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A - MSRA Paediatrics [15] > [60] Neonatal Feeding > Flashcards

[60] Neonatal Feeding Flashcards

1
Q

When is human milk recommended as the exclusive feed?

A

For all term infants for the first 6 months of life

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2
Q

Is human milk recommended for preterm infants?

A

Yes, but may require fortification

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3
Q

What is increasingly available for preterm infants in order to supplement maternal milk?

A

Donor breast milk

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4
Q

When should counselling regarding breast feeding commence?

A

Early in pregnancy

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5
Q

Who should assist mothers in breast feeding?

A

Nursing or lactation specialists

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6
Q

Should the choice to breast feed or formula feed be criticised?

A

No obviously not

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7
Q

How does the protein content of breast milk compare to unmodified cows milk?

A

It has a low protein content, but is more easily digestible

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8
Q

What amino acid is prominent in breast milk?

A

Glutamine

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9
Q

What is the importance of the glutamine in breast milk?

A

It stimulates enterotropic hormones, enhancing feeding tolerance

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10
Q

What kind of fat is present in breast milk?

A

Unsaturated

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11
Q

What kind of important fatty acid does breast milk contain?

A

Long-chain polyunsaturated fatty acids (LCPUFAs)

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12
Q

What is the importance of LCPUFAs?

A

Needed for nervous system development

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13
Q

Describe the carbohydrate content of breast milk?

A

Contains high lactose

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14
Q

How does the mineral content of breast milk compare to unmodified cows milk?

A
  • Low renal sodium load

- Reduced phosphate:calcium ratio

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15
Q

Is the vitamin content of breast milk sufficient?

A

No, supplementation is required to meet daily requirements

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16
Q

What is meant by formula milk being ‘humanised’?

A

It is manipulated to resemble human milk

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17
Q

What are the disadvantages of formula milk compared to breast milk?

A
  • Differences in amino acids and fatty composition

- Does not contain anti-infective properties of human milk

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18
Q

What major health concern arises from formula milk feeding in developing countries?

A

Infection from re-constituting milk powder with contaminated water

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19
Q

Are unmodified animal milks, e.g. cows, goats, sheep, suitable for infants?

A

No

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20
Q

What kind of formula is sometimes used to prevent allergic disorders such as eczema and asthma?

A

Soy (evidence for this is lacking)

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21
Q

What % of infants with cow’s milk protein intolerance become sensitive to soy?

A

10-30%

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22
Q

Is soy formula recommended for premature infants?

A

No

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23
Q

When should an infant first be placed on the breast?

A

Immediately or soon after birth

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24
Q

What environmental factors can encourage breastfeeding?

A

Quiet, supportive environment with comfortable positioning

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25
Q

What is better, fixed schedule feeding or demand feeding?

A

Demand feeding

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26
Q

Why is demand feeding better than fixed schedule feeding?

A

It stimulates milk production and reduces feeling of fullness and discomfort

27
Q

How often might an infant be put to the breast if demand feeding?

A

8-12 or more times per 24 hours

28
Q

When breastfeeding, which breast should the infant feed from?

A

Should be put to both breasts at each feeding, switching sides when the baby pauses and lets go of breast. Begin each feeding with the breast the baby last nursed from

29
Q

Should you restrict the duration of feeds when breastfeeding?

A

No

30
Q

What is the importance of emptying the breast adequately when breast feeding?

A

Avoids engorgement

31
Q

What is initially produced when starting breastfeeding?

A

Colostrum

32
Q

Describe the features of colostrum?

A

Low in volume, high in protein and immunoglobulin content

33
Q

How long does it take for breast milk to come in?

A

24-72 hours

34
Q

What do mothers needed to be warned of, regarding the babies weight?

A

Babies initially lose weight, up to 7-10% of their body weight

35
Q

When should babies start putting on weight after the initial loss?

A

After day 4 of life, returning to birth weight by 10-14 days

36
Q

Should infants be given supplementary water or formula when breastfeeding?

A

Not unless medically indicated

37
Q

What are the immediate advantages of breast-feeding for infants?

