Professional Documents
Culture Documents
Outline
2011
Case Studies
Discussion
2
Case Study S
Failure To Thrive (FTT) with Viral AGE
Baby S, 2 month-old Indian boy born FT with BW 3.03 kg Admitted with dehydration 2 Viral AGE Referred to dietitian for nutritional assessment Anthropometric data
Weight on admission 3.325 kg (<3rd percentiles) Weight crossing percentiles from 50th (1/12) to 3rd percentiles (2/12) Length 57 cm (50th percentiles)
Case Study S
Food/NutritionRelated History
Breastfeeding until 1/12 of age
Supplemented with Infant formula claimed not enough supply
On standard infant formula Dutch Lady 1 (dilution 2 scoops:3 oz), which was later changed to Lactogen 1 at similar dilution Also given glucose drinks at 1 scoop:2 oz
Case Study S
Nutrition Intervention
Nutrition education
Correct feeding dilution standard dilution Stop glucose drinks ensure all feeds are from infant formula Good hygiene practices Hand washing Sterilization techniques - Feeding bottles and teats
Coordination of care
Continuation of breastfeeding
1 scoop : 30 ml (1 oz)
1 scoop : 60 ml (2 oz)
2011
Case Study M
Baby M, 7 month-old Malay boy presented with AGE with mild dehydration and noted to be small for his age Anthropometric data
Weight 6.075 kg (<3rd percentiles) Length 67.5 cm (15th percentiles) Weight history crossing percentiles (from 50th to 3rd) at 3/12 of age
6.075kg
Case Study M
Nutritional Assessment
Referred to dietitian for nutritional assessment Which component of food/nutrition-related history need to be assessed?
Breastfeeding history Intake of infant formula Complementary feeding
Case Study M
Food and Nutritionrelated History
Breastfeeding history
Case Study M
Food and Nutritionrelated History
Complementary feeding
Age of introduction started at 6/12 Type and food texture plain porridge with added soup, hardly and meat/chicken/vegetables Feeding technique element of force feeding, child will cry during mealtimes Quantity 2 tbsp twice daily
Other habits
Thumb sucking
Case Study M
Nutrition Diagnosis and Intervention
Inadequate oral intake
Poor weight gain
Case Study Y
Baby Y, 6/52 old Chinese baby boy referred from Ampang Hospital for chronic diarrhea secondary to multiple protein allergy No other family history of allergy Negative stool reducing sugar
Anthropometric data
Birth weight 3.81 kg Current weight 3.495 kg (3rd 15th percentiles) Length 54.3 cm (15th percentiles)
3.81 kg
3.495 kg
Case Study Y
Breast milk first day On infant formula since D1 OL and feed up to 90 ml every 2-3 hourly Had frequent loose stools for 2/52 Admitted in Ampang Hospital at D19 OL with severe dehydration and metabolic acidosis
Food/nutritionrelated history
Case Study Y
Client History
Case Study Y
Progress at 4/12
Tolerated Alimentum very well, BO soft stool once a day Feeding up to 120 ml every 2-3 hourly Anthropometric data
Weight 6.045 kg (15th percentile) Length 61.5 cm (15th percentile)
Case Study Y
Progress at 6/12
Tolerated Alimentum very well, BO soft stool 1-2X day Feeding up to 150 ml every 2-3 hourly Anthropometric data
Weight 6.93 kg (15th percentile) Length 66 cm (15th percentile)
Complementary feeding
Readiness for solid Only given rice porridge
Case Study F
1 month-old Indonesian baby boy
Referred from Ampang Hospital for further management of persistent diarrhea Clinical history
Born FT, Birth weight 2.25 kg Previously well until D19 OL presented with AGE with 15% dehydration and metabolic acidosis Able to resume breastfeeding until 2 weeks later when he developed recurrent infection NBM X 5/7 noted no loose stools Wt on admission in UMMC -1.89 kg
2011 20
Case Study F
Feeding history
Breastfed until hospital admission Had h/o loose stools when standard infant formula was introduced at D4 OL
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2011
Case Study F
On admission
Physical examination - emaciated Plan for partialExtensively slow infusion of feed PN and
Lactose free formulas ?
