Rommel formula for premature babies. Nutrition of premature babies (Requirement for human milk)

Indications To tube feeding:

- absence of sucking and/or swallowing reflexes due to pronounced morpho-functional immaturity;

Severe intrauterine and postnatal infections accompanied by intoxication;

Intracranial birth injury, birth injury of the cervical spine, spinal cord and medulla oblongata;

Ischemic-hypoxic damage to the central nervous system (intracranial hemorrhage, cerebral edema);

Malformations of the hard and soft palate, upper lip;

Severe respiratory and cardiovascular failure. Tube feeding can be intermittent, portioned (bolus) and continuous, long-term (drip).

Feeding children born in a serious condition and requiring intensive care begins with uniform feeding through a tube using an infusion pump. The initial rate of introduction of milk or a specialized mixture is 0.5-1.0 ml/hour. With good absorption of nutrition, the rate is gradually increased to 1-2 ml/hour, after which they switch to fractional tube feeding (8-10 times a day). When the feeding volume reaches 350 ml/s (usually over two weeks of age), they switch to 7-8 feedings a day.

The lower the child’s body weight, the slower and more evenly the prescribed amount of nutrition should be introduced throughout the day. It is generally accepted to eat continuously for 1-2 hours with long breaks of 1-2 hours. A short overnight break is possible.

Tube feeding technique:

Use soft silicone probes of various diameters that do not injure the mucous membrane;

During the procedure, monitor skin color (the appearance of cyanosis), breathing, and heart rate;

Place the baby in the correct position: place him on his back, head raised;

Wet the end of the probe with sterile water;

Insert the tube carefully through the nose (nasogastric insertion) or preferably through the mouth (orogastric insertion);

The required distance is measured from the bridge of the nose through the earlobe to the xiphoid process;

Checking the correct position of the probe;

Then secure the probe with adhesive tape;

Monitor gastric residual volume before each feeding.

Formulas for calculating nutrition for premature babies.

1. Rommel's formula

Vday/100 gr.mass = n + 10

2. Khazanov's formula

Vday/100 gr.mass =nx10(15)

3. Chagall's formula (per 100 grams of mass)

1 week - n + 10

Week 2 - p + 15

Week 3 - p + 18

Week 4 - p + 20

4.Volume method

1 week - 1/8 body weight

Week 2 - 1/7 - " -

3 week - 1/6 - " -

4 week - 1/5 - " -

5Formula R.A. Malysheva (first 10 days of life)

V= 14 x weight x age (days of life)

V - daily volume of milk or formula (ml)

m is the child’s mass (kg).

6. Calorie method

The first 10 days of life - 10 cal x day x weight

2 weeks - 110cal/kg/day

3 week - 110 - 120 cal/kg/day

Week 4 - 130 - 140 cal/kg/day

After the 10th day of life - 100 cal + 10 cal for each week of life. The energy needs of premature babies by 3-4 weeks of life increase to 130 kcal/kg/day with artificial feeding and up to 140 kcal/kg/day with breastfeeding. Starting from the second month of life of a premature baby born with a body weight of more than 1500 g, the calorie content of the diet is reduced monthly by 5 kcal/kg/s to the norms accepted for mature children (115 kcal/kg/s). Reducing the calorie content of very premature infants (weight less than 1500 grams) is carried out at a later date - after three months of age. Nutrition calculations are carried out taking into account body weight at birth, and with the beginning of full weight restoration and the emerging increase in the weight curve - taking into account the actual weight.

When calculating nutrition for premature babies, it is better to use only the “calorie method”.

Nutrition for children aged 1 to 3 years.

In the second and third years of life, the child continues to grow rapidly, the processes of assimilation prevail over the processes of dissimilation. The child’s physical activity increases, and energy costs increase. The formation of the skeleton continues, muscle mass increases. The functional capacity of the digestive tract increases, taste perceptions become more differentiated. After the first year, food becomes more varied and approaches the composition and taste of adult food.

By the age of one year, a child may have 8 milk teeth, by the age of 2 - 20. The development of the masticatory apparatus allows the introduction of harder food that requires careful chewing. However, the transition to new food should occur gradually. For children from 1 to 1.5 years old, all dishes are prepared pureed (soups, cereals, meat and fish - in the form of soufflés, steamed cutlets, meatballs). By the age of 1.5 - 2 years, food can be more dense (vegetable, cottage cheese and cereal casseroles, stewed vegetables, salads from chopped boiled and raw vegetables), at the age of 2-3 years the child can be offered boiled and fried fish, deboned, fried cutlet, stew made from small pieces of meat.

