Breastfeeding Flashcards
How many lobes are in the breast?
- 20
- 9 functional
- duct system down to the nipples
What is each lobe considered to be?
- functional unit
What is the fat percentage of lactating breast?
- 50% fat
What is the fat percentage of lactating breast?
- 30% fat
What are the ducts described as?
- tortuous
- come to the nipple
How much of the secretory glandular tissue is within the nipple?
- 70% of the secretory glandular tissue (which secretes milk) is within 8cm of the nipple
- so breast size doesnt matter when breastfeeding
What is the basic unit of mammillary gland?
- alveoli
- lined by mammilary epithelial cells (cuboidal)
- surrounded by myoepithelial cells- contract to release milk
What is lactogenesis?
- preparation of the breast and milk production
What are the phases of lactogenesis?
- Lactogenesis 1
- Lactogenesis 2
What happens in lactogenesis I?
- early on in pregnancy
- HPL, prolactin rise: glandular development
- Progesteron and oestrogen rise: inhibit milk synthesis
How does fat amount change during lactogenesis I?
- from 50% fat to 30% fat bc increase in glandular tissue
What happens in lactogenesis II?
- progesterone and oestrogen fall= no inhibition of milk synthesis = START PRODUCING MILK
- prolactin= milk synthesis
- oxytocin= milk ejection
What stimulates prolactin release?
- suckling
What stimulates oxytocin release?
- higher centres
- suckling
What happens when milk builds up in the breast?
- autocrine inhibition of more milk production
- need to clear the milk in the breast to be able to make more
What happens to normal breast milk if you give formula milk?
- production of breast milk decreases
How does prolactin work to make milk?
- suckling
- prolactin released from anterior pituitary
- work on cuboidal epithelial cells
- start producing milk
When are prolactin levels highest?
- at night
What is the let down reflex?
- releasing of milk
- suckling
- oxytocin release from posterior pituitary
- myoepithelial cells contract
- gush of milk
- ejection from nipple
How can the response of breast milk being ejected be conditioned?
- bc oxytocin release is stimulated by higher centres
- release of milk can also happen because of thinking of the baby, hearing crying, cuddling, emotional state
What can drugs be used to for lactation?
- suppression
- augmentation
When does a doctor want to augment lactation?
- if premature/complicated pregnancy
- hard for mother to produce milk
- so need to increase prolactin
What do you need to give to increase prolactin in a mother?
- dopamine antagonist
What does dopamine do to prolactin?
- DOPAMINE INHIBITS PROLACTIN
Give examples of dopamine antagonists?
- domperidone
- metoclopramide
When does lactation need to be suppressed?
- if mother has chemo
- scared drugs might go into breast milk
What do you give to suppress lactation?
- need to decrease prolactin
- give dopamine analogue
Give examples of dopamine analogues
- bromocriptine
- cabergoline
How many pathways are there for milk to be made?
5
What is pathway I of milk production (golgi)?
- have lactose, Ca2+, PO4, citrate, and milk protein
- inside glandular cells, proteins made in RER
- packaged in golgi
- lactose is synthesised in golgi apparatus
- lactose cant cross the golgi apparatus
- water drawn into golgi vesicle
- Ca2+ and PO4 then packaged in the golgi vesicle
- fuse to membrane
- milk secreted into lumen of alveolus
- exocytosis
What is pathway II of milk production (Fat globules)?
- fat globules made in SER and cytoplasm
- fat globulins bind with one another to form larger droplets
- droplets bind against cell membrane
- separate from cell
- milk fat globule surrounded by cell membrane
What is pathway III of milk production?
- water, sodium, potassium travel across the cell membrane by osmosis
What is pathway IV of milk production (IgA)?
- secretory immunoglobulins and other specific proteins are transported through this pathway
- IgA circulating in the blood binds to a receptor on the basolateral side of the glandular cell (the side facing the blood vessels)
- enter cell
- cross to apical side (facing lumen of alveolus)
- in endocytic vesicle
- then secreted into lumen or into golgi apparatus
What is pathway V of milk production?
- pathway usually closed
- located between 2 glandular cells
- opens when mother has mastitis/engorgements
- bc of this opening, extra cells and plasma proteins released into milk
- milk now has HIGHER NA, CL, and LESS K AND LACTOSE
Whatis colostrum?
- first milk after childbirth
- less energy
- less lactose
- less fat
- more protein
THAN MATURE MILK
What is mature milk?
