Neonatology Flashcards
1
Q
What are the three shunts of the foetal circulation?
A
Ductus venosus
Foramen ovale
Ductus arteriosus
2
Q
How much of the foetal circulation does via the lungs?
A
7%
3
Q
How does the foetus prepare during the 3rd trimester?
A
Surfactant production Accumulation of glycogen in liver, muscle and heart Accumulation of brown fast: - Between scapulae - Around internal organs Accumulation of S/C fat Swallowing amniotic fluid
4
Q
What happens to catecholamines and cortisol at the onset of labour?
A
Levels increase
5
Q
What happens to the synthesis of lung fluid at labour?
A
Stops
6
Q
What effect does vaginal delivery have on foetal lungs?
A
Squeezes them
7
Q
How does the baby appear during the first few seconds after birth?
A
Initially blue
Starts to breathe and turns pink
Cries
8
Q
What happens to vascular resistance after birth?
A
Pulmonary resistance drops
Systemic resistance increases
9
Q
What happens to oxygen tension after birth?
A
Increases
10
Q
What happens to circulating prostaglandins in the foetus after birth?
A
Drop
11
Q
When the ductus constricts, what happens?
A
Increased pO2
Reduced flow and prostaglandins
12
Q
What does the ductus arteriosus become normally?
A
Ligamentum arteriosum
13
Q
How is a patent ductus arteriosus treated in preterm infant?
A
Indometacin
OR
Ibuprofen
14
Q
What does the ductus venosus become?
A
Ligamentum teres
15
Q
A baby is born with signs of asphyxia. She is tachypnoeic and has a loud S2 and harsh systolic murmur (tricuspid regurgitation). Her Apgar scores are persistently low. There is some meconium staining. The baby is cyanosed, with a low systemic BP. Signs of shock.
A
Persistent Pulmonary Hypertension of the Newborn
16
Q
How is Persistent Pulmonary Hypertension of the Newborn managed?
A
Ventilation Oxygen NO Sedation Inotropes Extracorporeal Life Support
17
Q
What physiological changes happen in the first few hours of life?
A
Thermoregulation
Glucose homeostasis
Nutrition
18
Q
What is the main method of heat generation following birth?
A
Non-shivering thermogenesis:
- Breakdown of stored brown adipose tissue to catacholamines
19
Q
Why do neonates need help with maintaining temperature?
A
Wet when born Large surface area;body mass ratio No shivering Non-shivering thermogenesis is not efficient in first 12 hours Peripheral vasoconstriction
20
Q
What infants are at increased risk of hypothermia?
A
Low stores of brown fat
Little S/C fat
Large SA;Vol. ratio
21
Q
What is glucose homeostasis following birth?
A
Drop in insulin; increase in glycogen
Mobilisation of hepatic glycogen stores for gluconeogenesis
Ability to use ketones as brain fuel
22
Q
How can hypoglycaemia arise due to increased energy demands?
A
Unwell
Hypothermia
23
Q
What effect does an increase in 2,3-diphosphoglycerate do to the Hb dissociation curve?
A
Shifts it right
24
Q
Where does haematopoeisis shift to after birth?
A
Bone marrow
25
Why is there a physiological anaemic following birth? When does it resolve?
Adult Hb synthesised sslower than foetal Hb broken down
| Nadir at 8-10 weeks
26
What cause physiological jaundice?
Breakdown of foetal Hb
Conjugating pathways immature
Increase in circulating unconjugated bilirubin
27
When does physiological jaundice usually occur?
1-7 days
28
When is jaundice pathological?
<24 hours after birth
OR
Lasting longer than >14 days
29
What does ineffective attachment result in?
Pain and damage to nipples
Breastmilk not removed effectively
Apparent poor milk supply
Breast milk production declines
30
What can the following cause:
- Poor positioning and incorrect attachment
- Mechanical pumping
- Tearing the nipple/areolar junction
- Detaching baby or pump incorrectly
Sore/Cracked nipples
31
What are the signs/symptoms of sore/cracked nipples?
```
Pain (specific to nipple)
Worsens at start of feeding
Nipple is wedge-shaped after feeding
Engorgement
Redness, blisters, bleeding and scabs
Baby may vomit blood
```
32
What can cause breast engorgement?
