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Develop Sem 4 > Breastfeeding > Flashcards

Breastfeeding Flashcards

1
Q

What is the structure of the breast?

A

20 lobules radiating around areola

Duct system draining down to the nipple

Lobules further divide into structures that produce milk

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2
Q

Which has more fat? The lactating or non-lactating breast?

A

Non-lactating breast (has 50% fat) has more

Lactating breast has hyperplasia of glandular tissue that takes up the space

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3
Q

Describe the structures located near the nipple

A

9 ducts emerge at the nipple where milk is secreted – ducts are tortuous and branch near the nipple

70% of glandular tissue is located within 8cm of the nipple

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4
Q

What type of epithelial cells surround alveoli?

A

cuboidal or low columnar myoepithelial cells surround the alveoli

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5
Q

What do myoepithelial cells do?

A

They contract and are responsible for milk ejection

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6
Q

What is lactogenesis I?

A

Preparing the breast for milk production during pregnancy

Increase in human placental lactogen (HPL) + prolactin once pregnant

This causes hyperplasia of the glandular tissue within the breast

High progesterone + oestrogen from placenta inhibit milk production but breast is being prepared and increasing in size

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7
Q

What is lactogenesis II?

A

Fall in progesterone + oestrogen = no more inhibition

Milk production = lactogenesis post partum

Suckling of infant on breast = stimulation on prolactin = milk synthesis

Also release of oxytocin = milk ejection (positive feedback)

Duct cells = autocrine inhibition = inhibition if there is lots of milk around anyway

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8
Q

How is milk synthesis controlled?

A

Mechanical stimulation of suckling

Release of prolactin from anterior pituitary

Acts on cuboidal cells of milk-producing alveoli to increase milk synthesis

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9
Q

When do prolactin levels peak?

A

Suckling episode stimulates more prolactin for the next feed

Prolactin causes milk synthesis

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10
Q

What is the let down reflex?

A

Suckling stimulates the hypothalamus to causes the release of oxytocin from posterior pituitary gland

Oxytocin causes myoepithelial cells to contract and secrete milk down the milk duct and out the nipple

Controlled by higher centres so can be stimulated by other stimuli as well

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11
Q

How do we augment lactation?

A

Encouraging lactation to occur

Increases prolactin secretion

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12
Q

What drugs augment lactation?

A

Dopamine antagonists. Domperidone + Metoclopramide (Galactogogues)

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13
Q

When would we augment lactation?

A

When a preterm infant is taken away to an incubator

Mother lacks the normal stimuli that allow her to produce breast milk

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14
Q

How can we suppress lactation?

A

Decrease prolactin secretion

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15
Q

What drugs suppress lactation?

A

Dopamine agonists e.g. bromocriptine + cabergoline

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16
Q

What are the 5 secretory pathways that get components of milk into the lumen of the milk-producing alveoli?

A 
Exocytosis
MFG
Osmosis
Immunoglobulin secretion
Paracellular Route
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17
Q

How is exocytosis involved in making milk?

A

Milk proteins, lactose, calcium, phosphate (major components of milk)

Packaged into secretory vesicles

Secreted by exocytosis

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18
Q

Describe how the major components of milk are synthesised?

A

Milk proteins are made by RER

Calcium + Phosphate are added at golgi

Lactose is made in the golgi vesicle and can’t move out

Water is drawn in osmotically

Vesicle fuses with apical membrane

Contents transferred to alveolar lumen

19
Q

What is MFG?

A

Milk fat globule

Lipids are produced on smooth endoplasmic reticulum

Packaged into milk fat globules

Surrounded by thin membrane and found in milk

20
Q

Describe how osmosis is involved in milk production

A

Secretion of ions

Water, Sodium, Potassium

Freely move out of the cell into the lumen

21
Q

Which antibody is present in breastmilk?

A

Secretory IgA

Binds to receptor on basolateral cellular wall

Receptor and IgA are transported in endocytotic vesicle

Emptied to Golgi body or apical membrane

22
Q

How is the paracellular route involved in milk production?

A

Normally closed but are open in pregnancy and mastitis

Movement between cells

Higher NaCl and lower concentrations of lactose and potassium in breast milk

Preterm baby will mean breast milk will be differently initially

23
Q

What are the components of breastmilk?

A

Nutrients – protein, carbs, fats

Trace elements – low solute load which is good for neonate kidneys

Secretory IgA

Macrophages + lymphocytes

Growth factors

24
Q

How much energy is in Breast milk?

