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Physiology & Science: Human Growth > Breastfeeding > Flashcards

Breastfeeding Flashcards

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1
Q

Describe the anatomy of the breast

A
  • 20 lobes with duct system draining down to nipple
  • -> ~9 lobes are functional, rest vestigal
  • Each lobe = separate functional unit
  • Non-lactating breast about 50% fat, lactating about 30% fat
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2
Q

The ducts are tortuous and branch near nipple. How many ducts emerge at the nipple?

A

~ 9

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3
Q

How much of the glandular tissue is wihtin 8cm of the nipple?

A

70%

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4
Q

Describe the structure of the mammary gland mid-trimester

A
  • Basic secretory unit is alveoli, set within connective tissue
  • Lined by mammary epithelial cells (cuboidal or low columnar)
  • Myoepithelial cells surround alveoli -> these are contractile + responsible for milk ejection
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5
Q

What hormone is released at around 10 weeks of gestation?

A

Prolactin

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6
Q

What happens in lactogenesis I?

A
  • Occurs in pregnancy
  • Placental lactogen and prolactin promote development of breast tissue
  • Progesterone + oestrogen inhibit milk secretion
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7
Q

What happens in lactogenesis II?

A
  • Post partum
  • Fall in progesterone + oestrogen reduces inhibition to milk prod
  • Suckling stimulus releases prolactin –> more milk synthesis
  • Suckling (+ higher cntrs) release oxytocin –> milk ejection
  • Some autocrine inhibition from duct cells (negative feedback mechanism - need to take away milk before more can be made)
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8
Q

What controls milk synthesis?

A
  • Sucking -> nerve pathway -> anterior pituitary -> prolactin in blood -> milk producing alveolus
  • Prolactin released by anterior pituitary, in response to sucking.
  • Milk synthesis is led by infant demand overall
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9
Q

Describe the mechanism of the “let down” reflex by oxytocin

A
  • Oxytocin release causes milk ejection
  • Suckling -> afferents to CNS (hypothalamus) -> posterior pituitary -> oxytocin in blood -> mammary gland -> acts on myoepithelial cells to cause milk ejection
  • This higher reflex can be inhibited by anxiety or stress eg. delivering prematurely can inhibit oxytocin release + milk ejection
  • Reflex may also become conditioned - hearing another baby cry might result in your own milk ejection
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10
Q

Which drug(s) will increase prolactin and hence augment lactation?

A

Dopamine antagonists eg. Maxolon, Domperidone, metoclopramide

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11
Q

Which drug(s) will decrease prolactin and hence suppress lactation?

A

Dopamine agonists eg. bromocriptine, cabergoline

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12
Q

There are 5 main secretory pathways in production of milk. What is the first major secretory pathway?

A
  • Pathway 1 - transcellular
  • Proteins made in RER, packaged into golgi vesicles
  • Calcium + phosphate added
  • Within golgi vesicle, lactose synthesised
  • Golgi impermeable to lactose so water drawn into vesicle
  • Vesicle moves to apex of cell -> exocytosis
  • Released into alveolar lumen
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13
Q

What is the second secretory pathway?

A
  • Pathway 2 - transcellular
  • Milk fat secretion
  • Triglycerides synthesised in cytoplasm + SER, become larger droplet
  • Droplets enveloped in apical membrane + separate from cell
  • Form milk fat globule
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14
Q

What is the third secretory pathway?

A
  • Pathway 3 - transcellular
  • Osmosis
  • Secretion of ions (Na, K, Cl) + water permeate apical cell membrane
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15
Q

What is the fourth secretory pathway?

A
  • Pathway 4 - transcellular
  • Immunoglobulin secretion
  • IgA + specific receptor combine on basolateral cellular wall
  • Both transported in an endocytotic vesicle
  • Emptied into either golgi or apical membrane
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16
Q

What is the fifth secretory pathway?

A
  • Pathway 5 - paracellular
  • Normally closed but open in pregnancy + mastitic breasts
  • Causes high conc of Na + Cl as well as plasma protein
  • Causes low conc of lactose + K
17
Q

Is it better for pre-term infants to be breastfed or formula fed?

A

Breastfed

18
Q

What are the components of breastmilk?

A
  • Nutrients - macronutrients + trace elements
  • Immunoglobulin (IgA)
  • Cells (macrophages + lymphocytes)
  • Non-specific immune components
  • Growth factors
19
Q

What happens to the volume and composition of breast milk over days postpartum?