Soy based Milk based
Breast Milk ?
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Case Study F
Progress
Tolerated breast milk well but noted poor supply of EBM. Supplemented with Comidagen Child was AOR discharged with breastfeeding and Comidagen. Given follow-up appt Weight - 2.1 kg
BUT.
He defaulted his follow-up appt At 3/12, readmitted with severe dehydration 2 aspiration pneumonia and post enteritis syndrome Weight - 3.12 kg Tried Similac NeoSure for 1 feed at home
2011 23
Case Study F
Management in the ward
Short term goal
Correct dehydration To resume feeding Comidagen
2011
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Case Study C
Client History
Baby C, 2 month-old Chinese baby boy Referred from Kuala Pilah Hospital Born FT with BW 3.3 kg At 2/52 old
c/o recurrent vomiting, diarrhea and intermittent fever and admitted in a private hospital in Kajang Discharged with soy based formula
At 1 months
Brought back with c/o intermittent fever and diarrhea 8-10X/day
Case Study C
Admitted to Kuala Pilah Hospital with c/o diarrhea, BO 8-10X with poor feeding Treated as AGE with 5% dehydration
At 2/12 OL
Case Study C
Complicated with sick thyroid 2 intercurrent illness NBM after an episode of blood-stained stool
US Abdomen noted no evidence of intussusception Planned for parenteral nutrition
Anthropometric data
Birth weight 3.3 kg Current weight 3.065 kg (<3rd percentile) Length 52.6 cm (3rd percentile)
3.065 kg 3.3 kg
Case Study C
Food/NutritionRelated History
Breastfeeding with mixed with standard infant formula until 2/52 old. Then switched to soy based formula (Isomil) Initially able to feed up at 60 ml but later reduced to 30ml every hourly
Case Study C
Feeding was resumed with Comidagen at 1 ml/h with increments at 0.5 -1.0 ml/kg/h A week later, he tolerated feeding well up to 15 ml/h and PN was discontinued Off tube feeding and later discharged with oral feed of Comidagen Weight on discharged 3.675 kg
Progress
Case Study C
Readmitted with c/o watery stools and vomiting after given one feed of 60 ml standard infant formula at home Had recent admission for RSV bronchiolitis
At 4/12 of age
Anthropometric data
Weight on 1st discharge 3.67 kg Weight on 2nd discharge 6.24 kg Current weight 5.5 kg (3rd percentile) Length 62 cm (15th percentile)
6.24 kg
5.5 kg
3.67 kg
Case Study C
Resume feeding with Comidagen Defer introduction of cows milk protein based formula after one year of age Complementary feeding at 6 month KIV for formula challenge after introduction of complementary foods with Alimentum
Nutrition Education
DISCUSSION
2011 35
Soy-based formulas
Lactose-free, Soy protein isolate Indications: Should be limited to infants with galactosemia or congenital lactase deficiency (Bhatia,2008) Strict vegan Should not be used as follows: Not recommended for low birth-weight preterm infants (ESPGHAN, 2005) Slower gains in weight and length Reduced bone mineralization in preterm <1800 g Prevention of colic or allergy Examples: Isomil, Nursoy, Enfalac A+ Soya (sucrosefree), Mamex GOLD Soya 1 (sucrose-free)
2011
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Lactose-free Formulas
Soy and lactose-free formulas shorten the course of diarrhea, but do not change overall recovery or weight 2 weeks after illness Most infants can safely continue breast milk or standard formula during diarrheal illnesses (Sandhu, 1997) At-risk infants might benefit from a switch to lactose-free formula following AGE (Heyman,2006) Younger than 3 months or Who are malnourish
2011
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Hypoallergenic formula is effective for the treatment of milk protein allergy and the prevention of atopic disease
Other indications:
Chronic diarrhea, chronic liver disease, short bowel syndrome
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Protein in form of amino acids Indications Severe cows milk protein or food allergies Severe cases of persistent diarrhea (Mattos,2004) Examples; Neocate, Comidagen
2011
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price
antigenicity hydrolysis
Disadvantages
Poor taste Greater cost Higher osmolarity
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2011