Exam 2- lactation

Question 1

colostrum

Answer 1

milk at birth

• yellow
• high IgA, high lactoferrin –> anti-infection properties
• high protein
• low fat/lactose
• *facilitates establishment of lactobacillus and passage of meconium

Question 2

transitional milk

Answer 2

2-14 days

• Igs and protein decreased
• lactose/ fat increase
• increase calories

Question 3

mature milk (3 major constituents)

Answer 3

1) water –> largest component, maintains hydration
2) lipids –> 50% of cals
3) proteins –> casein/ WHEY, lactoferrin

there are other things too, like CHO and Vit D

Question 4

whats the purpose of lactoferrin in breast milk? talk about iron in breast milk

Answer 4

1) antimicrobial- inhibits growth of iron dependent bacteria in GI tract

low levels of Fe but highly bioavailable –> no risk of deficiency in 1st 6 mo

Question 5

describe how nutritional comp of breast milk is tailored to nutritional needs of the little guy?

Answer 5

• low renal solute for immature kidneys

- modest protein –> rapid gastric emptying, softer poops, enhanced mineral absorption

Question 6

SIgA in breast milk… more…

Answer 6

most prominent Ig, highest conc in colostrum, declines over first month but persistent through 2 years of lactation

synth by maternal intestinal lymphoid tissue, rapidly transferred to baby

Question 7

benefit of bioactive lipids/ carbs in breast milk?

Answer 7

oligosacs and glycop’s prevent attachment of pathogenic agents to epith lining of mucosal surfaces

Question 8

bifidus factor

Answer 8

in human milk, N-containing carb that supports growth of non-pathogenic lactobacillus

Question 9

how does maternal malnutrition affect breast milk? t/f water intake is important?

Answer 9

reduced milk supply but minimally altered macronutrient content

TRUE. dehydrated mom will decrease water loss in urine before decreasing BM

Question 10

recommended additional caloric intake of breast feeding mom?

Answer 10

500kcal/day for first 6 mon vs 300kcal/day during late pregnancy

Question 11

why breast feed? advantages to infant

Answer 11

immune protection

• acute illnesses –> GI, LRTI, OM
• chronic –> celiac, cancer, obesity?

neurodevelopment

• bonding
• enhanced cog performance

Question 12

why breast feed? immediate advantages to mom

Answer 12

• prevent PPH (suckling –> oxytocin –> uterine contraction)
• weight loss to pre-preg weight
• lactational amenorrhea/birth spacing
• bonding/ stress reduction
• ECONOMIC. that shits free.

Question 13

long term adnvatages to mom for breast feeding?

Answer 13

breast/ovarian CA premenopause reduced when BF for > 12 mo

• dec osteoporosis
• improved CV outcomes

Question 14

medical contraindications to BF?

Answer 14

medications (mom’s)
active untreated substance abuse
infections –> TB, HIV (controversial)

baby–> galatosemia

Question 15

WHO recs for BF in developing countrains

Answer 15

BF unless access to formula and clean water

-risks of HIV transmission from birth vs breastfeeding are similar

Question 16

BFHI

Answer 16

baby friendly hospital initiative –> promotes/protects/supports BF with “10 Steps” (WHO/ UNICEF)

**the golden hour–> BF infant within first hour

Question 17

hospital practices that positively impact BF

Answer 17

• baby to breast in delivery
• rooming in
• staff initiation support
• mom seeing other moms doing it
• nursing/ feeding schedules

Question 18

hosp practices that negatively impact bf

Answer 18

• mom/babe sep at birth
• mom/babe housing sep
• mom “getting rest/space”
• d/c packs with formula kit

Question 19

BF recs

Answer 19

exclusive for 6 mo, continue through first or second year of life

Question 20

US healthy people 2020 for BF

Answer 20

• increase BF to 82%
• increase employers with support programs
• DEC BF newborns who get formula support within first 2 days
• INC live births in baby friendly hospitals

Question 21

in first 1-3 days, where does baby get energy?

Answer 21

• glycogen –> stores last 12 hours, come from intrauterine GCC
• low glu –> low ins/inc glucagon –> increase gluconeogenesis
• “stress” (hypoclyc/hypotherm/hypoxia) stimulates EPI–> lipase –> release TG –> glyc/fatty acids

Question 22

freq of newborn feeding

Answer 22

• 8-12x/ day (longest wait ~5 hours, but only one time in that day)
• 10-30 mins
• *thorough EMPTYING–> get that hindmilk, thats good for the babe

Question 23

normal patterns of weight loss/regain by infant

Answer 23

• lose 5-7% of weight, STOP at day 5 when milk comes in
• day 5- gain 15-30g a day
• regain BW by 7-14 days

Question 24

insufficient milk syndrome

Answer 24

common
-inadequate milk removal –> inadequate production

*primary milk insufficiency is rare ~5% of women

Question 25

alternatives to human milk

Answer 25

• based on cow milk, mod to mimic human milk
• might increase risk of atopic dz

**question: does human milk prevent dz, or do formulas cause risk?