Breastmilk by Dr. Olavidez (PPT) Flashcards
Each mammary gland forms a _____ of the breast which consists of a single major branch of alveoli and milk ducts that end at the nipple pore.
Lobe
The dark area around the nipple
Areola
Tube through which milk travels
Milk duct
Grape-like clusters of tissue that secrete milk
Alveoli cells
This causes the alveolar cells to secrete milk and swells the alveoli.
Prolactin reflex
Pathway:
- Nerve impulses from sucking go to brain
- The pituitary gland releases prolactin into the blood
- This causes the alveolar cells to secrete milk and swells the alveoli
This causes muscles around the alveoli in the breast to contract and squeeze the milk to the nipple.
The milk ejection/oxytocin reflex
Pathway:
- Nerve impulses from sucking go to the brain
- The pituitary gland releases oxytocin into the bloodstream
- This causes muscles around the alveoli in the breast to contract and squeeze the milk to the nipple.
Human milk is:
a. hypotonic
b. isotonic
c. hypertonic
Isotonic
- Milk and plasma are of similar ion concentration
- Milk is basically a suspension of fat and protein in carbohydrate mineral solution
Designed to protect infants against chronic childhood diseases
Human milk
Ratio:
- Breastmilk has T lymphocytes, B lymphocytes, neutrophils, macrophages and epithelial cells aid in protection
- IgA immunoglobulins
Two forms of breast milk:
- Colostrum
2. Mature milk
Volume of breast milk usually secreted ___________
600-900 mL/day
Thick yellow fluid
Colostrum
Colostrum is produced in the first ______ after birth.
2-4 days
Char-char: colos2rum = 2-4 days
Colostrum in human milk provides _____ cal/100 mL
58-70 cal/100 mL
High in protein, electrolytes, sodium, potassium, chloride and beta carotene
Colostrum
Low in fat and carbohydrate
Colostrum
Lactobacillus bifidus factor
Colostrum
Breast tissue development and secretion of colostrum and milk begins by 12th week of pregnancy and extends until shortly after delivery.
Lactogenesis I
Begins between the 2nd and 4th postpartum day and is characterized by the milk “coming in” in greater quanitity.
Lactogenesis II
7 to 10 days after delivery, milk is defined as __________
Transitional
14 days, milk is considered ________ has a volume of ________/24 hrs
Mature
600-900
Human milk is composed of ____ water.
87%
Human milk has _________ calories.
2,730-2,940 cal/L
Human milk is 98% triglycerides and mostly __________ and __________.
Palmitic and oleic acids
50% of TAG in human milk are in the form of ______.
DHA (Docosahexaenoic acid)
Other long chain polyunsaturated FA:
Arachidonic acid, linoleic and linolenic acids
Transport vehicle for fat-soluble vitamins and prostaglandins
Lipid component of breastmilk
75% of the nitrogen containing compounds in breast milk
Proteins
Non-protein nitrogen components in human milk:
Urea Nucleotides Peptides Free amino acids DNA
2 major components of protein:
- Casein
2. Whey
Mostly B-casein
Casein (40%)
Aqueous portion (60%)
Whey
Mainly a-lactalbumin, lactoferrin, secretory IgA
Whey
Increases in response to prolactin secretion
a-lactalbumin
Increases the production of lactose
a-lactalbumin
Forms a regulatory sub-unit of lactose synthase heterodimer while B-1,4 galactosyl transferase forms the catalytic component
a-lactalbumin
These proteins enable lactose synthase to produce lactose by transferring galactose moieties to glucose.
a-lactalbumin
a-lactalbumin binds strongly to _______ and _______.
Calcium and zinc
*Antibacterial and anti-tumor activity
Transports and promotes iron absorption
Lactoferrin
Bacteriostatic: inhibits growth of iron-dependent bacteria
Lactoferrin
Serves as nutritional protein
Lactoferrin
An enzyme that protects the infant against E. coli and Salmonella
Lysozyme
Promotes the growth of healthy intestinal flora and has anti-inflammatory functions
Lysozyme
Most abundant immunoglobulin in milk
Secretory IgA
Protects mucosal surfaces from infections by bacteria and viruses
Secretory IgA
Breastmilk also contains smaller amount of ________ and ________.
IgG and IgM
7.2 g/dL
Lactose
Disaccharide of galactose and glucose
Lactose
Dominant carbohydrate in human milk
Lactose
Enhances calcium absorption
Lactose
Glucose is an example of
Monosaccharides
Bifidus factor
Oligosaccharides and glycoproteins
Stimulate the growth of Lactobacillus bifidus bacteria in the gut
Oligosaccharides and glycoproteins
Inhibit the growth of E. coli and other enteropathogens
Oligosaccharides and glycoproteins
There are _____ bioactive enzymes
20
_________ in breastmilk works synergistically with lingual lipase and gastric lipase for complete digestion of human milk fat.
