COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

RESOURCE UNIT ON
NUTRITIONAL NEEDS OF A NEWBORN

SUBMITTED BY:
Capuyan, Jean Loury
Colonia, Noelle V.
Delara, Krishna Faith P.

SUBMITTED TO: Mr. Christian Perojon, RN

 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

NEGROS ORIENTAL STATE UNIVERSITY

VISION: A dynamic, competitive and globally responsive state university.
MISSION: The University shall provide excellent instruction, relevant and responsive research and extension services, and quality assured production through competent and highly motivated
human capital.

GOALS:
Negros Oriental State University strives to advance:
National development through international partnerships
Opportunity-laden educational access for poor but deserving students
Research-based and competency-driven instruction
Scholarship and innovation
Unity and diversity in culture
CORE VALUES: QUALITY POLICY:
Spirituality NORSU: commits itself to the
Accountability provision of quality instruction,
Professionalism research, extension services and
Patriotism production as well as compliance
Harmony to applicable regulatory
Integrity requirements and continual
Respect improvement of its management
Excellence system
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

CNPAHS VISION:
NORSU College of Nursing, Pharmacy and Allied Health Sciences (CNPAHS) as an educational institution to become the premiere provider of health care education in the country and
across the world.
CNPAHS MISSION:
Provide excellent instructions thereby developing competent future health leaders and practitioners who are intellectually and humanely responsive, self-directing and contributing
members of the society.
CNPAHS GOALS:
 Develop innovative approaches towards achieving quality teaching, research, service, and practice goals.
 Contribute to the knowledge base of the discipline through an active program of health care and interdisciplinary research that are responsive to the changing health needs of the
population.
 Cultivate the attitudes and skills necessary to think critically, manage information and assume accountability for independent decisions.
 Maintain an awareness of the historical trends, legal, social, economic, political and trans-cultural issues related to total health care education and practice.
CNPAHS OBJECTIVES:
 To synthesize theoretical and empirical knowledge from the general education subjects with professional subjects to produce competent graduates.
 To equip would-be health leaders and workers with comprehensive knowledge and skills in administering health services in various health settings.
 To motivate the faculty and students to undertake cutting edge research that will enhance the quality of human life and contribute to national and global development.
 To maintain collaborative and cooperative partnership with the community through health care programs and extension services.
 To value every individual as a unique and adaptive person who has worth and dignity and who engages in dynamic and reciprocal interaction with the environment.
 To collaborate with health consumers and providers in promoting, maintaining and restoring health and facilitate the provision of accessible, cost-effective, quality health care.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

BACHELOR OF SCIENCE IN NURSING PROGRAM OBJECTIVES

The students shall be given opportunities to be exposed to the various levels of health care (health promotion, disease prevention, risk reduction curative and restoration of health) with
values client (individual, family, population groups and community). These opportunities shall be given in graduated experiences to ensure that the competencies per course, per level and for the
whole program are developed. Before graduation, the student shall the competencies of a professional nurse as they assume the various roles and responsibilities. For each year level the following
shall be achieved.
LEVEL II
At the end of the second year, the student shall have acquired the holistic understanding of the human person as a bio-psycho cultural being focusing on the concept of health and illness as
it is related to the care of the mother and the child in varied settings. Specifically, the students shall:
1. Describe the health care delivery system and nurse’s role in it.
2. Demonstrate ethico-moral legal responsibilities in the care of individual, family, and community.
3. Demonstrate the beginning skills in the provision of the independent and collaborative nursing function.
4. Discuss the role of economics as it impacts on health and illness.
5. Relate the stages of growth and development in the care of the clients.
6. Demonstrate the beginning skills in the preparation of healthy and therapeutic diets in varied client cases.
7. Explain the dynamics of the disease process caused by microbes and parasites, and the environment.
8. Imbibe the core values cherished by the nursing profession such as love of God, caring, love and community and of people.
9. Design a plan that will focus on health promotion and risk reduction to clients.
10. Utilize the nursing process in the care of the high-risk mother and child in the family and in the community.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

