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Intrapartum > Breastfeeding/Lactation > Flashcards

Breastfeeding/Lactation Flashcards

1
Q

3 major components of lactation physiology

A
  1. Stages of lactogenesis
  2. Endocrine
  3. Nursing behavior and milk transfer
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2
Q

Lactogenesis I involves which 3 hormones to develop alveolar growth and maturation?

A

Progesterone
Prolactin
Human placental lactogen (hPL)

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3
Q

When can one start secreting milk?

A

Mid pregnancy

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4
Q

When does lactogenesis II begin and end?

A

Begins: After delivery of placenta, when progesterone levels drop
Ends 5-7 days pp

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5
Q

Colostrum has more________ & less ________ that mature milk

A

Colostrum has more protein & lactose and less fat than mature milk

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6
Q

What two hormones play major roles in L2 (lactogenesis II)?

A

Prolactin
&
Glucocorticoids

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7
Q

When does milk usually come in?

A

2-5 days postpartum

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8
Q

How much milk is produced once milk comes in?

A

500-700cc per day

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9
Q

When is engorgement most common?

A

When milk comes in at 2-5 days pp

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10
Q

When does lactogenesis III (aka galactopoiesis) usually begin and end?

A

Begins 5-7days pp

Ends when mother and infant are ready to discontinue BF

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11
Q

What are the “galactopoietic” and “galactokinetic” hormones?

A

Prolactin-creates milk by stimulating alveolar cells

Oxytocin —kinetic bc it contracts myoepithelial cells to secrete milk

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12
Q

What hormone dominates stage IV of lactogenesis?

A

Lactation inhibitory factor—releases if no feed in 24-48 hrs

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13
Q

Define lactogenesis IV

A

Involution and cessation if BF.
<6 episodes in 24 hrs
<400cc in 24 hrs

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14
Q

What metabolic hormones help produce breastmilk?

A

Cortisol
GH
Insulin
Parathyroid hormone

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15
Q

What is the main substrate for milk production?

A

Glucose

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16
Q

T or F: diet effects breastmilk

A

False

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17
Q

What is the threshold for weight loss in a breastfed infant at one week?

A

10% (7% if formula fed)

& by 14 days, the infant should return to birthweight

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18
Q

How can one be sure that ovulation (via LH) is suppressed during BF?

A

8+ feeds per day for at least 10-20 mins

19
Q

What might inhibit the let down reflex?

A

Pain, anxiety, insecurity and distractions

Oxytocin has an anti stress effect though!) :

20
Q

What are good signs of milk transfer?

A

Audible swallowing
Adequate I/Os
Feeling of emptying after feeds

21
Q

Describe foremilk and hindmilk

A

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

22
Q

Lactation depends on which 2 processes?

A
  1. Mammogensis (gorwth and delveopment of glandular tissue in breasts)
  2. lactogenesis (mammary epithelial cells are converted from nonsecretory to secretory state)
23
Q

Describe the effects of lactation on the breastfeeding person

A

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.

24
Q

Nutritional requirements of lactating women

A

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)

25
Q

Colostrum contains immunoprotective properties, including _____, ______, and __________ ______________.

A

secretory IgA
Oligosaccharides
Growth hormones

26
Q

Which has higher water content: colostrum or mature milk?

A

Mature milk

27
Q

Describe immunologic properties of breastmilk

A

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

28
Q

When is drug transfer to breastmilk more difficult?

A

Once milk production is established because alveolar cells expand, and intracellular gaps close. (So drugs pass more readily in the immediate PP period)

29
Q

What drug properties are less likely to transfer to milk?

A
  1. Highly protein bound (ibuprofen)
  2. Readily move from plasma to tissue, thereby lowering the chance to diffuse into milk
  3. Higher molecular weight (heparin, insulin)
  4. Ionized drugs
  5. Lipophilic drugs
  6. shorter half-life
30
Q

What drugs inhibit (or may inhibit) lactation?

A 
Estrogen >30mcg/day
Progestins (no known amount)
Testosterone
Antihistamines
Pseudoephedrine (sudefed)
Cabergoline (destinex)
Bromocriptine (parlodel
Ergotamine (cafergot)
Tomoxifen (Nalvadex)
31
Q

Mechanical ways to suppress lactation

A 
Breast binders (tight bra)
ice packs (avoid heat)
32
Q

Drugs that enhance milk production

A

Fenugreek
Metoclopramide
Domperidone

33
Q

Conditions that may adversely affect BF

A

PCOS
DM
Thyroid disorder
Breast surgery, infection, or pain

34
Q

What should you assess in the BF infant?

A 
Weight
head (cephalohematoma?)
Neck: Full ROM?
Mouth (thrush?)
Color (jaundice?)
35
Q

Nutritional requirements for a term newborn

A

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

36
Q

When should one introduce solid foods?

A

No earlier than 6 months of age

37
Q

What should breastfed infants be supplemented with?

A

400 IU Vitamin D

38
Q

Community resources available to breast-feeding mothers

A

La Leche League International
World Alliance for BF Action
Academy of BF Medicine
Human Milk Banking Association of North America
International Lactation Consultants Association

39
Q

Treatment for blocked duct or nipple blebs

A

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

40
Q

Tx for infectious mastitis

DCCE

A 
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 &amp; perform c/s)
41
Q

Tx for nipple infections (MB)

A

Mupirocin 2%-15g
Polymyxin (bacitracin)
(apply after each feed)

42
Q

Tx for ductal infections (CB)

A

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

43
Q

Outpatient & inpatient tx for puerperal abscess (DC/NCV)

A 
OUTPATIENT:
QID &amp; 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
44
Q

Mgmt/tx of nipple pain

A

1st: Breast milk, breast shield
2nd: Lanolin (must wipe away before feed),

Intrapartum (13 decks)

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