A
  • Promotes mother-infant bonding
  • Ideal nutritional composition
  • Contains immune factors
  • Reduces gastroenteritis and respiratory infections
  • Less feeding intolerance
  • Reduces incidence of necrotising enterocolitis in preterm infants
  • Promotes ketone production as an alternative energy substrate to glucose in first few days of life
38
Q

What are the long-term benefits of breastfeeding to the infant?

A
  • Reduces risk of SIDS (sudden infant death syndrome)
  • May decrease incidence and severity of eczema and asthma
  • Less obesity, T1DM, and IBD
39
Q

What are the advantages of breastfeeding to the mother?

A
  • Enhances mother-infant bonding
  • More rapid postpartum weight loss
  • Decreased risk of osteoporosis
  • Decreased risk of breast and bowel cancer
  • Increases time between pregnancies
40
Q

Where is increasing the time between pregnancies important?

A

In developing countries

41
Q

What are the potential complications of breastfeeding for the infant?

A
  • Cannot tell how much milk the baby has taken
  • Dehydration can occur
  • Jaundice associated with breast milk
  • Vitamin K deficiency
42
Q

How is the amount of milk a baby has taken when breastfeeding determined?

A

By monitoring baby’s weight and urine output

43
Q

When might dehydration occur when breastfeeding?

A
  • Inadequate milk supply/poor feeding technique

- Hot weather

44
Q

Is jaundice associated with breast milk common?

A

Yes

45
Q

What exacerbates jaundice caused by breast milk?

A

Dehydration

46
Q

Should breastfeeding be discontinued when it is causing jaundice?

A

No, even if it requires phototherapy

47
Q

In what % of infants who have jaundice caused by breastfeeding will it be prolonged (>2 weeks of age)?

A

Up to 15%

48
Q

What is required when jaundice caused by breastfeeding is prolonged?

A

Will require investigations to be performed

49
Q

Can neonates from multiple births be breastfed?

A

Twins can often be exclusively breastfed, but rarely higher-order births

50
Q

What might low levels of vitamin K in breast milk lead to?

A

Predisposes to haemorrhagic disease of newborn

51
Q

What is required when there are low levels of vitamin K in the breast milk?

A

Prophylaxis

52
Q

What are the potential complications of breast-feeding for the mother?

A
  • Maternal feeling of inadequacy/upset if unsuccessful
  • Breast engorgement
  • Cracked nipples
  • Mastitis
53
Q

What might help with breast engorgement and cracked nipples caused by breastfeeding?

A

Manual expression or a breast pump

54
Q

What is the problem with mastitis when breastfeeding?

A

It requires maternal treatment, and may disrupt feeding

55
Q

What are the potential contraindications to breastfeeding?

A
  • Maternal HIV
  • Maternal TB
  • Inborn errors of metabolism
56
Q

Give two examples of inborn errors of metabolism that are contraindications to breast feeding?

A
  • Galactosaemia

- Phenylketonuria

57
Q

Describe the excretion of drugs in breast milk

A

Most drugs are excreted in breast milk in such small quantities that they do not affect the infant

58
Q

Should drugs be taken while breastfeeding?

A

Where possible, all drugs including self-medication should be avoided during breast feeding

59
Q

What drugs should be avoided when breastfeeding?

A
  • Radioactive iodine
  • Cytotoxic agents
  • Diazepam
  • Tetracyclines
  • Lithium
60
Q

What effect may taking radioactive iodine whilst breastfeeding have on the infant?

A

Thyroid suppression

61
Q

What effect may taking cytotoxic agents during breastfeeding have on the infant?

A

Risk of cytotoxic effect

62
Q

What effect may taking diazepam when breastfeeding have on the infant?

A

Sedation, may accumulate

63
Q

What effect may taking tetracycline while breastfeeding have on the infant?

A

Possibility of permanently staining teeth

64
Q

What effect may taking lithium while breastfeeding have on the infant?

A

Risk of neurological effects or cardiac malformations

A - MSRA Paediatrics [15] (115 decks)

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