Prof.

dr Dejan Bokonjic

NUTRITION
Natural nutrition- physiological

The safest

The best The most

complete

Breast milk
 Advantages of breast feeding– for child
 Continuation of biological unity of mother and child / psychosocial effect
 Breast feeding diet stimulates psychomotor development, reduces the need
for additional educational methods (in 8 years of age have IQ from others)
 intake of 100 ml / kg / day breast milk increases MDI (mental development
index)
 Easiest way of diet, easy to learn, and the possibility of infection is minimal;
 All necessary substances, except vitamins C, D and Fe (less anemia,
asthma and eczema, proper development of teeth, jaws)
 Contains immune bodies (known to contain IL-10 which regulates
inflammation, modulates the function of T, B cells, NK cells , monocytes,
macrophages and neutrophils) - minor sepsis, NEC, urinary tract infections
and diarrhea;
 Contains growth factors / hormone - progresses better and faster;
 Biological benefits for GIT (bacillus bifidus), digested faster and better;
 Always the same temperature, always fresh;
 Advantages of breast feeding– for mother
 Faster recovery after childbirth;

 They are less likely to develop Ca breast cancer before

menopause;
 Reduced risk of osteoporosis (risk of hip fracture after the age of 65
is twice lower)
 98% is protected from re-pregnancy - contraception the beginning
of lactation is associated with the secretion of prolactin in the blood
which suppresses the ovulation cycle);
 Reduces the risk of epithelial ovarian tumors;
 Evolution of breast milk
COLOSTRUM
 For the first five days, yellowish-viscous liquid - proteins,
minerals, vitamins (A) and antibodies "first vaccine“. Quickly
digested and resorbed, laxative;
TRANSITIONAL MILK
 From 5 to 10 days; By composition between colostrum and
mature milk;
MATURE MILK
 White liquid (yellowish, bluish B2), pleasant smell, sweet taste,
 Contains: 87.1% water; 12.9% dry residue;
 12 g / L protein = (1.2 g%): casein 40%, lactalbumin and lactglobulin 60% -
ALBUMIN
 35 g 7 L = lipids: high% unsaturated fatty acids;
 70gr / L = carbohydrates: LACTOSE - lactobacillus
 2.1 gr / L minerals: ideal ratio of Ca and P, not enough Fe, vitamins C and D
 Artificial nutrition
EVERY OTHER FORM OF NUTRITION EXCEPT BREAST-FEEDING AT THE
TIME WHEN A NEWBORN AND INFANTS IS ACCORDING
TO THEIR NATURAL LAWS. SHOULD BE ON
MOTHER'S BREAST (first six months)

The mother does not have enough milk or breastfeeding is

contraindicated for health reasons!

Adapted to the digestive tract;

Adequate intake of water, protein, vitamins and minerals is provided;

The interval between meals should not be less than 3.5 hours;

Bacteriologically correct;
 Cow's milk
 Bacteriological protection of cow's milk (cooking, sterilization,
pasteurization);
COMPOSITION:
 45 g / L = lipids (low% unsaturated fatty acids);

 40 g / L = lactose (sugar should be added);

 Protein 80% casein, 20% lactalbumin and lactglobulin;

 Mineral substances (ratio of Ca and P is not appropriate)

 Modification of cow's milk
 DILUTION: ⅔ milk + ⅓ water = amount of casein and minerals as in
human milk, fat concentration decreases;
 CARBOHYDRATE ADDITION = caloric value increases and the
middle of the small intestine becomes fermentable;
 ACIDIFICATION - acidification = gastric acidity becomes the same
as in a child fed with breast milk.

100 ml MILK + 50 ml WATER + 8.5 g SUGAR = ⅔ MILK

⅔ MILK + 1½ LEMON JUICE = MARIOT MILK
 FORMULA – MILK POWDER

 NUTRICIA

 NESTLE

 MILUPA
Additional nutrition– enrichment of breast milk
HYPOGALACTIA
 sleeps poorly, often wakes up, cries, greedily catches the breast,
pulls, swallows air, lets out the breast, cries;
 flatulence, pain, crying;

 stagnates, does not progress, and even loses weight;

 slightly wet, stools in like “frog lime” - hunger stools!

Additional nutrition– enrichment of breast milk
DETERMINATION:
 measuring infants before and after breastfeeding - difference in
weight;
 indirectly - offer tea after breastfeeding; and note the quantity;

 smearing breast milk;

NEEDS:
 150 ml / kg TT for 24 hours

 in the afternoon and in the evening after breastfeeding

 “BANKS OF MILK”
 The advantage of ALWAYS is the breast milk; (due to
the variable fraction of nutrients depending on the
date of birth, as well as intrauterine growth)
 Donor of breast milk
 Mother which is tested:
Virus HIV

CMV

Hepatitis B,C

Sifilis
 COLLECTION AND PREPARATION OF MILK
 Collection under aseptic conditions;

 Sterile containers (glass);

 Plastic containers, freezing at -20 ° C;

 Defrosting: room temperature or water bath (must not be re-

frozen);
 Pasteurization, 2–3 min at 75–85°C;
Procedure with breast milk on different °T
Fresh breast milk Pasteurized
Methodology from donors breast milk from
donors
Room temp. 20°C 4h 4h

Fridge +4°C 48 h 48 h

Defrost 24 h 48 h

Deep frost-20°C
6 months 6 motnhs
 Breast feeding techniques
Preparing a newborn
 Sucking reflex;

 Swallowing reflex;

 The child is banned;

 Mother's preparation

 Hand hygiene;

 Breast hygiene;

 Comfortable position;
Breast feeding techniques

Breastfeeding technique Newborn's

 Head at the elbow;

 The index finger and middle finger encompass the breast around
the nipple and areola;
 Squeeze 2 to 3 drops of milk;

 10 minutes on each breast;

 Raise the child to expel air (protective diaper);

 Start on the breast on which the previous breastfeeding is

completed;
BOTTLE AND PACIFIER NUTRITION TECHNIQUE
 Sterile bottles and pacifiers;

 Aperture size;

 Checking the temperature of the milk;

 The child is bandaged Hand

 Hygiene;

 Protective diapers;

 Pacifier and neck of the bottle in the plane;

 Raise the child to exhale;

 In hospital conditions note (type and quantity);

 Mixed nutrition
•According to the advice of a pediatrician at the
counseling center
•Gradually
“... not only because it is a consequence
of inadequate nutrition, the occurrence
of growth retardation, but also
includes long-term consequences of
the impact on growth and cognitive
development”.
Ziegler, 2001