```
Delay in first feed
Poor positioning and attachment
Restricted feeding
Ineffective emptying
Supplementation
```
33
What are the signs/symptoms of breast engorgement?
```
Breasts shiny (due to oedema)
Pain
Poor flow due to increased pressure
Redness
Fever
```
34
What can cause mastitis?
```
Plugged milk duct
Breast infection
Poor positioning and attachment
Infrequent feeds
Consistent breast pressure
Dummies
Supplementation
Trauma
```
35
How does a blocked duct present?
Tender spot
Redness
Sore lump without fever
36
How does a breast infection present?
Tender spot/lump
| Low grade fever
37
What may an infective mastitis present with?
Cracked nipple
Pus and blood in milk
Red streaks from site back into breast
38
What antibiotics can treat mastitis?
Flucloxacillin 1g qid
OR
Clindamycin 450mg tds
39
When is the prevalence of breast thrush minimal?
First 6 weeks following birth
40
What are the signs/symptoms of breast thrush?
```
Agonising pain in BOTH breasts:
- Pain equal in both
Pain after every feed
No change in nipple colour
No change in nipple shape
Oral swab positive for candida
```
41
How is superficial breast thrush treated?
Miconazole cream 2% for 1 week
42
How is deep breast thrush treated?
Fluconazole 300mg loading dose
| Then 150mg daily for at least 10 days
43
How is infantile thrush treated?
Younger than 4 months:
- Nystatin oral suspension for 1 week
Older than 4 months:
- Miconazole oral gel 24mg/ml qid for 1 week
44
If there is no improvement in how many days, when should the diagnosis of breast thrush be reconsidered?
10 days (with combined therapy)
45
How much does the average male weigh at 28 weeks?
1150g (3.5% fat)
46
How much does the average male weigh at term?
3550g (15% fat)
47
What is the average daily weight gain?
24g
48
When is a birth deemed term?
After 37 weeks completed gestation
49
When is a birth deemed post-term?
After 41 weeks completed gestation
50
What is a normal birth weight?
2.5-4kg
51
What hormones enhance foetal adaptation?
Cortisol
| NA
52
What effect does prolonged labour have on the foetus?
Reduced foetal reserves
53
In APGAR, what does the first A stand for and what possible scores are available?
A is Appearance (Skin colour):
- 0 points = Blue/pale all over
- 1 point = Blue at extremities; body is pink
- 2 points = No cyanosis; body/extremities pink
54
In APGAR, what does the P stand for and what possible scores are available?
P is Pulse rate:
- 0 points = Absent
- 1 point = <100
- 2 points = >100
55
In APGAR, what does the G stand for and what possible scores are available?
G is Grimace (reflex irritability):
- 0 points = None
- 1 point = On aggressive stimulation/suction
- 2 points = Cries on stimulation
56
In APGAR, what does the second A stand for and what possible scores are available?
A is Activity:
- 0 points = None
- 1 point = Some flexion
- 2 points = Flexed arms and legs that resist extension
57
In APGAR, what does the second R stand for and what possible scores are available?
R is Respiratory effort:
- 0 points = Absent
- 1 point = Weak, irregular gasping
- 2 points = Strong, robust cry
58
What is a normal APGAR score?
>=8
59
What is the incidence of Haemolytic Disease of the Newborn?
~2/1000
60
How can Haemolytic Disease of the Newborn be prevented?
Vitamin K
61
What vaccination can be given at birth?
Hep B
62
What vaccination can be given in the first month?
BCG
63
When are the first routine vaccinations given?
8 weeks
64
What maternal vaccines are given?
Pertussis
| Flu
65
What screening tests are done after birth?
```
Universal hearing
Hip:
- Clinical
- USS
CF
Metabolic:
- Thyroid
- MCCAD
- PKU
- Haemoglobinopathies
```
66
Who carries out the top to toe examination following delivery?
Midwife
67
When is the formal newborn examination carried out and by who?
24 hours after birth
| A variety of different staff groups
68
What should the newborn heart rate be?
120-140 bpm
69
What should the newborn respiratory rate be?
