Setting up of a nutrition unit in NICU: Benefits & Challenges: Nestle

Speaker: Dr Umesh Vaidya,Neonatal Intensive Care Unit KEM Hospital, Pune. Presented at: Nestlé Nutrition Institute Workshop, Pune

Summary

Neonatal Intensive Care Units should have a nutrition unit set up so as to take care of the nutrition of the preterm babies born. The nutritional challenges faced are limited nutrient stores, physiological immaturity and neonatal illnesses. This requires for nutrition sensitivity and planning. Ideal practices for preterm baby nutrition should involve minimal enteral feeds (10 ml/kg/day), human breast milk, feed advancement 20 ml/kg/day, and human milk fortification 100 ml/kg/day.

Neonatal malnutrition has its severe consequences, immediate consequences determines mortality & morbidity of the baby, susceptibility to infection and increased hospital stay, while late consequences are social consequences of poor growth, neurocognitive development and origin of adult diseases. Poor growth in NICU is seen due to various reasons like nutritional sensitivity of clinicians, withholding feeds critical illnesses, slow grading up incorrect feeding policies delayed or no TPN since there are concerns of costs, fortified EBM less calorie/protein, and sub optimal nutritional products. Target for growth should be weight gain of 10-15 gm./kg/day, length gain 0.75-1 cm/week, and head circumference gain 0.75 cm/week. Optimal growth can be achieved in NICU by establishment of lactation, calorie protein intake, fortification, parenteral nutrition, nutritionally supportive interventions and post discharge by growth monitoring and Vitamin and Mineral supplementation. The nutritionist is knowledgeable in physiology, biochemistry, paediatric and geriatric nutrition, clinical nutrition, advanced dietetics, community nutrition, and much more.

The roles of nutritionist are to ensure optimal nutrition in critically ill neonates in NICU, to support breastfeeding, to provide nutritionally supportive interventions, parenteral nutrition and post discharge nutrition. Ill neonates need to be provided with aggressive nutrition by uninterrupted transfer of nutrients after birth and by use of nutrient intakes of the established recommendations.

There are various problems in establishing lactation like separation of mother and infant, stress (physical, emotional), difficulties in milk expression, poor suck of the preterm LBW and long hospital stay. Lactation support by initiating breastfeeding, continuous dialogue/ on-going support, training in milk expression, checking on diet/health/medications, troubleshooting for lactation problems such as sore nipples, engorgement etc. and creating mother support group should be provided. Nutritionally supporting interventions by minimal enteral feeding and non-nutritional sucking should be provided.

Post discharge nutrition is provided by growth monitoring which is monitoring of catch up growth essential, appropriate charts, and correction of age necessary. The role of nutritionist also extends to scope for research. The potential for research is in areas of protein fortification, initial feeding volume, maximum feeding volume, metabolic bone disease, Vitamin D status and needs optimising growth and long term outcomes.