Neonatal Feeding Flashcards
When is human milk recommended as the exclusive feed?
For all term infants for the first 6 months of life
Is human milk recommended for preterm infants?
Yes, but may require fortification
What is increasingly available for preterm infants in order to supplement maternal milk?
Donor breast milk
When should counselling regarding breast feeding commence?
Early in pregnancy
Who should assist mothers in breast feeding?
Nursing or lactation specialists
Should the choice to breast feed or formula feed be criticised?
No obviously not
How does the protein content of breast milk compare to unmodified cows milk?
It has a low protein content, but is more easily digestible
What amino acid is prominent in breast milk?
Glutamine
What is the importance of the glutamine in breast milk?
It stimulates enterotropic hormones, enhancing feeding tolerance
What kind of fat is present in breast milk?
Unsaturated
What kind of important fatty acid does breast milk contain?
Long-chain polyunsaturated fatty acids (LCPUFAs)
What is the importance of LCPUFAs?
Needed for nervous system development
Describe the carbohydrate content of breast milk?
Contains high lactose
How does the mineral content of breast milk compare to unmodified cows milk?
- Low renal sodium load
- Reduced phosphate:calcium ratio
Is the vitamin content of breast milk sufficient?
No, supplementation is required to meet daily requirements
What is meant by formula milk being ‘humanised’?
It is manipulated to resemble human milk
What are the disadvantages of formula milk compared to breast milk?
- Differences in amino acids and fatty composition
- Does not contain anti-infective properties of human milk
What major health concern arises from formula milk feeding in developing countries?
Infection from re-constituting milk powder with contaminated water
Are unmodified animal milks, e.g. cows, goats, sheep, suitable for infants?
No
What kind of formula is sometimes used to prevent allergic disorders such as eczema and asthma?
Soy (evidence for this is lacking)
What % of infants with cow’s milk protein intolerance become sensitive to soy?
10-30%
Is soy formula recommended for premature infants?
No
When should an infant first be placed on the breast?
Immediately or soon after birth
What environmental factors can encourage breastfeeding?
Quiet, supportive environment with comfortable positioning
What is better, fixed schedule feeding or demand feeding?
Demand feeding
Why is demand feeding better than fixed schedule feeding?
It stimulates milk production and reduces feeling of fullness and discomfort
How often might an infant be put to the breast if demand feeding?
8-12 or more times per 24 hours
When breastfeeding, which breast should the infant feed from?
Should be put to both breasts at each feeding, switching sides when the baby pauses and lets go of breast. Begin each feeding with the breast the baby last nursed from
Should you restrict the duration of feeds when breastfeeding?
No
What is the importance of emptying the breast adequately when breast feeding?
Avoids engorgement
What is initially produced when starting breastfeeding?
Colostrum
Describe the features of colostrum?
Low in volume, high in protein and immunoglobulin content
How long does it take for breast milk to come in?
24-72 hours
What do mothers needed to be warned of, regarding the babies weight?
Babies initially lose weight, up to 7-10% of their body weight
When should babies start putting on weight after the initial loss?
After day 4 of life, returning to birth weight by 10-14 days
Should infants be given supplementary water or formula when breastfeeding?
Not unless medically indicated
What are the immediate advantages of breast-feeding for infants?
- Promotes mother-infant bonding
- Ideal nutritional composition
- Contains immune factors
- Reduces gastroenteritis and respiratory infections
- Less feeding intolerance
- Reduces incidence of necrotising enterocolitis in preterm infants
- Promotes ketone production as an alternative energy substrate to glucose in first few days of life
What are the long-term benefits of breastfeeding to the infant?
- Reduces risk of SIDS (sudden infant death syndrome)
- May decrease incidence and severity of eczema and asthma
- Less obesity, T1DM, and IBD
What are the advantages of breastfeeding to the mother?
- Enhances mother-infant bonding
- More rapid postpartum weight loss
- Decreased risk of osteoporosis
- Decreased risk of breast and bowel cancer
- Increases time between pregnancies
Where is increasing the time between pregnancies important?
In developing countries
What are the potential complications of breastfeeding for the infant?
- Cannot tell how much milk the baby has taken
- Dehydration can occur
- Jaundice associated with breast milk
- Vitamin K deficiency
How is the amount of milk a baby has taken when breastfeeding determined?
By monitoring baby’s weight and urine output
When might dehydration occur when breastfeeding?
- Inadequate milk supply/poor feeding technique
- Hot weather
Is jaundice associated with breast milk common?
Yes
What exacerbates jaundice caused by breast milk?
Dehydration
Should breastfeeding be discontinued when it is causing jaundice?
No, even if it requires phototherapy
In what % of infants who have jaundice caused by breastfeeding will it be prolonged (>2 weeks of age)?
Up to 15%
What is required when jaundice caused by breastfeeding is prolonged?
Will require investigations to be performed
Can neonates from multiple births be breastfed?
Twins can often be exclusively breastfed, but rarely higher-order births
What might low levels of vitamin K in breast milk lead to?
Predisposes to haemorrhagic disease of newborn
What is required when there are low levels of vitamin K in the breast milk?
Prophylaxis
What are the potential complications of breast-feeding for the mother?
- Maternal feeling of inadequacy/upset if unsuccessful
- Breast engorgement
- Cracked nipples
- Mastitis
What might help with breast engorgement and cracked nipples caused by breastfeeding?
Manual expression or a breast pump
What is the problem with mastitis when breastfeeding?
It requires maternal treatment, and may disrupt feeding
What are the potential contraindications to breastfeeding?
- Maternal HIV
- Maternal TB
- Inborn errors of metabolism
Give two examples of inborn errors of metabolism that are contraindications to breast feeding?
- Galactosaemia
- Phenylketonuria
Describe the excretion of drugs in breast milk
Most drugs are excreted in breast milk in such small quantities that they do not affect the infant
Should drugs be taken while breastfeeding?
Where possible, all drugs including self-medication should be avoided during breast feeding
What drugs should be avoided when breastfeeding?
- Radioactive iodine
- Cytotoxic agents
- Diazepam
- Tetracyclines
- Lithium
What effect may taking radioactive iodine whilst breastfeeding have on the infant?
Thyroid suppression
What effect may taking cytotoxic agents during breastfeeding have on the infant?
Risk of cytotoxic effect
What effect may taking diazepam when breastfeeding have on the infant?
Sedation, may accumulate
What effect may taking tetracycline while breastfeeding have on the infant?
Possibility of permanently staining teeth
What effect may taking lithium while breastfeeding have on the infant?
Risk of neurological effects or cardiac malformations