A

70 Kcal per 100ml

25
Q

How does the composition of breast milk change over time?

A

Milk production increases a lot after day 3 post-partum

Increases over time to meet child’s demand up to 6 months of age

Lactose is low initially but increases over time

Salt levels are high initially but decrease over time

Fat increases over time

26
Q

What is hindmilk

A

Milk that is fat rich

Often produced many days post partum

27
Q

What are the nutritional benefits of breastfeeding for the baby?

A

Higher whey fraction (70%) to casein fraction (30%). Whey is soluble in stomach acid, promotin gastric emptying.

Lactoferrin, lysozyme + sIgA + whey proteins are important for baby’s immunological defence

LCPUFA (long chain polyunsaturated fatty acids) needed for brain + retinal development

Bile salt activated lipase – aids digestion of fat that comes into contact with bile salts in stomach

Prevents necrotising enterocolitis (NEC) – transmural necrosis of the bowl wall

28
Q

What form of LCPUFA does cow’s milk contain and why is this not ideal?

A

Carbon 18 LCPUFA
Linoleic
Not enough on its own for the baby
Should be for brain and retinal development

29
Q

What are the immunological benefits of breastmilk?

A

IgG is transferred to the baby across the placenta in the 3rd trimester so baby has passive immunity – term baby

If mother delivers preterm (before 37 weeks), the baby has missed out on IgG so the immunity will come from the mother’s breast milk

30
Q

What immune factors are present in breast milk?

A

sIgA – for immune response

C3 = complement protein

Lactoferrin – inhibits bacterial growth by binding iron

Lysozyme – cleaves peptidoglycans of bacterial walls

Cytokines – anti-inflammatory cytokines allows human milk to protect but not to injure the GIT

PAF acetylhydrolase – inhibits platelet factor

Oligosaccharides – act as food for bacterial flora in colon, this inhibits binding of enteric/ respiratory pathogens to epithelial cells

Epidermal growth factors – enhance development of GI epithelium

Cellular elements – neutrophils + macrophages

31
Q

What is the difference in immunological protection between a preterm and term baby?

A

Term = protection from IgG

Preterm – no protection

32
Q

What is the enteromammary axis?

A

How the baby receives sIgA

Pathogens recognised in intestine

Activate immune response in Peyer’s Patches

Antigen stimulated lymphocyte starts releasing sIgA for pathogen that infects mother

33
Q

What are the short term benefits for the infant?

A

Improved immunity, less infections and infectious morbidity
Reduces GI infection
Reduces respiratory infections
Reduces UTIs

34
Q

What does SIDS stand for?

A

Sudden infant death syndrome

Breastfeeding reduces the risk of this

35
Q

What are the long term benefits of breastfeeding for the infant?

A 
Breasted infants grow better
Lower risk of Type 1 and 2 diabetes mellitus
Reduced risk of childhood obesity 
Prevention/ delay of allergies
Reduced risk of childhood leukaemia
Reduced adolescent cholesterol levels
Lower BP
Better cognitive development
36
Q

What is the relationship between social class and breastfeeding?

A

Higher social class = more likely to be breastfed

37
Q

What are the benefits for mothers from breastfeeding?

A 
Breastfeeding releases oxytocin
Oxytocin causes the uterus to contract
Reduces risk of post-partum haemorrhage
Good straight after delivery
Lower risk of breast cancer due to oestrogen exposure
Reduced chance of ovarian cancer
Weight Loss?
38
Q

What is the rooting reflex?

A

Touch baby’s cheek

It moves to same side and opens its mouth

Helps baby’s mouth to latch on to the breast

Aids rooting and sucking

39
Q

What are the signs of a good attachment?

A

Mouth wide open
Being full

Chin should close to breast

Lower lip everted

More of areola should be visible above the baby’s mouth than below

Hear suckling and swallowing as milk goes in

Allows for effective milk removal

40
Q

What are the two patterns of sucking?

A

Non-nutritive

Nutritive

41
Q

What is non-nutritive suckling?

A 
Baby first goes on the breast
Short fast bursts
2 sucks a seconds
When there is little or no milk
No let down reflex yet
42
Q

What is nutritive suckling?

A

Let down reflex is now activated through mechanical stimulation
Slower paced suckling

43
Q

What is meant by tummy to tummy?

A

Baby’s stomach is against mothers

Positioning when breastfeeding

44
Q

What happens when latching goes wrong?

A

Trauma to the nipple
Ineffective breast drainage
Infection of the breast tissues – mastitis

Develop Sem 4 (2 decks)

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