Breastfeeding/Lactation Flashcards
3 major components of lactation physiology
- Stages of lactogenesis
- Endocrine
- Nursing behavior and milk transfer
Lactogenesis I involves which 3 hormones to develop alveolar growth and maturation?
Progesterone
Prolactin
Human placental lactogen (hPL)
When can one start secreting milk?
Mid pregnancy
When does lactogenesis II begin and end?
Begins: After delivery of placenta, when progesterone levels drop
Ends 5-7 days pp
Colostrum has more________ & less ________ that mature milk
Colostrum has more protein & lactose and less fat than mature milk
What two hormones play major roles in L2 (lactogenesis II)?
Prolactin
&
Glucocorticoids
When does milk usually come in?
2-5 days postpartum
How much milk is produced once milk comes in?
500-700cc per day
When is engorgement most common?
When milk comes in at 2-5 days pp
When does lactogenesis III (aka galactopoiesis) usually begin and end?
Begins 5-7days pp
Ends when mother and infant are ready to discontinue BF
What are the “galactopoietic” and “galactokinetic” hormones?
Prolactin-creates milk by stimulating alveolar cells
Oxytocin —kinetic bc it contracts myoepithelial cells to secrete milk
What hormone dominates stage IV of lactogenesis?
Lactation inhibitory factor—releases if no feed in 24-48 hrs
Define lactogenesis IV
Involution and cessation if BF.
<6 episodes in 24 hrs
<400cc in 24 hrs
What metabolic hormones help produce breastmilk?
Cortisol
GH
Insulin
Parathyroid hormone
What is the main substrate for milk production?
Glucose
T or F: diet effects breastmilk
False
What is the threshold for weight loss in a breastfed infant at one week?
10% (7% if formula fed)
& by 14 days, the infant should return to birthweight
How can one be sure that ovulation (via LH) is suppressed during BF?
8+ feeds per day for at least 10-20 mins
What might inhibit the let down reflex?
Pain, anxiety, insecurity and distractions
Oxytocin has an anti stress effect though!) :
What are good signs of milk transfer?
Audible swallowing
Adequate I/Os
Feeling of emptying after feeds
Describe foremilk and hindmilk
Foremilk is emptied within 5-10mins and is composed of carbohydrates
Hindmilk is emptied afterwards (which is why it’s important to stick to one breast for one feed) and is composed of lipids & is calorie dense
Lactation depends on which 2 processes?
- Mammogensis (gorwth and delveopment of glandular tissue in breasts)
- lactogenesis (mammary epithelial cells are converted from nonsecretory to secretory state)
Describe the effects of lactation on the breastfeeding person
Decrease HTN, CV dz, PP blood loss, cancers (breast and ovarian), and accelerates uterine involution.
Amenorrhea if 8+ feeds in 24hrs for at least 10-20 mins.
Nutritional requirements of lactating women
8-12 glasses of water a day (one glass for every feed)
Extra 500-700 calories a day
Vitamin D, B12 (2.8 mcg/day), DHA may be necessary in certain populations (vegans)
Colostrum contains immunoprotective properties, including _____, ______, and __________ ______________.
secretory IgA
Oligosaccharides
Growth hormones
Which has higher water content: colostrum or mature milk?
Mature milk
Describe immunologic properties of breastmilk
Colonizes newborn gut with lactobacillus and bifidobacterium organisms through fermentation of nondigestible oligosaccharides. (70% of developing immune system is found within the GI system)
Prebiotics
Probiotics
Long-chain polyunsaturated fatty acids
IgA
Nucleotides (anti-inflammatory properties)
Decreases allergic responses
When is drug transfer to breastmilk more difficult?
Once milk production is established because alveolar cells expand, and intracellular gaps close. (So drugs pass more readily in the immediate PP period)
What drug properties are less likely to transfer to milk?
- Highly protein bound (ibuprofen)
- Readily move from plasma to tissue, thereby lowering the chance to diffuse into milk
- Higher molecular weight (heparin, insulin)
- Ionized drugs
- Lipophilic drugs
- shorter half-life
What drugs inhibit (or may inhibit) lactation?
Estrogen >30mcg/day Progestins (no known amount) Testosterone Antihistamines Pseudoephedrine (sudefed) Cabergoline (destinex) Bromocriptine (parlodel Ergotamine (cafergot) Tomoxifen (Nalvadex)
Mechanical ways to suppress lactation
Breast binders (tight bra) ice packs (avoid heat)
Drugs that enhance milk production
Fenugreek
Metoclopramide
Domperidone
Conditions that may adversely affect BF
PCOS
DM
Thyroid disorder
Breast surgery, infection, or pain
What should you assess in the BF infant?
Weight head (cephalohematoma?) Neck: Full ROM? Mouth (thrush?) Color (jaundice?)
Nutritional requirements for a term newborn
100-110kCal/kg per day
First days of life: 0.5-1 oz/feed
“always be fed on cue” with no breaks longer than 4-5 hours
When should one introduce solid foods?
No earlier than 6 months of age
What should breastfed infants be supplemented with?
400 IU Vitamin D
Community resources available to breast-feeding mothers
La Leche League International
World Alliance for BF Action
Academy of BF Medicine
Human Milk Banking Association of North America
International Lactation Consultants Association
Treatment for blocked duct or nipple blebs
Mupirocin 2% ointment, if recurrent/persistent, c/s & tx w/
Fluconazole (Diflucan) 200-400 mg followed by 100-200 mg QID x 2-3 wks
Tx for infectious mastitis
DCCE
Dicloxacillin (Dynapen) 500 mg Cephalexin (Reflex) 500 mg Clindamicin 300 mg Erythromycin 250-500 mg (all tx QID for 10-14 days, or 30d for recurrent & perform c/s)
Tx for nipple infections (MB)
Mupirocin 2%-15g
Polymyxin (bacitracin)
(apply after each feed)
Tx for ductal infections (CB)
c/s & tx for at least 14 days or until s/sx resolve for at least 7d
Clindamycin 300 mg QID
Bactrim 500 mg BID
Outpatient & inpatient tx for puerperal abscess (DC/NCV)
OUTPATIENT: QID & 10-14 d of: Dicloxacillin (Dynapen) 500 mg Clindamycin (Cleocin) 300 mg INPATIENT: IV Nafcillin 2g q 4hr IV Cefazolin 1g q6hr IV Vacomycin 1g q12 hr
Mgmt/tx of nipple pain
1st: Breast milk, breast shield
2nd: Lanolin (must wipe away before feed),
