lactation

Question 1

colostrum

Answer 1

Yellow in color. High in IgA and lactoferrin. Anti-infection properties. Higher protein, lower fat and lactose. Facilitates- Establishment of lactobacillus and Passage of meconium

Question 2

transitional milk

Answer 2

2-14 days. Immunoglobulins and protein decrease. Lactose and fat increase. Increase in calories. Vitamin changes

Question 3

mature milk

Answer 3

Mainly water to maintain infant hydration. Lipids provide 50% of calories. Proteins- casein and whey (primary). Lactoferrin – inhibits growth of Fe dependent bacteria in GI tract. sIgA provides immunity. Carbs- lactose, galactose and glucose. Elements: iron, zinc, Vit D.

Question 4

foremilk vs hindmil

Answer 4

foremilk is milk at the beginning of a feeding which has less fat than hindmilk, from the end of a feeding.

Question 5

How does maternal diet influence breast milk

Answer 5

•Malnourished mothers have the same proportions of protein, fat and CHO as well nourished mothers, but they produce less milk. Dehydrated mothers will decrease water loss in urine before diminishing BM output.. Fat intake influences lipid content, not linked to infant health at this point.

Question 6

Breast feeding advantages to infant

Answer 6

Immunologic protection- Acute illness: reduced rates of gastrointestinal infection, respiratory illness (LRI, wheezing), otitis media, sepsis, necrotizing enterocolitis (premature infants). Chronic conditions: obesity, ? celiac disease, childhood cancer. Immune priming. Neurodevelopmental benefits: bonding; enhanced cognitive performance

Question 7

Breast feeding advantages to mother

Answer 7

Prevention of post-partum hemorrhage, Weight loss (average return to pre-pregnancy weight after ~ 6 mo of lactation), Lactational amenorrhea/birth spacing; amenorrhea also spares nutrients, esp Fe

Question 8

WHO infant feeding recommendations

Answer 8

Exclusive breastfeeding for 6 mo., Continue to breastfeed least 2 years with complementary feeding initated at 6 months.

Question 9

American academy of Pediatrics infant feeding recommendations

Answer 9

Exclusive breastfeeding for 6 mo., Continue to breastfeed least 1 year with complementary feeding initated at 6 months.

Question 10

Healthy people 2020 goals

Answer 10

82% “ever breastfed”, 61% breastfed for 6 months, 34% breastfed for 12 months. Increase worksite lactation support programs, decrease breastfed infants who receive formula supplementation within first 2 days of life. Increase births in facilities that provide recommended care for BF mother/infant

Question 11

barriers to breastfeeding

Answer 11

higher socioeconomic status, well educated, married, older >25, non smoker, not employed outside house, caucasians and hispanics > blacks, less acculturated

Question 12

Baby Friendly Hospital Initiative

Answer 12

written breastfeeding policy, Train all health care staff, Inform all pregnant women about benefits, Help mothers initiate breastfeeding within half hour of birth, show mothers how to breastfeed, No food/drink other than breast milk, rooming in, breastfeeding on demand, no artificial teets or pacifiers, support groups

Question 13

What happns in first hour after birht

Answer 13

AAP & WHO recommend infants be nursed (skin to skin) within the first hour after birth. Infant typically alert for first hour, then sleeps for several. Thermoregulation with skin-to-skin. Better Breast feeding outcomes at 4 mo

Question 14

Hospital practices that support successful breastfeeding

Answer 14

breast feed in 1st hour, Skin to skin contact, Rooming in, Lactation consultants, Peer role modeling, Ad lib nursing/feeding

Question 15

Hosital practices that undermine successful breastfeeding

Answer 15

Separation of inf/mom, Mother discouraged, BF/limited time suckling, Covert formula feeding, D/C packs with formula, Lack of support, Pacifier use

Question 16

breastfeeding for first 1-3 days

Answer 16

colostrum (high fat, protein, Igs), practice Bfing. Glycogen stores last about 12 hours (stimulated by intrauterine Glucocorticoids). Low glucose leads to decreased insulin & increased glucagon > gluconeogenesis. “Stress” leads to lipase release, then release of TG > glycerol & fatty acids. Brown and white fat provide substrate for energy intake

Question 17

When does lactogenesis stage 2 begin

Answer 17

3-4 days after birth. “milk comes in”

Question 18

frequency and duration of breast feeding

Answer 18

Every 30 minutes, to 4 hours (no more). 8-12 times per day in beginning. Thorough emptying of breast important For hindmilk (high fat – good for infant
growth). Good for lactogenesis. 10-30 minute durations

Question 19

Newborn weight changes

Answer 19

Infants expected to lose 5-7% of their birth weight. Typically stop losing by 5 days then regain birth weight by 7-14 days.

Question 20

Breastfeeding difficulties

Answer 20

First 1-3 weeks is common time for problems. Mother may have trouble positioning baby due to shape of breast/nipple, infant size, development. Infant needs to have proper rooting, sucking and swallowing reflexes

Question 21

Insufficient milk syndrome

Answer 21

common. Inadequate milk removal leads to inadequate milk production. Factors may include Maternal – stress, medical problems, separation from infant, older maternal age. Infant – LBW/prematurity, poor suck/latch, neurologic issues, lethargy, illness, formula supplementation

Question 22

describe components of infant formula

Answer 22

Cow milk base. Protein load modified to better approach human milk (casein:whey ratio). High quality amino acid mix. Fortified with essential vitamins & minerals. Lipid blend modified, including omega-3 FA. Soy protein is 2nd most common choice.

Question 23

compare infant formula vs human milk

Answer 23

Macronutrients are similar, but there are significant differences in micronutrients. Ie. Iron in IF is 4X human milk

Question 24

conditions associated with infant formula

Answer 24

Atopy (allergy), type 1 diabetes, obesity

Question 25

Type 1 diabetes associated with formula- mechanism

Answer 25

Proposed that bovine serum albumin found in infant formulas may trigger an autoimmune response. Proposed that a cell-mediated response to beta-casein (cow’s milk protein) . Exposure leads to proliferation of peripheral blood T-cells

Question 26

Obesity associated with formula- mechanism

Answer 26

More responsive feeding style allowing for greater infant self-regulation of energy intake , thereby preventing overeating.Also, prevention of rapid infant weight gain in first 6 months which has been linked with childhood obesity

Question 27

compare infant growth for formula fed and breast fed infants

Answer 27

First 3 months: Similar weight gain BF to formula fed. After that – formula fed gain more weight. At 12 months: Formula fed infants 0.65 kg more than a BF infant.

Question 28

Are growth charts based on BF or formula fed infants?

Answer 28

Until recently were based on a sample of formula fed infants.BF infants at risk of being labeled “growth faltering” due to slower growth.