1. Mariechen Puchert 2010
NOTE/Disclaimer: These are notes I made for myself during my second year. I cannot
guarantee that there aren’t mistakes. I do know that studying them were great help to me. I
used notes and powerpoints given to my class by lecturers (University of Stellenbosch,
Tygerberg Campus, South Africa) as well as the following textbooks:
Clinical Gynaecology : TF Kruger, MH Botha
Ostetrics in South Africa: Cronje
Nutrition
Growth charts
Oral rehydration
Breastfeeding
Immunisation
Female education
Family planning
Food supplementation
Indications for NGT
• Less than 34 weeks gestation
• Respiratory Distress Syndrome
• Feeding difficulties – ill, cleft palate, asphyxia
• Abdominal distension
Length of NGT = [manubrium to xiphisternum] x 2 + 2.5
Advantages of cup feeding
o Small preterm infants can
o Little energy required
o Hygienic, easy to clean
o Breast milk can be expressed into
o Safe
o Moves tongue in same way as breastfeeding
o Infant determines rate
Indications for bottle-feeding
1. Adoption
2. HIV-exposed infant
3. Maternal psychosis
4. Maternal breast cancer
5. Medications
♫ Term infants require 80-90 calories per day
♫ Preterm infants require 120 calories per day
♫ Preterm infants need vitamin and iron supplementation
Breast milk
Most appropriate food for the newborn up to 6 months.
Ideal: exclusively breastfed and then weaned from 6 months to two years.

2. Mariechen Puchert 2010
Tandem feeding Feeding babies at the same time from different pregnancies
Adequate feeding:
• Satisfactory weight gain
• Five to six wet nappies per day
• Happy, content baby
Breast milk advantages
o Less protein than cow’s milk
o Whey is major protein as opposed to casein in cow’s milk. Whey is more
digestible and less allergenic.
o Whey-casein ratio = 60:40
o Colostrums
o Unsaturated easily digested fats (cow’s milk has saturated)
o More lactose than cow’s milk
o Less vitamin D and K, but better absorbed
o Anti-infective properties
o Lower incidence of allergies
o Bonding
o Cognitive development
Maternal benefits of breastfeeding
1. Uterine involution
2. Reduced risk of breast cancer
3. Rapid return to pre-pregnant figure
4. Cost saving
Indications for fortification of breastmilk
a. Preterm <1500g
b. Fluid-restricted infant
c. Unsatisfactory weight gain
Weaning Process of gradually introducing solids into the baby’s diet
Indications for expression
• Working mother
• Engorged breasts
• Nipple problems
• Weak baby
Signs of correct attachment
o Baby’s whole body faces mother
o Baby’s head in line with body
o Baby’s head free to move
o Baby’s face close to breast
o Baby’s chin touches breast
o Baby’s mouth wide open
o Areola almost completely in mouth
o Slow, deep suckles

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Formula Feeds
Newborn contraindications to breastfeeding
Galactosemia
Phenylketonuria
STANDARD INFANT FORMULAS FOR HEALTH TERM BABY
0-6 months Nan 1 S-26-1
Lactogen 1 SMA 1 Similac
Infacare 1 C&G Premium 1
6-12 months Nan 2 Lactogen 2 S-26 Promil 2
Infacare 2 Similac C&G Follow On 2
>12 months Cow’s milk – pasteurised and full strength
Nan 3 Inacare 3 C&G Step-up 3
SPECIAL MILK PROFILES
Low Birth Weight Prenan S26 LBW Gold C&G Nenatal
Cow’s milk allergy Nan-HA Similac AdvanceHA Soy Milk
Lactose intolerance Infasoy 1, 2 Isomil 1, 2 Nan Soya 1, 2
Sucrose intolerance AL 110
Fat intolerance Portagen
Chronic diarrhoea Alfare Pregestimil C&G Pepti Junior
Intestinal resection Alfare Pregestimil C&G Pepti Junior
No refrigeration Nan Pelargon
Drugs while breastfeeding
General guidelines
1. Only essential drugs given
2. Short-acting forms
3. Alternative forms
4. Single components rather than compounds
Contraindicated agents
• Drugs of abuse
• Antineoplastic drugs
• Immunosuppressants
• Gold salts
• Iodides
• Radio-pharmaceuticals
Agents to avoid
o Alcohol
o Amioderone
o Antidepressants
o Aspirin
o Iodine and lithium

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o Retinoids