40-60/min
70
What bacterial infections are common in newborns?
```
Group B Strep.
E. coli
Listeria myocytogenes
Staphylococcus aureus
Staph. epidermidis
```
71
What viral infections are common in newborns?
CMV
Parvovirus
Herpes
Enteroviruses
72
What other viral infections can occur in newborns?
Toxoplasma gondii
HIV
Treponema pallidum
TORCH
73
What causes Hypoxic Ischaemic Encephalopathy?
Multi-organ damage due to tissue hypoxia
74
What are the signs of Hypoxic Ischaemic Encephalopathy?
Poor Apgar scores:
- Active resuscitation required
Neurodevelopmental sequelae:
- Variable prognosis
75
What respiratory conditions can occur after birth?
Transient Tachypnoea of the New born
Pneumothorax:
- Spontaneous vs Secondary to active resuscitation
76
What congenital heart diseases can present at birth?
```
Tetralogy of Fallot
Transposition of great arteries
Coarctation of aorta
TAPVD
Hypoplastic heart
```
77
What congenital respiratory diseases can present at birth?
Tracheo-oesophageal fistul
| Diaphragmatic hernia
78
What congenital neurlogical diseases can present at birth?
Microcephaly
| Spina bifida
79
What congenital renal disease can present at birth?
Potters Syndrome
80
What congenital musculoskeletal disease can present at birth?
Myotonic Dystrophy
81
What are some risk factors for preterm birth?
>2 preterm deliveries (Increases risk by 70%)
Abnormally shaped uterus
Multiple pregnancy (9x risk)
Interval of <6 months between pregnancies
IVF
Smoking/Alcohol/Illicit drugs
Poor nutrition/High BP/DM/Multipel miscarriages or abortions
82
When can cord clamping be delayed?
If baby is okay and can be kept warm
83
How long can cord clamping be delayed for?
1 minute
84
What does delaying cord clamping do?
Allows placental transfusion resulting in better circulatory stability
85
What happens in a newborns lungs are overinflated?
Damage
Inflammation
Bronchopulmonary dysplasia
86
What is gestational correction?
Adjusts the plot of a measurement to account for number of weeks born early
87
When is gestational correction not used?
In term infants (37+ weeks)
88
When should gestational correction be continued until?
1 year for infants born 32-36 weeks
| 2 years for infants born <32 weeks
89
What causes early onset of neonatal sepsis?
Bacteria acquired before and during delivery
90
What causes late onset of neonatal sepsis?
Acquired after delivery:
- Nosocomial
- Community
91
What gram negatives can cause neonatal sepsis?
Klebsiella
E. coli
Psuedomonas
Salmonella
92
What gram positives can cause neonatal sepsis?
Staph. aureus
Coagulase nehative Strep.
Strep. pneumoniae
Strep. pyogenes
93
What is the commonest cause of neontal sepsis?
Group B Strep.
94
What is the primary pathology of Infant Respiratory Distress Syndrome?
Surfactant deficiency
| Structural immaturity
95
What is the secondary pathology of Infant Respiratory Distress Syndrome?
Alveolar damage
Formation of exudate from leaky capillaries
Inflammation
Repair
96
What is the incidence of Infant Respiratory Distress Syndrome in infants born before 29 weeks?
75%
97
What is the incidence of Infant Respiratory Distress Syndrome in infants born after 32 weeks?
10%
98
What are the clinical features of Infant Respiratory Distress Syndrome?
```
Tachypnoea
Grunting
Intercostal recessions
Nasal flaring
Cyanosis
Worsens over minutes to hours
```
99
When does Infant Respiratory Distress Syndrome worsen until?
Days 2-4 (nadir)
100
How is Infant Respiratory Distress Syndrome managed?
```
Maternal steroid
Surfactant
Ventilation:
- Invasive
- Non-invasive
```
101
Where does bleeding initially occur in intraventricular haemorrhage?
Germinal matrix
102
How can prematurity increase the risk of intraventricular haemorrhage?
Germinal matrix still resent
| Cerebral autoregulation immature
103
How can Infant Respiratory Distress Syndrome increase the risk of intraventricular haemorrhage?