Proper diet is important. Up to 1.5 years of age, it is advisable to feed a child 5 times a day: breakfast, lunch, afternoon snack, dinner and evening milk feeding (about 23-24 hours); By the end of the second year of life, many children gradually abandon the fifth, night feeding and switch to 4 feedings a day. Regardless of the number of meals, feeding hours should be strictly fixed, deviations from the set time should not exceed 15-30 minutes. Between feedings, children should not receive any food, especially sweets, cookies, buns, as this reduces appetite.

Children over 1 year of age should be taught to eat independently, chewing their food thoroughly. By the end of the first year of life, the child should independently hold the spoon in his hand, first by the middle of the handle, and after 2 years, children are taught to hold the spoon correctly. Children hold the cup with both hands. In early childhood, when skills and habits are actively being formed and consolidated, it is of great importance to educate the child in culturally hygienic skills related to eating. Preparing for food sets the mood for food: the baby’s hands are washed, a bib is tied, and a napkin is prepared. It is necessary to develop the aesthetics of eating in a little person: set the table with a bright napkin or oilcloth, put colorful dishes. It is important that the appearance of the dishes attracts the child’s attention, arouses interest in food and stimulates the appetite. During feeding, you should not distract the child by telling fairy tales, showing pictures, toys, etc.

Force feeding is strictly excluded so as not to cause negative emotions and an even greater decrease in appetite. Feeding should take place in a calm, friendly environment. You should feed the child slowly, do not rush, do not get irritated and do not scold the baby for the slow pace of eating, for the sloppiness that is natural at first at this age.

The ratio of proteins, fats and carbohydrates should be approximately 1:1:4; animal proteins - 75% of the total daily amount of protein. Fats need to provide about 30-40% of the total calorie intake; at least 10-15% of all fats should come from vegetable fats.

In the nutrition of children over one year old, a large role belongs to milk and dairy products, including cottage cheese and cheese, rich in proteins, calcium and phosphorus salts. Sour cream is used to season soups and salads.

Gradually increase the amount of meat and fish. It is recommended to use low-fat beef, veal, chicken, rabbit, and offal (liver, tongue, heart). Lean pork and lamb are acceptable. Use low-fat varieties of river and sea fish (in the form of fillets). Children under 3 years of age should not be given dishes made from fatty meat, geese and ducks, as they contain large amounts of difficult-to-digest fats. It is not recommended to feed children under 2 years of age sausages and sausages.

Bread is provided daily for first and second courses. Bread made from rye flour and coarse wheat flour is especially useful. For cereals up to 1.5 years old, they mainly use buckwheat, rice, oatmeal, and semolina; at older ages, millet, pearl barley, and barley cereals are used.

Babies weighing about 1500 g or less usually breastfeed poorly and become very tired, and it is advisable to bottle-feed them or put them to the breast not every feeding. When the first symptoms of fatigue appear (lethargy, cyanosis of the nasolabial triangle), the baby should be weaned from the breast and bottle-fed.

If the baby's body weight at birth is about 2000 g, then he usually takes the breast well and sucks out the required amount of milk.

The number of feedings of a premature baby is determined by its weight, condition, and degree of functional maturity. The most commonly prescribed feedings are 7 times a day with a 6-hour night break. Only if the child is severely ill and ill, the number of meals can be increased to 10. When the body weight of a premature baby reaches 3000-3500 g, at the age of 2-3 months he can be transferred to 6 meals a day. The subsequent feeding pattern is not much different from the physiological pattern of the first year of life.

When determining the amount of food needed by a premature baby, it is usually based on its individual characteristics, body weight at birth, and general condition. A premature baby has increased growth energy compared to a full-term baby, so he needs an amount of food that would satisfy his energy needs. At the same time, food tolerance in premature infants is reduced due to the functional immaturity of the gastrointestinal tract. The capacity of the gastrointestinal tract in such children is small, and the digestive activity of juices is significantly reduced. All this requires a very precise and precise determination of the amount of food.

Usually, on the first day of life, a premature baby receives 5-10 ml of milk per feeding, on the second day - 10-15 ml, on the third day - 15-20 ml. Over the next 10 days, the amount of food needed for a premature baby can be approximately calculated using Rommel's formula:
V=n+10,
where V is the amount of milk in ml for every 100 g of the child’s body weight, and n is the number of days of life.

For example, if a child’s body weight on the 5th day of life is 2000 g, then the amount of food per day should be (5 + 10) X 20 = 300 ml. Then, for one feeding with 7 meals a day, the child should receive 43 ml of milk (300:7).