- milk produced few days after childbirth
- more energy
- more lactose
- more fat
THAN COLUSTRUM
What does formula milk have?
- more proteins than breast milk
- same calories as breast milk
- so babies on formula milk are taller and leaner
What does breast milk consist of?
- Nutrients
- IgA
- macrophages, lymphocytes
- growth factors
What happens to the volume of milk as the baby grows?
- increases
- lactose increases
- electrolytes decrease (Na, Cl, K etc)
How does the compositition of a FEED change?
- fat goes up as feed progresses
(so should finish one breast before going onto another)
What are the benefits of breastfeeding a baby?
- protein (High whey, low cassein)= opposite in cow milk
- lipid digestion
- human milk has biologically active whey proteins e.g. lactoferrin, lysozyme, and IgA which have immune and nutritional functions
- GI benefits
- immune system benefits
- complements from breast milk
What is formula milk made of?
- cow milk plus things are added
Why is formula milk not beneficial for babies?
- more cassein and less whey in cow milk (formula milk)
- cassein less digestible by human babies
What cant babies do to lipid?
- digest it
What does breast milk contain to allow babies to digest lipids?
- bile salt activated lipase
What does human milk contain that is important for retinal development?
- long chain polyunsaturated fatty acids
- really needed for newborn babies esp preterm babies
- arachodonic acid C20 is important
- omega fatty acids (C22) important= mothers recommended fish
- cows milk only has precursors to C18 long chain polyunsaturated fatty acids
What is GI benefit of breastmilk?
- human milk = more digestible, improves gastric emptying
- people on formula milk= 5-10% more likely to get NECROTIZING ENTEROCOLITIS (intestine death)
What is seen in X rays to show necrotizing enterocolitis?
- gas bubbles in the intestine
In breast milk, which complements are there high amounts of?
- C3
What does lactoferin do?
- inhibit bacterial growth by binding to iron
What do lysozymes do?
- break bacteria peptidoglycan cell wall
What are oligosaccharides?
- found in breast milk
- stop binding of enteric (gastrointestinal) and respiratory pathogens
- don’t get digested
- move to colon
- digested by good bacteria
- babies on formula milk have more bad bacteria in colon
What is PAF acetylhydrolase?
- this inhibits platelet activating factor
What do epidermal growth factors do?
- enhance development of the gastrointestinal epithelium
What are short term immunity benefits?
−less gastrointestinal infections
−less respiratory infections
−less urinary tract infections
−protection against sudden infant death
What are long term immunity benefits?
−protects against type I and II diabetes
−reduces the risk of obesity
−the baby is protected against dermatitis, cow’s milk allergy, and wheezing
−protects against childhood leukaemia (acute lymphoblastic leukaemia and acute myeloblastic leukaemia)
−reduces the ratio of LDL to HDL cholesterolthus reducing the chances of high blood pressure and heart problems
What are the neurological benefits of breastmilk?
- better cognitive outcomes than formula fed babies (on developmental tests)
- BUT growth of the breast fed babies was poorer
What are the maternal benefits of breastfeeding?
- lower breast cancer risk
- lower ovarian cancer risk
- lose calories (equivalent to swimming 30 laps in the pool)
What is rooting?
- stimulate the side of the baby’s cheek and the baby turns their face towards the stimulus and opens their mouth
What is suckling?
- nipple comes in contact with the baby’s mouth the baby begins to suck
What are signs of good attachment?
- most of the nipple and the areola (area around the nipple) sits inside the baby’s mouth
- the tip of the nipple sits at the edge of the end of the hard palate
- the mouth is wide open and full
- the chin is close to the breast
- the bottom lip is everted
- more of the areola is visible above the baby’s mouth than below
- you should also be able to hear sucking and swallowing as the baby breastfeeds
What is non- nutritive suckling?
- 2 sucks/sec which occurs at start of breast feeding
- stimulates prolactin and oxytocin release to call up more milk to cause the let down response
What is nutritive suckling?
- 1 suck/sec with pauses for swallowing of the milk
What should the position of the baby be when breastfeeding?
- baby ventral surface against mummy ventral surface
What happens if latching is not good?
- e.g. when only the nipple is inside the baby’s mouth and not the whole areola= THIS IS BAD
- can get traumatized nipple
- can also get ineffective draining of the breast due to bad latching= lead to mastitis= painful
