Neonates - General

1. Nutrition
    A. 110 ~115 kcal/kg/day，growth rate: 30 g/day
    B. Newborns usu. begin feeding within 6 hrs of life
    C. Breastfed or formula fed Q3H~Q4H thereafter
         a. The more often baby sucks on the nipple, the more milk will be produced.
    D. If the child stops losing weight by 5 ~7 days, and begins to gain by 12 ~14 days, then feeding is okay.
    E. No juice or water before 6 months
    F. Solid food should be introduced btw 4-6 months。New foods needs to be introduced individually and a week apart to identify allergies and intolerance.
        a. Bland to sweetest: Veggies --> green to orange --> fruits  
        b. Ready for solid foods?
            1) Hand-to-mouth coordination
            2) ↓ tongue protrusion reflex
            3) Sits with support
            4) Improved head control
            5) Drooling
            6) Opens mouth to spoon

2. Insufficient Feeding of Infant
    A. < 6 wet diapers/day after age 1 wk，1 diaper/day for 1st wk
    B. Continual hunger and crying
    C. Continually sleepy and lethargic baby
    D. <7 feeds/day  
    E. Long intervals btw feedings
    F. Sleeping through the night w/o feeding
    G. >10% wt loss
    H. Increasing jaundice



3. Contraindications to Breast-Feeding
    A. Breast Ca
    B. Cancer chemotherapy
    C. Certain meds
    D. Street drugs
    E. Herpetic breast lesions
    F. Active TB
    G. CMV infection
    H. HIV infection
    I. Infant galactosemia

4. Failure to Gain Weight and Grow
    A. Inappropriate formula
    B. Skim + 2% milk before age 2 yrs
    C. Prolonged use of diluted formula
    D. Prolonged use of bananas, rice, applesauce, toast diet after illness
    E. Too much juice or water
    F. Inconsistent care
    G. Inappropriate schedule for feeding

5. Supplements
    A. Fluoride supplement 
          a. After age 6 months if water is not fluorinated.
          b. If <3.3 ppm, supplement with 0.25 mg/day
         c. Def: dental caries
    B. Vit. D
          a. Supplement with 400 IU/day
          b. Def: rickets, tetany, hypocalcemia
    C. Iron
          a. Breast-fed infants need iron supplements at 4 - 6 months. Preterm start at 2 months
    D. Vit. K
          a. Deficient in breast milk
          b. 1-mg vit. K shot at birth for all newborn
              a. BW > 1,500 g, Vit K1 1 mg
              b. BW < 1,500 g, Vit K1 0.5 mg
          c. Def: hemorrhagic disease of the newborn  
    E. Zinc
          a. Def: acrodermatitis, alopecia, growth failure
    F. Vit. A
          a. Hypervitaminosis A
              a. No enzyme to convert provitamin A carotenoids to vitamin A
              b. Acute: Pseudotumor cerebri, N/V
              c. Chronic: poor wt gain, irritability, tender swelling of bones, pruritus, fissures
          b. #1 worldwide most common cause of blindness in young children
    G. Others
         a. Vegetarian mom
              a) Supplement thiamine + vit. B12

6. Fluid Therapy
    A. Total daily fluids (TDF)
          a. Wt >1500 g
               a) Day 1-2: 80 ml/kg/day
               b) Day 3-15: 110 ml/kg/day
               c) Day >15: 130 ~ 150 ml/kg/day
          b. Wt > 1250 g
               a) Day 1-2: 90 ml/kg/day
               b) Day 3-15: 120 ml/kg/day
               c) Day >15: 130 ml/kg/day
          c. Wt >1000 g
               a) Day 1-2: 100 ml/kg/day
               b) Day 3-15: 130 ml/kg/day
               c) Day >15: 140 ml/kg/day
     B. Dehydration signs
         a. Lethargic, increased HR, low BP, no tears, oliguria/anuria, no skin turgor, sunken anterior fontanelle, delay in capillary refill, dry/parched/cracked mucous membranes
     C. Replacement: Holliday-Segar Method

   

6. Electrolytes

     A. Sodium: 3-5 mEq/kg/day

     B. Potassium: 2-4 mEq/kg/day

     C. Calcium

        a. Acute replacement: 30-45 mg/kg/day

        b. Chronic replacement: 100-150 mg/kg/day 

(Reference: NTUH Pediatrics Handbook，First Aid for Pediatrics Clerkship)