case study: pre-term infant
by Jacqui Lowdon
Specialist Paediatric Dietitian
Pre-term infant with Vitamin D
defi cient mother
Born at 33 weeks gestation, with a birth weight of
1.8kg, C50th, Baby D was initially tube fed with
expressed breast milk. Top-ups via an NGT were
administered whilst breast feeding was being es-
tablished. On occasions, a preterm formula was
used whilst Mum was establishing breast milk
production. However, Baby D was successfully
discharged home at 8 weeks post delivery,
on full breast feeds.
Weight on discharge was 3.0kg, C9th eight on discharge was 3.0kg, C9th
– 25th. Weaning was commenced at 33
weeks post delivery (19 weeks/4 months
corrected). By then, weight gain was
poor, with weight now on C2nd. It was
thought that introducing solids would
help with weight gain. Although the
introduction of solids is not recom-
mended before six months of age,
these guidelines are not for special
groups, such as pre-terms. There is very
little guidance in this area, although
generally it is usually advised not to start
earlier, unless under special circumstances
(seven months post-delivery has been suggest-
ed (1)).
However, weight gain remained poor and at 6
months corrected age, with weight now on the C0.4th,
a referral was made to a paediatric dietitian. Mum was
continuing to breast feed and had introduced solids
twice a day. These consisted of pureed vegetables/fruit/
baby rice only, with expressed breast milk being used to
D’s weight had demonstrated signs of an upward trend
add to the solids. Mum felt that Baby D was feeding well
with weight now heading back towards the C2nd. Once
from the breast and was not keen to top up with a nutri-
a weight gain had been established and the dietitian
ent dense formula milk.
was happy with mum’s improvement to her diet, follow
When Mum was asked in detail about her diet it soon
up was with regular weight checks with the health visitor.
became apparent that the reason why Baby D may
This case highlights the importance of discussing a
have faltering growth, was that Mum was following a nu-
pregnant woman’s diet and eating habits as early as
tritionally inadequate vegetarian diet. Her diet was lack-
possible, so that concerns can be addressed as soon as
ing in protein, particularly of high biological value, iron
possible - this is particularly important if Mum intends to
and calcium. Dietary vitamin D intake was also poor and
breast feed.
she had not been advised to supplement with vitamin
In March 2008, NICE published guidance on Mater-
drops whilst breast feeding. This was especially pertinent
nal and Child Health and Antenatal care (2), highlight-
in this case as Mum has a darker skin pigmentation and
ing diet in pregnancy, vitamin D and the Healthy Start
so was at high risk of vitamin D defi ciency.
vitamins. They state that early on in pregnancy, women
Nutritional advice was provided to Mum: increase
should be provided with information on the benefi ts
intake of protein and improve the quality and improve
of a healthy diet and practical advice on how to eat
iron, calcium and vitamin D intake. Mum was advised to
healthily throughout pregnancy and breastfeeding. The
commence the Healthy Start vitamin supplements (vita-
important role dietitians play in this area was highlighted.
mins C (70mg), D3 (10ug) and folic acid (400ug)), which
References
should be advised for all breast feeding mothers, espe-
1 Clinical Paediatric Dietetics 3rd Edition, 2007
cially those in high risk groups (such as those with darker
2 NICE Public Health Guidance 11 Maternal and Child Nutrition March 2008
www.nice.org.uk/PHO11
skin pigmentation).
NICE Clinical Guidance 62 – Antenatal Care. Routine care for healthy pregnant
Follow up was arranged in two months. By then, Baby
women March 2008
www.nice.org.uk/CG062
NHDmag.com July ‘08 - issue 36 31
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