatrics II

GI Diseases of the Newborn – Intro

Dra. Alabastro
shar, maqui, viki
2nd Shifting/September 8, 2008

PHYSIOLOGY OF SWALLOWING 1. Gestational or postnatal age

• Swallowing movement in fetus as early as the 12th week
2. Clinical status

• Coordination of swallowing, epiglottal and uvular closure 3. Extrauterine adaptation

of the larynx and nasal passages and normal esophageal
motility attained after 34 weeks AOG
• Digestive enzymes mature after 28 weeks
inadequate amount of bile salts
• Gastric capacity of newborn is 10-20mL
• Supplementary parenteral fluids for small premature
infants during the first 24-72 hours
AOG;
• Partial or total parenteral nutrition for the very sick or the
very small infants

• No excretion by way of GIT unless the anal sphincter BABIES AT RISK FOR DEVELOPING FEEDING PROBLEMS
relaxes (relaxes only when there is oxygen deprivation) • Preterm: <32-34 weeks AOG

• Fluid requirements vary according to gestational age • Very low birth weight (VLBW) regardless of gestational
age: <1500g
• 1st stools passed within 24 hours; 1-6 stools per day for
• Depressed/asphyxiated infants
premature

• Infants with respiratory distress

CRITERIA FOR INITIATING NORMAL INFANT FEEDING
• Normal bowel sounds, soft abdomen • GI anomalies

• Should have passed meconium

METHODS OF FEEDING
• Breastfeeding (PO)
• Infant should be stable (HR, CR)

- Attempted only in infants 34 weeks AOG or older

• Absence of abdominal distension or peritonitis
- Sucking and gagging reflexes checked before
• No billous aspirates or emesis 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 • Intermittent orogastric (IOG)/nasogastric (ING)

- Used for infants on ventilation or acutely distending

CONSIDERATIONS IN FEEDING THE NEWBORN stomach
• Nutritional care of all newborns demand that calories be
provided either enterally or IV to meet metabolic - Begin with 3cc/kg every 2 hours; increase by 1-
demands in the first 6-12 hours 2cc/kg every other feeding until desired volume is
reached
1. Provide adequate nutrition
- Allowable gastric residuals 50% of feeding volume
2. Supply energy
- Change to every 3 hours when further volume is
3. Stimulate maturation of gut desired

4. Provide weight gain • Continuous orogastric (COG)/nasogastric (CNG)

• Method of feeding is individualized - 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
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- 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