TOPIC TITLE Nutritional Need of a Newborn

This topic deals with the concepts related to nursing care of newborn’s nutritional needs. It includes the
TOPIC DESCRIPTION different minerals and vitamins, physiology of breast milk production as well as its advantage on the infant
and mother, the feeding formula and the discharge planning for newborn nutrition.
TIME ALLOTMENT 45 minutes
PLACEMENT 1st Semester, SY 2021 – 2022
PARTICIPANTS BSN Level II Nursery Group 1
ROTATION NURSERY/ PRENATAL/LRDR/POSTPARTUM
GENERAL At the end of 45 minutes of varied teaching-learning activities, the learners will be able to demonstrate
OBJECTIVES excellent knowledge in giving proper nutrition to support the growth of the baby.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES

TEACHING-
SPECIFIC TIME
CONTENT/TOPIC LEARNING MATERIALS EVALUATION
OBJECTIVES ALLOTMENT
ACTIVITIES

I. Nutritional Allowances for a Newborn At the end of the 45

A. Calories minutes discussion
 The calorie requirement in the growth of neonatal period and learners will be able to:
early infancy is more rapid than at any other period of life. It
usually depends on the infant’s activity level and growth rate.  Identify and  45  Focused and  Powerpoint  Instant
 The commercial formulas for infants are designed to simulate provide the needed minutes Lecture Presentation Feedback
the breast milk to have the same number of calories per vitamins and Discussion with Video  15- items quiz
ounce of it. It contains about 9% to 12% of its calories as minerals to Clips  Oral
protein and 45% to 55% of calories as lactose carbohydrate. support the baby’s Assessment and
growth. Recitation
B. Protein
 A newborn baby has a high requirement of protein, which is
necessary for the formation of new cells. This is needed to
provide for the rapid growth of new cells as well as for the
maintenance of existing cells.
 Both human milk and commercial formulas provide all the
essential amino acids necessary to form protein and one of
this is the Histidine – which is an amino acid that is essential
for infant growth but not necessary for adult growth.
 Unaltered cow’s milk is not recommended for newborns
because it contains about 16% of its calories as protein and it
can cause microscopic bleeding in the GI tract that could
probably result to blood loss and anemia. These problems
occur because the protein in cow’s milk has casein that
determines its curd tension. Casein’s curd is large, tough and
difficult to digest compared to the curd of human milk.

C. Fat
 An essential fatty acid called Linoleic acid is necessary for
brain growth and skin integrity in infants. If the amount of
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES
this is sufficient, the infant can then manufacture
docosahexaenoic acid (DHA), an omega-3 fatty acid, and
arachidonic acid (ARA), an omega-6 fatty acid, both of which
are important for brain growth.
 Use fat-free milk for longer periods in newborn and infants to
help develop the brain and nerve growth of the baby but fat-
free milk does not contain sufficient calories for a newborn; it
only has about half as many calories as commercial formulas
or breast milk.

D. Carbohydrate
 Lactose, a disaccharide found in human milk and added to
commercial formulas, appears to be the most easily digested
of the carbohydrates. It improves calcium absorption and aids
in nitrogen retention. Additionally, it produces stools
consisting predominantly of gram-positive rather than gram-
negative bacteria and therefore decreases the possibility of
gastrointestinal illness.

E. Fluid
 It is important to maintain a sufficient fluid intake in
newborns because their metabolic rate is so high. This can be
supplied completely by breastfeeding or formula feeding.
 A newborn’s body surface area is large in relation to body
mass. This further means that a baby loses water by
evaporation much more readily than does an adult and,
because the kidneys of a newborn are not yet capable of fully
concentrating urine, the newborn cannot conserve body water
by this mechanism to prevent dehydration.

