Breastfeeding Flashcards
1
Q
How many lobes are in the breast?
A
- 20
- 9 functional
- duct system down to the nipples
2
Q
What is each lobe considered to be?
A
- functional unit
3
Q
What is the fat percentage of lactating breast?
A
- 50% fat
4
Q
What is the fat percentage of lactating breast?
A
- 30% fat
5
Q
What are the ducts described as?
A
- tortuous
- come to the nipple
6
Q
How much of the secretory glandular tissue is within the nipple?
A
- 70% of the secretory glandular tissue (which secretes milk) is within 8cm of the nipple
- so breast size doesnt matter when breastfeeding
7
Q
What is the basic unit of mammillary gland?
A
- alveoli
- lined by mammilary epithelial cells (cuboidal)
- surrounded by myoepithelial cells- contract to release milk
8
Q
What is lactogenesis?
A
- preparation of the breast and milk production
9
Q
What are the phases of lactogenesis?
A
- Lactogenesis 1
- Lactogenesis 2
10
Q
What happens in lactogenesis I?
A
- early on in pregnancy
- HPL, prolactin rise: glandular development
- Progesteron and oestrogen rise: inhibit milk synthesis
11
Q
How does fat amount change during lactogenesis I?
A
- from 50% fat to 30% fat bc increase in glandular tissue
12
Q
What happens in lactogenesis II?
A
- progesterone and oestrogen fall= no inhibition of milk synthesis = START PRODUCING MILK
- prolactin= milk synthesis
- oxytocin= milk ejection
13
Q
What stimulates prolactin release?
A
- suckling
14
Q
What stimulates oxytocin release?
A
- higher centres
- suckling
15
Q
What happens when milk builds up in the breast?
A
- autocrine inhibition of more milk production
- need to clear the milk in the breast to be able to make more
16
Q
What happens to normal breast milk if you give formula milk?
A
- production of breast milk decreases
17
Q
How does prolactin work to make milk?
A
- suckling
- prolactin released from anterior pituitary
- work on cuboidal epithelial cells
- start producing milk
18
Q
When are prolactin levels highest?
A
- at night
19
Q
What is the let down reflex?
A
- releasing of milk
- suckling
- oxytocin release from posterior pituitary
- myoepithelial cells contract
- gush of milk
- ejection from nipple
20
Q
How can the response of breast milk being ejected be conditioned?
A
- 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
21
Q
What can drugs be used to for lactation?
A
- suppression
- augmentation
22
Q
When does a doctor want to augment lactation?
A
- if premature/complicated pregnancy
- hard for mother to produce milk
- so need to increase prolactin
23
Q
What do you need to give to increase prolactin in a mother?
A
- dopamine antagonist
24
Q
What does dopamine do to prolactin?
A
- DOPAMINE INHIBITS PROLACTIN
25
Give examples of dopamine antagonists?
- domperidone
| - metoclopramide
26
When does lactation need to be suppressed?
- if mother has chemo
| - scared drugs might go into breast milk
27
What do you give to suppress lactation?
- need to decrease prolactin
| - give dopamine analogue
28
Give examples of dopamine analogues
- bromocriptine
| - cabergoline
29
How many pathways are there for milk to be made?
5
30
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
31
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
32
What is pathway III of milk production?
- water, sodium, potassium travel across the cell membrane by osmosis
33
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
34
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
35
Whatis colostrum?
- first milk after childbirth
- less energy
- less lactose
- less fat
- more protein
THAN MATURE MILK
36
What is mature milk?
- milk produced few days after childbirth
- more energy
- more lactose
- more fat
THAN COLUSTRUM
37
What does formula milk have?
- more proteins than breast milk
- same calories as breast milk
- so babies on formula milk are taller and leaner
38
What does breast milk consist of?
- Nutrients
- IgA
- macrophages, lymphocytes
- growth factors
39
What happens to the volume of milk as the baby grows?
- increases
- lactose increases
- electrolytes decrease (Na, Cl, K etc)
40
How does the compositition of a FEED change?
- fat goes up as feed progresses
| (so should finish one breast before going onto another)
41
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
42
What is formula milk made of?
- cow milk plus things are added
43
Why is formula milk not beneficial for babies?
- more cassein and less whey in cow milk (formula milk)
| - cassein less digestible by human babies
44
What cant babies do to lipid?
- digest it
45
What does breast milk contain to allow babies to digest lipids?
- bile salt activated lipase
46
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
47
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)
48
What is seen in X rays to show necrotizing enterocolitis?
- gas bubbles in the intestine
49
In breast milk, which complements are there high amounts of?
- C3
50
What does lactoferin do?
- inhibit bacterial growth by binding to iron
51
What do lysozymes do?
- break bacteria peptidoglycan cell wall
52
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
53
What is PAF acetylhydrolase?
- this inhibits platelet activating factor
54
What do epidermal growth factors do?
- enhance development of the gastrointestinal epithelium
55
What are short term immunity benefits?
−less gastrointestinal infections
−less respiratory infections
−less urinary tract infections
−protection against sudden infant death
56
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
57
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
58
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)
59
What is rooting?
- stimulate the side of the baby’s cheek and the baby turns their face towards the stimulus and opens their mouth
60
What is suckling?
- nipple comes in contact with the baby’s mouth the baby begins to suck
61
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
62
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
63
What is nutritive suckling?
- 1 suck/sec with pauses for swallowing of the milk
64
What should the position of the baby be when breastfeeding?
- baby ventral surface against mummy ventral surface
65
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
