A day in the life of a NICU/pediatrics registered dietitian

By Selma Al-Samarrai

March 25, 2019 – At Unity Health Toronto, patients as young as 30 weeks old receive care from registered dietitians.

Debby Arts-Rodas (top photo) and Alyson Martinez (photo below) work with two patient groups: premature babies in the Neonatal Intensive Care Units at St. Joseph’s Health Centre and St. Michael’s Hospital, and patients in the hospitals’ outpatient pediatric clinics.

“People are often surprised that a premature baby in a NICU needs care from a registered dietitian but they are actually one of the highest nutrition-risk groups in the hospital,” explained Martinez, who works at St. Michael’s.

“My job is to manage the babies’ feeds and ensure they’re getting enough calories and micronutrients to grow properly, gain weight and to help facilitate neurodevelopment.”

The third trimester is when critical fat, muscle mass and brain development take place in the fetus, so premature babies are born without this development having been completed.

The registered dietitian’s role is to develop a specialized fortification plan for the baby. This involves adding a fortifier – which is a mix of fat, protein, vitamins and minerals – into the mother’s pumped breast milk or donor milk to ensure that the baby gets all the nutrients that they didn’t receive in-utero.

Arts-Rodas joined St. Joseph’s 20 years ago and was instrumental in the creation of the registered dietitian role in the NICU. The youngest babies she sees are born 10 weeks early, and their average stay in the NICU is between five and seven weeks.

“A lot of development takes place in that time frame. Sometimes, babies are not ready to eat by mouth, so we use intravenous nutrition and/or nasogastric tubes to feed them,” explained Arts-Rodas.

In the outpatient pediatric clinics, Arts-Rodas and Martinez work with infants, children, adolescents and teenagers under the age of 18 who have eating issues such as picky eating, anemia, obesity, failure to thrive, and food allergies.

They assess their patient’s health, nutrition needs and personal preferences, and then create a nutrition plan with the parents to ensure their child is receiving the nutrients they need.

“More often than not, parents come in to see me because they’re bombarded by so much information about nutrition and want to make sure they’re making healthy food choices for their children,” explained Arts-Rodas.

Martinez also sees complex pediatric patients in the Specialized Nutrition Clinic, which deals with nutrition issues associated with conditions such as cerebral palsy, severe autism, trisomy 21 or Rett syndrome. Her role involves creating a tube-feeding plan, helping co-ordinate coverage to pay for specialty feeding plans, or assessing for micronutrient deficiencies that are common in children on the autism spectrum.

“My job offers me the opportunity to get to know families over a long period. For many of them I first get to know them during their NICU stay, and then I am able to see them transition through milestones as they continue receiving care in our outpatient pediatric clinic. Being able to see them grow and thrive is so rewarding,” explained Martinez.

“Our relationship with food is built within the first five years of life. Helping parents to encourage a positive relationship with food for their children is vital in being able to sustain that relationship in adulthood.”