F. Minerals
i. Calcium
 Calcium is important to the newborn because a
newborn’s skeleton grows rapidly. Since milk is high
in calcium, tetany resulting from a low calcium level
seldom occurs in infants who suck well, regardless of
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES
whether they are fed human milk or commercial
formula.

ii. Iron
 The adequate iron intake of the mother during
pregnancy theoretically, will last for the first 3
months of baby’s life, or until the newborn begins to
produce adult hemoglobin.
 Since not all mothers eat an iron-rich diet during
pregnancy the American Academy of Pediatrics
(AAP) recommends infants who are formula fed
ingest an iron-enriched formula for the entire first
year of life.
 Women who breastfeed are also advised to
supplement iron to ensure that their infant does not
develop iron deficiency anemia.

iii. Fluoride
 Fluoride is an essential component for building sound
teeth and for preventing tooth decay.
 A lactating mother should continue drinking
fluoridated water and formulas should be prepared
with fluoridated water.
 A fluoride supplement of 0.25 mg daily, may be
given to the infant beginning at 6 months of age.
G. Vitamins
 Although both breast milk and commercial formulas contain
sufficient vitamins for growth, the AAP recommends that
breastfed babies be given a supplement of 400 International
Units per day of vitamin D, beginning in the first few days of
life.
 Additional vitamins are not usually begun until the infant
approaches 6 months of age.
 Describe the
II. Breastfeeding physiology of
breast milk
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES
Breastfeeding remains the ideal nutritional source for infants production and
through the first year of life. As nurses, we should help create an study its
atmosphere conducive to breastfeeding success in health care advantage in the
facilities by implementing steps, such as: mother and the
• Educating all pregnant women about the benefits and baby.
management of breastfeeding.
• Helping women initiate breastfeeding within half an hour after
birth.
• Assisting mothers to breastfeed and maintain lactation even if
they should be separated from their infant.
• Not giving newborns food or drink other than breast milk unless
medically indicated, so they are hungry to breastfeed. Advise
women they need not introduce solid food until at least 4 months.
• Not giving newborns pacifiers to quiet them as this can reduce
the sucking initiative.
• Supporting rooming-in (such as allowing mothers and infants to
remain together) 24 hours a day.
• Encouraging breastfeeding on demand.
• Fostering the establishment of breastfeeding support groups and
referring mothers to them on discharge from the birthing center or
hospital.

A. Physiology of Breast Milk Production

 Breast milk is formed in the acinar or alveolar cells of the
mammary glands through the hormone called Prolactin
-which stimulates the production of milk. (Fig. 19.1).
 Additionally, the sucking motion of the baby in the breast
of the mother activates the nerve impulses in the nipples to
the hypothalamus thus stimulating the production of
prolactin.
 The adrenocorticotropic hormone, thyroid-stimulating
hormone, and growth hormone, play also a role in the
growth of the mammary glands and its ability to secrete
milk.
 Colostrum, a thin, watery, yellow fluid composed of
protein, sugar, fat, water, minerals, vitamins, and maternal
antibodies, is secreted by the acinar breast cells starting in
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES
the fourth month of pregnancy.
 Milk flows from the alveolar cells to the small tubules
reservoirs for milk called the lactiferous sinuses which
constantly forms the fore milk.
 The sucking motion of the baby releases oxytocin form the
posterior pituitary forcing the milk forward through the
nipples making it available for the baby. This action is
called a let-down reflex which can also be triggered by the
sound of a crying baby.
 A new milk called hind milk which is higher in fat than
fore milk is formed after the let-down reflex.
 Additionally, the release of oxytocin helps contract the
uterus. As a result, a woman may feel a small tugging or
cramping in her lower pelvis during the first few days of
breastfeeding.
 The average mother of a term infant is able to produce an .
adequate supply of breast milk but for the mothers of
preterm infants, however, may need a milk production
stimulant such as domperidone (Motilium), which
increases prolactin production by the pituitary gland.

