Exam 2- lactation Flashcards
colostrum
milk at birth
- yellow
- high IgA, high lactoferrin –> anti-infection properties
- high protein
- low fat/lactose
- *facilitates establishment of lactobacillus and passage of meconium
transitional milk
2-14 days
- Igs and protein decreased
- lactose/ fat increase
- increase calories
mature milk (3 major constituents)
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
whats the purpose of lactoferrin in breast milk? talk about iron in breast milk
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
describe how nutritional comp of breast milk is tailored to nutritional needs of the little guy?
- low renal solute for immature kidneys
- modest protein –> rapid gastric emptying, softer poops, enhanced mineral absorption
SIgA in breast milk… more…
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
benefit of bioactive lipids/ carbs in breast milk?
oligosacs and glycop’s prevent attachment of pathogenic agents to epith lining of mucosal surfaces
bifidus factor
in human milk, N-containing carb that supports growth of non-pathogenic lactobacillus
how does maternal malnutrition affect breast milk? t/f water intake is important?
reduced milk supply but minimally altered macronutrient content
TRUE. dehydrated mom will decrease water loss in urine before decreasing BM
recommended additional caloric intake of breast feeding mom?
500kcal/day for first 6 mon vs 300kcal/day during late pregnancy
why breast feed? advantages to infant
immune protection
- acute illnesses –> GI, LRTI, OM
- chronic –> celiac, cancer, obesity?
neurodevelopment
- bonding
- enhanced cog performance
why breast feed? immediate advantages to mom
- prevent PPH (suckling –> oxytocin –> uterine contraction)
- weight loss to pre-preg weight
- lactational amenorrhea/birth spacing
- bonding/ stress reduction
- ECONOMIC. that shits free.
long term adnvatages to mom for breast feeding?
breast/ovarian CA premenopause reduced when BF for > 12 mo
- dec osteoporosis
- improved CV outcomes
medical contraindications to BF?
medications (mom’s)
active untreated substance abuse
infections –> TB, HIV (controversial)
baby–> galatosemia
WHO recs for BF in developing countrains
BF unless access to formula and clean water
-risks of HIV transmission from birth vs breastfeeding are similar
BFHI
baby friendly hospital initiative –> promotes/protects/supports BF with “10 Steps” (WHO/ UNICEF)
**the golden hour–> BF infant within first hour
hospital practices that positively impact BF
- baby to breast in delivery
- rooming in
- staff initiation support
- mom seeing other moms doing it
- nursing/ feeding schedules
hosp practices that negatively impact bf
- mom/babe sep at birth
- mom/babe housing sep
- mom “getting rest/space”
- d/c packs with formula kit
BF recs
exclusive for 6 mo, continue through first or second year of life
US healthy people 2020 for BF
- 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
in first 1-3 days, where does baby get energy?
- 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
freq of newborn feeding
- 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
normal patterns of weight loss/regain by infant
- 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
insufficient milk syndrome
common
-inadequate milk removal –> inadequate production
*primary milk insufficiency is rare ~5% of women
alternatives to human milk
- 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?
