58. Breast feeding Flashcards
what is the composition of Colostrum (the first milk available after labor) ?
rich in protein, sodium, and immunoglobulins while being low in lactose
*After 30-40 h’ postpartum, the milk composition changes by an increase of lactose and dilution of other constituents as the volume increases
why Newborns should not go longer than 4-5 h’ without feed?
risk of hypoglycemia
when should an Infant feed?
on demands, usually every 2-3 h’ for 10-15 min’.
the broad consensus of breastfeeding
exclusive breastfeeding for the first 6 months and continued breastfeeding, along with the introduction of solid foods, for at least one year after birth (as long as it is mutually desired by mother and infant).
what is the best indicator of appropriate feeding?
number of wet diapers.
Benefits of breastfeeding
- Breast milk is the ideal food for the newborn, it is inexpensive, and is usually in good supply
- Establishment of mother-infant bonding
- Nursing accelerates the involution of the uterus
- Immunologic advantages for the infant → transfer of maternal Ab’s, transfer of maternal lymphocytes
- Transfer of appropriate maternal bacteria to the infant’s gut, supporting the growing microbiome (Bifidobacterium and Lactobacilli)
- Lactoferrin acts by increasing fetal iron absorption and preventing its degradation by bacteria
- Breast milk is a source of omega-3 fatty acids, which are important for early brain development
- Breastfeeding is associated with a lower risk of newborn upper respiratory tract infections, diarrhea, SIDS, childhood asthma, type 1 diabetes, food allergies, and obesity
- Breastfeeding is associated with a lower risk of maternal breast cancer, ovarian cancer, type 2 diabetes, and postpartum depression
what are the changes after delivery initiating lactation?
(1) Rapid decrease in progesterone disinhibits prolactin → initiation of lactation.
(2) Suckling stimulates the release of prolactin and oxytocin → increase milk production and ejection.
Common problems from breastfeeding and weaning
- Inadequate milk production/intake.
- Breastfeeding jaundice (on the 1st week postpartum, due to inadequate breastfeeding).
- Breast milk jaundice (on the 2nd week postpartum, due to metabolites in breast milk inhibiting bilirubin conjugation in the infant).
- Mastitis and breast abscess.
- Nipple pain, trauma, dermatitis.
- Galactocele (milk retention cyst).
- Breast engorgement (breast fullness and firmness, accompanied by pain and tenderness, most commonly presents on days 0-7 postpartum).
what hormones promote the proliferation of alveolar cells and duct cells needed for lactation?
Estrogen
Growth hormone (via IGF-1)
Prolactin
Cortisol
what hormones promote initiation of milk production
by alveolar cells?
Prolactin
Human placental lactogen (hPL)
Insulin
what hormone promotes the contraction of myoepithelial cells (milk ejection)?
oxytocin
what hormones maintain milk production after it has
been established?
Prolactin
Cortisol (permissive effect)
Contraindications to breastfeeding
- Infant has classic galactosemia
- Mother has HIV infection
- Mother is infected with HTLV I or II
- Mother is using illicit drugs
- Mother has suspected or confirmed Ebola virus disease
- Mother has untreated brucellosis
- Mother is taking certain medications
- Mother has an active HSV infection with breast lesions
what drugs excreted in breast milk potentially causing infant harm?
- Tetracycline
- Chloramphenicol
- Chemotherapy agents
- Amiodarone
- Retinoids
- Lithium
- Alcohol
- Illicit drugs
when do mastitis and breast abscesses occur?
in up to 10% of nursing mothers (2-4 weeks postpartum).
