Exam 4 - Newborn Nutrition Flashcards
When should discussions about breastfeeding begin?
During pregnancy
How long do professional societies (AAP, NAPNAP, ACOG) recommend moms to breast feed for?
At least a year or longer as desired
Supportive measures to promote breastfeeding during pregnancy
- 1+ support persons during childbirth
- Care by doula
Non-supportive measures that do not promote breastfeeding during pregnancy
- Use of oxytocin for labor
- Widespread use of epidural anesthesia
- Operative delivery
- C-section
Ways to promote breastfeeding during postpartum period
- Skin-to-skin contact following delivery
- All newborn care should be completed in the mom’s arms (e.g. hep B shot, vitamin K, erythromycin ointment)
Pathophysiology of breastfeeding - what maintains milk supply in the mom?
Maintaining adequate milk supply depends on nutritive stimulation of the breast and removal of milk on a regular and frequent basis
What is the suck-swallow-breathe ratio for newborns when they are nursing?
1 sec : 1 sec : 1 sec
True/False - newborn guts are nonsterile
False - they are sterile
- Gut becomes colonized with maternal bacteria through contact with breastfeeding
What is the significance of bacteria colonization in the newborns gut?
Bacteria colonization is how newborns develop their immune systems
- 70% of infants developing immune system found in GI tract
Colostrum vs transitional milk vs mature milk
- Which milk is present first?
Colostrum - present as early as 3 months gestation
- High in protein
- Lasts until day 5 of infants life
- Yellow-gold color
Colostrum vs transitional milk vs mature milk
- How is transitional milk different from colostrum?
Higher in protein content, high in carbohydrate content
- Present until 2 weeks of life
- Bluish color, translucent
Colostrum vs transitional milk vs mature milk
- When is mature milk present?
After 2 weeks of life
- Made up of foremilk and hindmilk
- Foremilk - high in carbohydrates
- Hindmilk - protein and fat rich
When do babies get the nutrients of hindmilk during breastfeeding?
Moms should put their baby on the breast and make sure they’re draining the breast completely to get hindmilk
What is LactMed?
Database where providers can plug in different medications and therapeutics to learn if they’re safe for a mom during breastfeeding
Contraindications to breastfeeding
- Maternal substance abuse
- Cytotoxic and immunosuppressive drugs
- Active TB
- HSV lesions on the breast
- Including pumping
- Active varicella infection
- HIV infections (in developed countries)
- Neonatal galactosemia
- Infant cannot properly break down milk
Common problems with breastfeeding
- For the mother
- Sore nipples
- Flat/inverted nipples
- Engorgement
- Insufficient milk supply
- Candidiasis (cracked/peeling nipples, itchiness, discomfort)
- Mastitis
- Feeding refusal
Common problems with breastfeeding
- For the infant
- Late preterm infant (35-36 weeks)
- More difficulty latching onto breast
- Tongue-tie
- Palate abnormality
- Hypoglycemia
- Jittery, difficulty latching onto breast
Patient education regarding breastfeeding
- Obtain a pump early during pregnancy
- Safe pumping
- Returning to work
- Introducing the bottle
Safe breastmilk storage patient education
- Room temp for 4-6 hours
- Cooler with ice packs for 24 hours
- Refigerator for 3-8 days
- Freezer for 4-6 months
- Deep freeze freezer for 6-12 months
Proper formula preparation patient education
1 scoop per 2 oz water
- Improper preparations can lead to electrolyte imbalances
How can hydrolyzed based formulas be benefitial for newborns?
Hydrolyzed formulas are partially broken down milk/soy proteins that make it easier to digest for infants that have difficulty with digestion or are really gassy
When would amino acid based formulas be indicated for newborns?
For newborns who may have a soy protein or cow’s milk protein intolerance
- AEB blood in stool or significant skin findings (e.g. eczema)
Feeding issues that might occur in breastfed/formula fed infants
- GERD
- Constipation
- Infrequent stooling is common (some may only stool once a week)
- Diarrhea
- Colic
- 3 hours/day of crying that occurs more than 3 days/week and more than 3 weeks in a row
- Starts at 3 weeks of age; resolves by 3 months
- Consider probiotics
If a newborn has GERD, when would symptoms normally present?
3 weeks of life and persists until 6 months to 1 year