B. Advantages of Breastfeeding
Breastfeeding is the best nutrition for human infants, but it is
contraindicated in some circumstances, such as:
• An infant with galactosemia (such infants cannot digest the
lactose in milk).
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES
• Herpes lesions on a mother’s nipples.
• Maternal diet is nutrient restricted, preventing quality milk
production.
• Maternal exposure to radioactive compounds (such as
occurs with thyroid testing).
• Mothers receiving antimetabolites or chemotherapeutic
agents.
• Mothers receiving prescribed medications that would be
harmful to an infant, such as lithium or methotrexate.
• Mothers who live in an area where environmental
contaminants can be carried via breast milk to the infant.
• Women with maternal active, untreated tuberculosis, who
need to be evaluated individually depending on the stage of
their disease.
• Women who are positive for HIV, who are advised not to
breastfeed in the United States until further studies confirm
the risk of not being breastfed outweighs the risk of breast
milk transmission of the virus (AAP, 2012a). In developing
countries, HIV-positive women may be advised to
breastfeed because commercial formula is not available.
• Women who are addicted to drugs, who also must be
evaluated individually as to the drug, the half-life of the
drug, and if drinking breast milk might actually aid drug
withdrawal symptoms in the newborn.

i. Advantages of Breastfeeding for Women

A woman gains several physiologic benefits from
breastfeeding:
 The release of oxytocin from the posterior pituitary gland
aids in uterine involution.
 Breastfeeding may serve a protective function in
preventing breast cancer and possibly ovarian cancer.
 A woman may return to her prepregnant weight sooner and,
if menstruation is delayed, this may serve as a temporary
family planning method.
 Successful breastfeeding can have an empowering effect
because it is a skill only a woman can master.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES
 Breastfeeding reduces the cost of feeding and preparation
time for infant feeding. A long-term effect may include a
decreased risk of hip fractures and osteoporosis in the
postmenopausal period for the woman (AAP, 2012a).
 Breastfeeding provides an excellent opportunity to enhance
a true symbiotic bond between mother and child. Although
this does readily occur with breastfeeding, a woman who
holds her baby to formula feed can form this bond as well.

ii. Advantages for Infants

 Linoleic acid which is an essential fatty acid good for skin
integrity and has less sodium, potassium, calcium, and
phosphorus is present in breast milk than other formulas.
 It contains secretory immunoglobulin A (IgA), which
binds large molecules of foreign proteins, including viruses
and bacteria, thus keeping them from being absorbed from
the gastrointestinal tract.
 Lactoferrin which is an iron-binding protein in breast milk
interferes with the growth of pathogenic bacteria.
Lysozyme which is an enzyme in breast milk apparently
actively destroys bacteria by lysing their cell membranes,
possibly increasing the effectiveness of antibodies.
 Leukocytes in breast milks provide protection against
common respiratory infectious invaders. Macrophages,
responsible for producing interferon help interfere with
the virus growth. The presence of L. bifidus in breast milk
interferes with the colonization of pathogenic bacteria in
the gastrointestinal tract, thus reducing the incidence of
diarrhea.
 In addition to these anti-infective properties, breast milk
also contains electrolyte and mineral composition for
human infant growth. It is high in lactose, an easily
digested sugar that provides ready glucose for rapid brain
growth.
 Since the protein in breast milk is easily digested, the ratio
of cysteine to methionine (two amino acids) in breast
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES
milk favors rapid brain growth in the early months.
 Another advantage of breastfeeding is that breastfed
newborns appear to be able to regulate their
calcium/phosphorus levels better than infants who are
formula fed. A decreased calcium levels in a newborn can
lead to tetany (muscle spasm).
 Breastfeeding may also help prevent excessive weight gain
in infants.
 In addition, breastfeeding results in a formation of the
dental arch because of the “sucking” movement of their
mouths.