However, when calculating nutrition using Rommel's formula, slightly overestimated amounts of food are obtained. Therefore, a more correct method is calculating nutrition by calorie content, which is mainly used in the domestic diet. According to these recommendations, a premature baby should receive 30-60 kcal/kg body weight in the first three days of life, 70-80 kcal/kg body weight by the 7-8th day of life, and 100-100 kcal/kg by the 10-14th day of life. 120 kcal/kg body weight, and at one month of age - 135-140 kcal/kg body weight. From 2 months of age, caloric intake is calculated based on body weight at birth. For children born weighing more than 1500 g, caloric intake is reduced to 130-135 kcal/kg body weight. In children born weighing 1000-1300 g, up to 3 months of age the caloric content of food should be 140 kcal/kg body weight, and at 4-5 months - 130 kcal/kg body weight. In this case, the general condition of the child, his ability to digest food, the intensity of weight gain, etc. are taken into account.

For example, a child’s body weight by the 8th day of life is 2300 g. At this age, he should receive 80 kcal per 1 kg of weight, which will be 184 kcal per day. This amount of calories is contained in 260 ml of breast milk, which has a calorie content of 70 kcal per 100 ml. With seven meals a day, the child should receive an average of 37 ml at each meal.

In recent years, all over the world it is considered the most physiologically justifiable to put the baby to the breast in the delivery room and the further stay of the mother and newborn together in the maternity hospital. The most important advantage is the possibility of feeding “on demand” (10-12 times a day without observing clear intervals between feedings and with breastfeeding at night). The benefits of on-demand feeding are:

The volume of mother's milk is noticeably greater already in the first days of lactation,
than when feeding “by the hour”;

Physiological loss of body weight is reduced and noticeably faster
the newborn's original weight is restored,

The risk of developing purulent-inflammatory diseases in
period newborn™.

Feeding “on demand” can be carried out until the age of introduction of main complementary foods, but in the vast majority of cases it is limited to the neonatal period. If the mother retains a sufficient amount of milk after 1-1.5 months, the baby develops an individual daily feeding rhythm and, on average, is applied to the breast 6-7 times a day. Subsequently, the frequency of feeding in the first half of the year does not exceed 6 times, and in the second half of the year - 5 times a day.

Using the “on demand” feeding method for breastfed children allows, in most cases, to avoid calculating the volume of milk. However, some children, especially those with contraindications to feeding, require feeding with expressed milk, and therefore in the first days of life it is necessary to calculate the volume and frequency of feedings.

FORMULAS USED TO CALCULATE THE VOLUME OF FEEDING FOR TERM BABIES

Zaitseva formula: daily amount of milk = 2% body weight
at birth x p, where p is the day of the child’s life.

Finkelyytein-Tur formula: daily milk volume = n X 70
(or 80), where n is the day of the child’s life, and the coefficient depends on the mass
body at birth (for weights less than 3200 g, the coefficient is used
70, and with a birth weight of more than 3200 g - coefficient 80).

Shabalov’s formula: one-time feeding volume = 3 X gd X p, where m -
body weight at birth (in kilograms), an - day of the child’s life;

“Volume” method: one-time feeding volume = n X 10, where n is
day of a child's life.

FORMULAS USED TO CALCULATE THE VOLUME OF FEEDING FOR PREMATURE BABIES

Shabalov's formula: see above.

Rommel's formula: daily feeding volume = (n + 10) per
every 100 g of the child’s body weight at birth, where n is the number of days
life.

METHODS FOR CALCULATING THE DAILY VOLUME OF FEEDING CHILDREN OVER 10 DAYS OF AGE

The most common and fairly accurate calculation method is the “volumetric” method - the daily feeding volume is equal to:

V.5 body weight at the age of 2 to 6 weeks;

Weight of body weight between 6 weeks and 4 months;

1/7 body weight between 4 and 6 months;

] / 8 body weight at the age of 6 to 9 months.

In this case, the daily volume of feeding, regardless of body weight, should not exceed 1 liter. In the second half of life, a single feeding volume can exceed 200 ml (with 5 feedings per day, the daily volume exceeds 1 liter), usually due to juice and fruit puree, however, it is necessary take into account the capacity of the child's stomach.

