2025 – PAGE 168 – NEONATOLOGY

NEONATAL CALORIC REQUIREMENT

As a rule of thumb, term newborns require 100–120 kcal/kg/day for normal growth, while premature babies may require even more than 120 kcal/kg/day.

PEARL: This is a GENERAL GUIDE. If a child is not gaining weight normally, increase the caloric intake.

EXCLUSIVELY BREASTFED BABIES

In exclusively breastfed babies, look for Vitamin D and Vitamin K deficiencies.

PEARL: ALL BABIES under 1 year of age (breast and formula fed) are supposed to get a total of 400 IU (international units) of Vitamin D per day in their diet. Supplementation of Vitamin D is required for all breastfed babies. For formula-fed babies, Vitamin D supplementation the requirement is usually satisfied through the formula, but supplementation for formula-fed infants is required if the intake is less than 32 oz of formula per day. Vitamin D deficiency can lead to Rickets!

PEARL: Patients with CF (CYSTIC FIBROSIS) or RICKETS need > 1600 IU per day!

BREAST MILK

Breast milk contains arachidonic acid, DHA, whey, casein, colostrum, hind milk, etc. It’s a lot to remember, so memorize the following and move on!

• ARACHIDONIC ACID (AA) & DOCOSAHEXAENOIC ACID (DHA): Help with neurologic development. The greatest amount is in COLOSTRUM—not as much in mature milk.
• WHEY: The primary protein in breast Breast milk is WHEY better!
• CASEIN: The primary protein in FORMULA.
• COLOSTRUM: The milk produced at the end of pregnancy and early after delivery. Only small amounts are expressed in the first few days until the more mature milk finally comes in.
  • The yellow color is from carotene.
  • Colostrum stimulates the passage of meconium.
  • It is high in PROTEIN (immunoglobulins, especially IgA).
• HIND MILK: Last bit of milk expressed during breastfeeding. It is highest in CALORIES and FAT.
• FROZEN BREASTMILK: Good for 3–6 months. Once it is thawed, use within 48 hours.
• CONTRAINDICATIONS TO BREASTFEEDING include herpes simplex virus (HSV) with lesions on the breast; HIV; active, untreated tuberculosis (TB); most recreational drugs; chemotherapy; sulfa drugs (in the first month of life); tetracycline; some psychotropic drugs; a number of other drugs. Breastfeeding is also usually contraindicated if the baby has classic galactose deficiency and may need to be modified if it has certain other INBORN ERRORS OF METABOLISM. An inverted nipple may be a contraindication depending on the degree of inversion. Nipple shields or breast shells may be needed.

PEARL: Candidiasis, mastitis, and fibrocystic disease are NOT contraindications.

PEARL: Hepatitis B is NOT a contraindication for breastfeeding. Mothers who are CMV carriers (not recent converters) may also breastfeed.

MNEMONICS:

• COLOSTRUM: Although it is supplied to babies very EARLY in life, it has tremendous LONG-TERM protective benefits/ingredients (AA, DHA, IG’s/IgA AKA protein).
• MATURE MILK is the regular, everyday milk that provides the regular, everyday ingredients to a baby (fat, lactose, “energy,” etc.).
• HIND MILK: HIND milk has a high FAT and CALORIC content, like the unusually oversized beHIND of an appropriately overweight/fat new mom. (Sorry for the un-PC mnemonic. Hopefully it helps.)
• WHEY: Breast milk is WHEY better, and FORMULA comes IN a CASE (CASE-IN). (Thanks to PBR member “SC” for submitting this one!)