Lipase
Important during the months after birth when pancreatic enzyme and bile salt levels are low.
Enzymes
Bioactive hormones:
Thyroxine Prolactin Erythropoetin Epidermal growth factor Insulin Leptin Gastrin
For gastrointestinal motility
Prostaglandins
Breastmilk contains __________ which contains NEUTROPHILS, MACROPHAGES and LYMPHOCYTES.
4000 cells per cubic mm
Most concentrated in colostrum but continue to be present in transitional and mature milk.
Cellular components
Help prevent infection of the breast tissue
Neutrophils
Involved in providing immuno-protection
Macrophages (2000-3000 per cubic mm)
Lymphocytes (400 per cubic mm)
Secrete lysozyme, kill bacteria, active in phagocytosis
Macrophages
Released first
Foremilk
Hindmilk is released _______ minutes into the feeding
10-20 minutes
Lower in fat
Foremilk
Higher in fat
Hindmilk
Higher in carbohydrate
Foremilk
Resembles cream
Hindmilk
Lower in carbohydrate
Hindmilk
Amount of fat in FOREMILK
1.7%
Amount of fat in HINDMILK
5.5%
Amount of protein in FOREMILK
0.9%
Amount of fat in HINDMILK
0.7%
Drugs contraindicated during breastfeeding:
- Alcohol
- Nicotine
- Caffeine
- Marijuana and other narcotics
- Cytotoxic drugs
- Ergotamine
- Lithium
- Phenobarbital
- Atenolol
- Acebutolol
- Radioactive isotopes
This promotes mother and child bonding
Breastfeeding
It prevents uterine bleeding in the mother after delivery
Breastfeeding
Breastfeeding is a natural form of ______________.
Family planning
This reduces the risks of breast and ovarian cancer in the mother.
Breastfeeding
This saves time and precious expenses need not be used for buying milk powder and health care
Breastfeeding
This provides the best possible nutrition to the young child.
Breastfeeding
It is essential for the optimal physical, emotional and mental development of the child
Breastfeeding
NEWBORNS:
Feed _______ minutes per breast.
Every _______ hours.
________ feedings per day.
5-10 minutes
2-3 hours
10-12 feedings per day
Feed less frequently but for a longer duration at each feeding session.
One month or more
One month or more:
______ minute per breast every _____ hours.
20-40 minute
3-4 hours
Feed for 20-40 minutes per breast so 3-5 times per day.
By 6 months
Contraindications to breastfeeding:
- Active/untreated TB
- Mom takes radioactive compound (cancer for chemotherapy)
- Mom takes illegal drugs/narcotics
- HIV infection
- Galactosemia
Breastfeeding is not contraindicated:
- Hepatitis B surface antigen-positive
- Hepatitis C virus
- Febrile
- Exposed to low-level environmental chemical agents
- CMV
- Tobacco
- Jaundice or hyperbilirubinemia
25-37 C
4 hours
15-25C
8 hrs
Below 15C
24 hours
Milk should not be stored above ________.
37C
Refrigerated (2-4C)
8 days
If temperature of the refrigerator is not kept constant
3-5 days
Freezer compartment of a refrigerator
2 weeks
Freezer of a 2 door refrigerator (-20C)
3 months
Deep freezer
6 months
Thawed in refrigerator
24 hours
Treatment for full breast
Frequent feeds
Milk has “come in”
Full breast
Hot heavy and hard
Full breast
Milk flowing well
Full breast
Sometimes feels lumpy
Full breast
Normal fullness
Full breast
Breast is overfull
Engorged breast
Partly filled with milk
Engorged breast
Partly with tissue fluid and blood
Engorged breast
Interferes with milk flow
Engorged breast
Breast is shinny
Edematous
Painful
Engorged breast
Milk does not flow well
Engorged breast
In engorged breast, the nipple is
Stretched tight
Poor attachment or wrong attachment
Sore nipple
Candidiasis
Sore nipple
Not properly positioned pump
Sore nipple
Too much stretching of nipple caused by the pump/wrong position
Sore nipple
It is recommended for women who do not know their status and whore are HIV negative
Breastfeeding
When replacement feeding is ____________________, avoidance of all breastfeeding by HIV-infected mothers is recommended.
AFASS (Acceptable, Feasible, Affordable, Sustainable and Safe)