The calorie method is considered more accurate - per 1 kg of body weight, the child should receive:

At the age of 0 to 6 months - 115 kcal/day;

At the age of 6 to 12 months - 110 kcal/day.

m ix6uii<,i x потребность в ккал на кг X1000
Slight calorie content of the product (in 1 liter)

Formulas used to calculate the amount of food for full-term newborn babies:

1) Zaitseva’s formula: daily amount of milk = 2% of body weight at birth *n, where n is the day of the child’s life;

2) Finkelstein-Tur formula: daily milk volume = n*70 (or 80), where n is the day of the child’s life, and the coefficient depends on body weight at birth (for a weight less than 3200 g, a coefficient of 70 is used, and for body weight at birth more than 3200 g - coefficient 80);

3) Shabalov’s formula: one-time feeding volume = 3*m*n, where m is body weight at birth (in kilograms), and n is the child’s day of life.

Formulas used to calculate the amount of food for premature babies:

1) Shabalov formula: see above;

2) Rommel’s formula: daily feeding volume = (n + 10) for every 100 g of the child’s body weight at birth, where n is the number of days of life.

Methods for calculating the daily amount of food for children over 10 days old:

1) volumetric method: a child aged 2 to 6 weeks should receive 1/5 per day, from 6 weeks to 4 months - 1/6, from 4 to 6 months - 1/7, from 6 to 9 months - 1/ 8 body weight. In this case, the daily volume of food, regardless of body weight, should not exceed 1 liter. In the second half of life, a single feeding volume can exceed 200 ml, mainly due to juice and fruit puree, and it is necessary to take into account the capacity of the child’s stomach;

2) caloric method: per 1 kg of body weight, a child should receive 115 kcal/day at the age of 0 to 6 months, and 110 kcal/day at the age of 6 to 12 months. The daily amount of food is calculated based on the calorie content of breast milk or formula.

Calculation of nutrition for children born with a large weight and having high rates of physical development: at the age of 1 month, such a child should receive 700-800 ml of milk, and for each subsequent month 50 ml more. From 5 months, the volume of food should not exceed 1000-1100 ml of milk.

Feeding newborn babies

A healthy newborn baby has a good sucking reflex immediately after birth. In recent years, healthy newborns are increasingly recommended to be put to the breast in the delivery room, extending such contact to 30 minutes. Early breastfeeding stimulates lactation, promotes uterine contraction, and accelerates the separation of the placenta.

Currently, from the first days of a child’s life, it is recommended to feed on demand, without a fixed schedule. It is most preferable for mother and child to stay together in the maternity hospital. Without serious medical indications, newborns should not be fed or supplemented.

After discharge from the maternity hospital, it is advisable to continue feeding the child using the free feeding method up to 10-12 times a day, including at night, for the entire neonatal period.

When breastfeeding twins, the fussiest baby is fed first. The second baby should be placed on the same breast to empty it more completely, and then fed from the other breast. The next feeding should begin with the same breast from which the second child was fed.

Nutrition for pregnant and lactating women

If a pregnant woman is malnourished, not only milk production suffers, but also its chemical composition. In the first half of pregnancy, the average energy requirement is 2500-3000 kcal per day, in the second half it increases to 3000-3500 kcal. The total amount of protein in a pregnant woman's diet should be 100-120 g per day (of which 60% is of animal origin), fat - 80-100 g (vegetable oils 15-20%). The amount of carbohydrates, especially easily digestible ones, should be limited to sugar, confectionery, pasta, and bread. A pregnant woman's diet should include vegetables and fruits. In the second half of pregnancy, especially the last two months, the amount of salt should not exceed 5 g per day.

A pregnant woman needs increased amounts of vitamins. Vitamin D is of particular importance for the development of a child. According to WHO, for a pregnant and lactating woman, the need for vitamin D is 1000 IU per day. Additional amounts of vitamin D are needed by: urban women, primigravidas, women with a professional deficiency of exposure to the fresh air, those on mandatory bed rest, with a vegetarian diet, and those receiving anticonvulsant therapy for a long time. In the first 7 months of pregnancy, a woman should receive 400 IU of vitamin D daily, later - 1000 IU. To more reliably provide the fetus with vitamin D at the beginning of the 7th month of pregnancy, which occurs in the autumn-winter time, you can give a single loading dose of 200,000 IU of vitamin D.

The nutrition of a nursing mother should be approximately the same as during pregnancy. It is advisable for a woman who is breastfeeding to eat 5-6 times a day, 30-40 minutes before feeding the baby, which promotes better milk secretion. An approximate daily set of products should include: 200 g of meat or fish, 1 liter of milk or fermented milk products, 150 g of cottage cheese, 20-30 g of cheese, 500-600 g of vegetables, 200-300 g of fruit. Of the fats, it is better to consume butter (15-20 g) and vegetable oil (25-30 g). To correct nutrition, use “Femilak-2”, “Empha-mama”, “Dumil-Mama plus”, enriched with proteins, vitamins and minerals.