A
  • Volume increases
  • Na+ and Cl- decrease
  • Lactose increases
  • Potassium increases slightly then decreases
20
Q

What happens to the fat concentration as the baby feeds?

A
  • Fat conc goes up over duration of baby feeding
  • Thinner more protein-rich milk at the beginning, fatty at the end
21
Q

Describe the whey and casein content of human milk and why it’s better than cow milk

A
  • Human milk: whey 70%, casein 30%
  • Cow milk: whey 18%, casein 82%

Whey is good as it remains in solution in the acidic media (stomach), so more easily digested and promotes gastric emptying.

Casein has a low solubility in acid media, so less favourable.

22
Q

Which whey proteins specifically are present in human milk and what is their function?

A
  • Lactoferrin, lysozyme and sIgA
  • Important in host defence
23
Q

What is the lipid content of breast milk and how is it of benefit?

A
  • Contains LCPUFA important for brain/retinal development
  • Substantial amount of lipase (activated by bile-salt), which is inactive in cow milk
24
Q

What is the benefit of breastmilk to the gastrointestinal system of the newborn?

A
  • Human milk improves gastric emptying
  • Human milk important in preventing necrotizing enterocolitis in preterm infant
25
Q

Immunity is an important part of breast milk. What immune factors are present in breast milk?

A
  • sIgA
  • Complement
  • Lactoferrin
  • Lysozyme
  • Cytokines
  • PAF acetylhydrolase
  • Oligosaccharides
  • Epidermal growth factors
  • Cellular elements

Can you describe what immune effect each of these induce? (refer to lecture slide 20)

26
Q

What is the importance of lactoferrin in human milk?

A
  • It binds iron
  • So basically removes iron from baby’s system
  • This inhibits bacterial growth
  • Reduces neonatal sepsis
27
Q

What is the purpose of oligosaccharides (indigestable sugars) being present in breast milk?

A
  • Food source for good bacteria in baby’s gut
  • Inhibits binding of enteric/respiratory pathogens
28
Q

Describe the enteromammary axis and how secretory IgA is produced

A
  • Mum exposed to antigens in environment via Peyer’s Patches in gut
  • Antigen stimulated lymphocytes go from Peyer’s patches -> lymph node
  • sIgA produced -> into blood stream -> into breast milk

Particular mother will produce sIgA for the antigens in her environment, this protects baby against pathogens in the same environment.

29
Q

What are the short term benefits of breastfeeding?

A
  • Improved immunity, less infections + less infectious morbidity
  • (GI, resp + urinary tract infections specifically)
  • Breastfeeding also reduces risk of sudden infant death syndrome by around 50% at all ages throughout infancy
30
Q

In terms of long term infant benefits, what diseases/morbidities are prevented by breastfeeding?

A
  • Type 1 + 2 diabetes
  • Obesity
  • Allergic disease
  • Childhood leukaemia
  • Cholesterol levels
  • Blood pressure
31
Q

Does breast feeding make you smarter?

A

Study from 1990

  • Feeding study of premature infants
  • Cognitive outcome better but growth poorer with human milk
32
Q

How does breastfeeding reduce the risk of postpartum haemorrhage?

A

Breastfeeding releases oxytocin -> uterus contracts -> reduces risk of PPH

33
Q

What major disease(s) does breastfeeding reduce the risk of (for the mother)?

A
  • Breast cancer (due to reduced oestrogen xposure)
  • Ovarian cancer - lactation protects against it
  • Breastfeeding = swimming 30 laps in a pool
34
Q

What is meant by ‘latching on’?

A

A primitive reflex of the baby rooting to the nipple and sucking

35
Q

What are signs of good attachment?

A
  • Mouth wide open
  • Mouth full
  • Chin close to breast
  • Lower lip everted
  • Sucking changes
  • More of the areola is visible above baby’s mouth than below
36
Q

What is the positioning for breastfeeding?

A

Tummy to mummy

37
Q

What is non-nutritive sucking?

A
  • Occurs in short, fast bursts at rate of up to 2 sucks/second
  • When baby first goes to breast + little/no milk available prior to reflex milk ejection
  • ‘Call up sucking’
38
Q

What is nutritive sucking?

A
  • Occurs at a slower pace - about 1 suck / second
  • Early in the feed, sucks appear in a continuous stream
  • Later on sucking is fragmented into bursts
39
Q

What are consequences of when “latching-on” goes wrong?

A

Causes by incorrect positioning + attachment

  • Traumatised nipple
  • Ineffective breast drainage
  • -> infection of breast tissues or “mastitis”

Physiology & Science: Human Growth (9 decks)

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