C. Techniques of Breastfeeding

i. Beginning Breastfeeding
 Breastfeeding should begin as soon after birth as
possible, ideally while the woman is still in the birthing
room and while the infant is in the first reactivity period.
The release of oxytocin by breastfeeding at this time
begins the let-down of milk and also stimulates uterine
contraction.
 Milk forms in response to being used. If breasts are
completely emptied, they completely fill again. If half
emptied, they are only half fill, and after a time, milk
production will become insufficient for proper
nourishment. Urge women to always place their infant
first at the breast at which the infant fed last in the
previous feeding, to help ensure each breast is completely
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES
emptied at every other feeding.

ii. Prolonged Jaundice in Breastfed Infants

 Jaundice, or yellowing of the skin, occurs in as many as
15% of breastfed infants because pregnanediol in breast
milk depresses the action of glucuronyl transferase, the
enzyme that converts indirect bilirubin to the direct form,
which is then readily excreted in bile.
 To prevent this excess buildup of bilirubin in their infant,
women should feed frequently in the immediate postbirth
period because colostrum is a natural laxative and helps  Recognize the
promote passage of both meconium and bile. proper formula
and adequacy for
III. Formula Feeding feeding the infant.
A. Preparing for Formula Feeding
There are infants who is allergic to the protein in infant
formulas, which can lead to severe intestinal inflammation,
diarrhea, and vomiting, anemia, and dehydration. In these instances,
the infant needs to be switched to a specially designed prescription
formula

i. Commercial Formulas
 There are three types of formulas: modified milk
based, soy based, and elemental (fat, protein, and
carbohydrate content is modified, such as in
lactose-free formula).
 Modified milk-based formulas are used for the
average newborn; lactose-free formulas are used for
infants with lactose intolerance or galactosemia
(inability to use sugar). Soy formulas is devised for
infants who are allergic to cow’s milk protein,
although such infants may be given casein
hydrolysate formulas, which have protein particles
too small to be recognized by the immune system.
Elemental formulas are used for infants with protein
allergies or fat malnutrition.
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES
 Commercial formulas are supplied in four separate
forms:
• Powder that is combined with water
• Condensed liquid that is diluted with an equal
amount of water
• Ready-to-pour type, which requires no dilution
• Individually prepackaged and prepared bottles of
formula.
ii. Calculating a Formula’s Adequacy
 To calculate the adequacy of a formula, remember
these two rules of thumb:
1. The total fluid ingested for 24 hours must be
sufficient to meet the infant’s fluid needs: 75 to 90 ml
(2.5 to 3 oz) of fluid per pound of body weight (150  Explain and
to 200 ml/kg) per day. implement the
 2. The number of calories required per day is 50 to discharge planning
55 per pound of body weight (100 to 120 kcal/kg). for newborn
nutrition to the
IV. Discharge Planning for Newborn Nutrition mother.
 Be certain to review a mother’s plans for feeding her baby
before discharge so there is time to answer any remaining
questions.
 Review with the mother the criteria to use to assess if her
infant is receiving adequate fluid
 Remind her that infant nutrition is an important topic and
one that she should always feel free to discuss at health
care visits.
 Empowering women to learn to make decisions regarding
feeding and to not be reluctant to ask for help when they
need it will go a long way toward solving these problems.

Learning Environment: BSN LEVEL 2

Resources: Non-Print Reference Materials, Electronic Equipment and Supplies
Course Requirements:
• Attendance in 45 minutes discussion.
• Active participation in the discussion
 COLLEGE OF NURSING, PHARMACY AND ALLIED HEALTH SCIENCES
Course Grading System /Evaluation Tools:
The learning outcomes in learners will be determined by their active participation in the forms of:
• Oral Assessment & Recitation
• 15 items quiz

REFERENCES:
Pillitteri, A. (2014). Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. Philadelphia: Lippincott Williams & Wilkins.