The amount of liquid in the daily diet (soup, tea, milk, kefir, juices) is increased to 2 liters. Drinking alcohol and smoking are not allowed. Harmful substances easily penetrate into breast milk and lead to disturbances in the baby’s nervous system.

The diet should limit chocolate, natural coffee, nuts, honey, mushrooms, citrus fruits, which can cause allergic reactions in the child. Onions and garlic can cause a baby to refuse breastfeeding.

Ways to stimulate lactation

If the mother has a slight deficiency of milk, she should place the baby on each breast in turn and carefully express the milk. The number of feedings can be increased, including through night feedings. Increased lactation can be achieved by stopping bottle-feeding, psychoprophylaxis, normalizing the mother's nutrition, relaxation while breastfeeding, constant contact with the child, and increasing the duration of breastfeeding. Large amounts of liquid consumed by the mother can reduce milk production.

In order to increase milk production, it is recommended to consume drinks prepared using herbal lactation stimulants: dandelion, nettle, dill, oregano, cumin, lettuce, carrots, radish. A shower-massage procedure stimulates lactation - after feeding, the breasts are washed with hot water (45 o C) and at the same time a massage is carried out from the center to the periphery and from top to bottom. The procedure is carried out for 10 minutes, 2 times a day for each breast. The shower can be replaced with compresses made from terry cloth soaked in hot water.

For the treatment of hypogalactia, the following can be used: UV irradiation of the mammary glands (from 1/4 to 1 biodose for 10 days), electrophoresis with nicotinic acid, ultrasound, warming with a Solux lamp (from 5 to 30 minutes with a daily increase in session time by 5 minutes , course - 5-10 days), paraffin applications on the mammary glands, alternating vibration massage and diathermy, acupuncture.

It is recommended to use a feeding tube (the principle of a cocktail straw). One end of a thin (!) tube is lowered from a cup of milk, and the other is secured along the nipple. The flow of milk is regulated by clamping the tube.

Drug treatment of hypogalactia should be used in combination with other methods. The duration of the course of therapy is 7-10 days, courses can be repeated if necessary.

1st complex: apilak 0.01 g 3 times a day under the tongue, "Gendevid" or "Undevid" 1 tablet 2 times a day after meals, vitamin E 0.1 g 3 times a day, glutamic acid 1.0 g 3 times per day 20 minutes after meals (drink with strong tea), nicotinic acid in an individually selected dose (0.05-0.1 g) 4 times a day after meals 15-30 minutes before feeding the child. The dose of the drug is selected as follows: if there is enough milk for the first two feedings, then before the third feeding nicotinic acid is given in a dose of 0.05 g. If this dose gives a feeling of warmth, then this is the required dose of the drug, if this feeling is not present, then the dose gradually increase to 0.1 g.

2nd complex:(prescribed 7-10 days after the first complex in case of insufficient effect) brewer's yeast 60 g 3 times a day (if the yeast is dry, then take 1 teaspoon 3 times a day) or gefefitin 1 tablet 4 times a day day, lipoic acid 1 tablet 3 times a day, asparkam 1 tablet 3 times a day.

A positive effect can be obtained by prescribing a 0.05% solution of potassium iodide, 1 teaspoon 3 times a day for 7-10 days. To treat hypogalactia after premature birth, cerucal is used, which stimulates the secretion of prolactin. On days 10-15 after birth, if attempts to increase milk volume are unsuccessful, Cerucal is prescribed 1 tablet 3 times a day 15 minutes before meals for 7 days (the drug can be given for up to 3 months). The drug is contraindicated in hypertension. According to WHO recommendations, chlorpromazine is prescribed 25 mg three times a day for 7 days.

Measures to prevent the development of hypogalactia include feeding in a relaxed state, drinking a warm drink before feeding, and starting feeding as soon as the mother feels pressure in the chest.

With true hypogalactia, it is necessary: ​​1) to feed the baby with each breast twice. 2) stimulate the oxytocin reflex: express milk in a calm environment (with an assistant). While pumping, you should hold the baby on your lap or look either at him or at his photo. Drink a warm, soothing drink (not coffee). Warm the chest (compress, heating pad, warm shower). Gently massage the breast towards the nipple. Ask the assistant to rub the mother's back for 1-2 minutes on both sides of the spine, starting from the neck to the shoulders.