Lec 13 Premature infant and their feeding infant formulas. Lactose intolerance.

Premature infants feeding :

The pre term babies are best fed with unprocessed human milk obtained from their mothers. It
has been shown that milk of mothers delivering prematurely has high caloric, fat, protein and
sodium content which is suitable for nutritional needs of low birth weight babies. If the baby
does not gain weight satisfactorily with breast milk alone , dietary supplements like vegetable
oils may be used which increase the calorific value without increasing its volume.When
mothers milk is not possible it can be feed infant formulas . Based on birth weight, general
condition of the baby and maturity it was decided to go for breast milk / gavage.

Bolus , intermittent nasogastric tube feeds every 2 hours in small babies and every 3 hours in
larger babies.

Initial volume used will be as low as 1-2 ml for feeding infants of 1000 g or less or as much as 4-
5 ml /feed for an infants of 1500 g.

If oral feeds are tolerated then increase the volume of feeding by 1 ml/ day in smaller infants /
by as much as 3-5 ml in the larger infants.

Feeding must be reduced / withheld /even omitted entirely when there is gastric retention or
abdominal distention.

Ultimately the volume of intake should be 150-170 ml /kg/day and calorific value 110-120
ml/kg/day.

Lactose intolerance

What Is Lactose Intolerance?

Lactose intolerance is a digestive disorder caused by the inability to digest lactose, the
main carbohydrate in dairy products.
It can cause various symptoms, including bloating, diarrhea and abdominal cramps.
People with lactose intolerance don't make enough of the enzyme lactase, which is needed to
digest lactose.
Lactose is a disaccharide, meaning that it consists of two sugars. It is made up of one molecule
each of the simple sugars glucose and galactose.
The lactase enzyme is needed to break lactose down into glucose and galactose, which can
then be absorbed into the bloodstream and used for energy.
Without sufficient lactase, lactose moves through your gut undigested and causes digestive
symptoms.
Lactose is also found in breast milk, and almost everyone is born with the ability to digest it. It
is very rare to see lactose intolerance in children under the age of five.
Currently, about 75% of the world's population is lactose intolerant.
Causes of Lactose Intolerance
There are two main types of lactose intolerance, which have different causes.
Primary Lactose Intolerance
Primary lactose intolerance is the most common. It is caused by a decrease in lactase
production with age, so that lactose becomes poorly absorbed .
This form of lactose intolerance may be partially caused by genes, because it's more common
in some populations than others.
Population studies have estimated that lactose intolerance affects 5–17% of Europeans, around
44% of Americans and 60–80% of Africans and Asians.
Secondary Lactose Intolerance
Secondary lactose intolerance is rare. It is caused by illness, such as a stomach bug or a more
serious issue like celiac disease. This is because inflammation in the gut wall can lead to a
temporary decline in lactase production. Secondary lactose intolerance is caused by
inflammation in the gut, secondary to an infection or disease.

What Are the Symptoms of Lactose Intolerance?

If not managed properly, lactose intolerance can cause severe digestive problems.
The most common symptoms are
 Bloating
 Abdominal cramps
 Gas
 Diarrhea
 Diarrhea occurs due to undigested lactose in your small intestine, which causes water to
move into your digestive tract.
 Once it reaches your colon, the lactose is fermented by the bacteria in your gut,
forming short-chain fatty acids and gas. This causes the bloating, flatulence and pain.

Treatments for Lactose Intolerance

If you don't want to give up dairy, then there are a few natural treatments that can help.
1. Enzyme Supplements
It's possible to buy enzymes to help digest lactose. These are tablets you swallow or drops you
add to foods and drinks.
However, the effectiveness of these products seems to vary from person to person
Nevertheless, lactase enzyme supplements may be very effective for some people.
One study examined the effects of three different types of lactase supplements in lactose-
intolerant people who took 20 or 50 grams of lactose .
Compared to placebo, all three lactase supplements improved overall symptoms when taken
with 20 grams of lactose.
However, they weren't effective at the higher dose of 50 grams of lactose.
2. Lactose Exposure
If you are lactose intolerant, regularly including lactose in your diet could help your body adapt
to it.
In one small study, nine lactose-intolerant people experienced a threefold increase in their
lactase production after 16 days of eating lactose .
More rigorous trials are needed before definite recommendations can be made, but it may be
possible to train your gut to tolerate lactose.

3.Probiotics and Prebiotics

Probiotics are microorganisms that provide health benefits when consumed .
Prebiotics are types of fiber that function as food for these bacteria. They feed the beneficial
bacteria you already have in your gut, so that they thrive.
Both probiotics and prebiotics have been shown to reduce symptoms of lactose intolerance,
although most studies so far have been small .
One of the most beneficial probiotics is thought to be Bifidobacteria, often found in probiotic
yogurts and supplements.

People With Lactose Intolerance May Be Able to Eat Some Dairy

All dairy foods contain lactose, but this doesn't mean they are totally off limits for people with
lactose intolerance.
Most people with lactose intolerance can tolerate small amounts of lactose. For example,
some people can tolerate the small amount of milk in tea but not the amount you would get
from a bowl of cereal.
In fact, research has shown that many people with lactose intolerance can tolerate up to 12
grams of lactose in one sitting, which is approximately the amount in 1 cup (230 ml) of milk .
Some types of dairy are also naturally low in lactose when eaten in their usual portions.
Butter, for example only contains 0.1 grams of lactose per 20-gram portion.
Certain types of cheese also have less than 1 gram of lactose per serving. This includes
cheddar, Swiss, Colby, Monterey Jack and mozzarella.

Good Non-Dairy Sources of Calcium.

The recommended intake for calcium is 1,000 mg per day.
Some good non-dairy sources of calcium include:
 Calcium-fortified foods: There are many calcium-fortified foods, including juices,
breads and non-dairy milks such as almond, soy or oat milk. Shake the carton before
use, since the calcium can settle on the bottom.
 Boned fish: Canned fish with bones, such as sardines or whitebait, are high in calcium.
 High-calcium plants foods: Many plant foods contain reasonable amounts of calcium.
However, this calcium is often poorly absorbed due to the presence
of antinutrients like phytate and oxalate.