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Chapter 7 : Use of Nonsterile Nutritionals for Neonates in the Hospital and after Hospital Discharge: Control Measures Currently Instituted at One Tertiary Care Institution
Category: Applied and Industrial Microbiology
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Much remains to be done to establish the best evidence-based practices to maximize the benefit of available nutritional products and to minimize the risk of microbial contamination. This chapter outlines some of the strategies have been adopted to date at SickKids to optimize this balance in the context of infants (birth to 12 months of age). It discusses the guidelines for optimal feeding of infants, both term born and born prematurely. The authors address the approaches have been taken to enrich human milk and formula with nutrients in the event that this is required to improve the nutritional status of a small and/or sick infant. As much of the confusion in responding to initial safety warnings about Enterobacter sakazakii surrounded a lack of knowledge about appropriate substitutions for specific categories of powdered formula, the authors have reviewed the general categories of infant formulas (cow milk, soy, lactose free, hydrolysate and amino acid based) and indications for use. The authors have reviewed guidelines and specific procedures that have been implemented to collect breast milk, inventory formula and expressed breast milk, and store them centrally. The guidelines and procedures that have been implemented to prepare specialized feedings for infants and basic bedside management of delivery and administration of these feedings (called hang and hold times) are also reviewed in the chapter. The authors have also outlined how to approach the issue of infants going home on specialized feedings.
Suggested enteral feeding selection for infants. This list is not exclusive; additional products exist that may be equally suitable to an infant’s needs.
Nutritional assessment of infants—key resources to get you started a
Guidelines for preventing and addressing symptoms of food allergy in infants a
Guidelines for preparation and handling of enteral feedings designed for infants in the hospital setting a
Guidelines for the collection and storage of human milk for hospitalized infants a
Guidelines for preparation and handling of enteral feedings designed for infants at home a