Hypoxia; Acidosis; Hypotension
| Results in unstable cerebral circulation
104
90% of intraventricular haemorrhages occur in what time period?
First 72 hours
105
How can intraventricular haemorrhage be prevented?
Antenatal steroids
Prompt and appropriate resuscitation
Avoid haemodynamic instability
106
What must be avoided to prevent intraventricular haemorrhage?
Hypoxia
Hypercapnia
Hyperoxia
Hypocapnia
107
What are grades 1 and 2 of intraventricular haemorrhage?
Germinal matrix haemorrhage
OR
IVH with no enlargement
108
What are grades 3 and 4 of intraventricular haemorrhage?
IVH with enlargement
| +/- extension into brain
109
What is the most common neonatal surgical emergency?
Necrotising enterocolitis
110
What is necrotising enterocolitis?
Widespread necrosis in small and large intestine
111
What is the clinical picture of necrotising enterocolitis?
```
Usually after recovering from respiratory distress syndrome
Early signs:
- Lethargy
- Gastric residuals
Blood stool
Temperature instability
Apnoea
Bradycardia
```
112
When does retinopthy of prematurity occur?
Usually 6-8 weeks after delivery
113
What is Grade 0 of the Modified Oxford Scale mean? (And its ICS equivalent)
No discernible contraction of pelvic floor
| ICS - Absent
114
What is Grade 1 of the Modified Oxford Scale mean? (And its ICS equivalent)
Flicker
| ICS - Weak
115
What is Grade 2 of the Modified Oxford Scale mean? (And its ICS equivalent)
Weak contraction
| ICS - Weak
116
What is Grade 3 of the Modified Oxford Scale mean? (And its ICS equivalent)
Moderate contraction
| ICS - Normal
117
What is Grade 4 of the Modified Oxford Scale mean? (And its ICS equivalent)
Good contraction
| ICS - Normal
118
What is Grade 5 of the Modified Oxford Scale mean? (And its ICS equivalent)
Strong contraction against max. resistance
| ICS - Strong
119
What lifestyle factors can help in gynaecological disorders?
```
Healthy BMI
Avoid constipation
Smoking cessation
Avoid heavy lifting
Reduce caffeine
```
120
What lifestyle factors can manage bladder symptoms?
```
Reduce caffeine
Bladder training
Voiding/Double voiding techniques
Pelvic floor exercises
Constipation reduction
```
121
What lifestyle factors can manage bowel symptoms?
```
Regulate stool
Pelvic floor exercises
Difficulty wiping clean:
- Lepicol
Urge:
- Holding on programme
Frequency:
- Holding on programme
- Caffeine reduction
```
122
How often are pelvic floor muscle exercises carried out?
Performed until fatigue several times a day
| Practised for 15-20 weeks
123
What enzyme breaks down Haem and into what?
Haem oxygenase (NADPH and Oxygen):
- Iron
- CO
- Biliverdin
124
What enzyme converts Biliverdin into Bilirubin?
Biliverdin Reductase (NADH or NADPH)
125
How much conjugated bilirubin is produced by the liver per day?
260mg
126
Where does conjugated bilirubin move to after leaving the liver?
Small intestine -> Colon
127
What is conjugated bilirubin converted to in the intestines and colon?
Urobilinogen
128
What happens to urobilinogen?
Enterohepatic recycling
129
What happens to urobiliogen that returns to the liver?
Enters systemic circulation
Then enters the kidney
Excreted as urinary urobilinogen (0-4mg/day)
130
How much faecal urobilinogen is excreted per day?
125-130mg/day
131
What are the pathological causes of jaundice?
```
Blood group incompatibility
Other haemolytic disorders (eg. G6PD deficiency)
Sepsis
Liver disease
Metabolic disorders
```
132
Why does physiological jaundice develop?
```
Increased production
Reduced uptake and hepatocyte binding
Reduced conjugation (most important)
Reduced excretion
Increased enterohepatic circulation of bilirubin
```
133
When is 'too early' jaundice?
<24 hours
134
What usually causes jaundice in neonates <24 hours?
Haemolysis resulting in increased bilirubin
135
What are the causes of early jaundice? (most common ones in descending order)
ABO incompatibility
Rh immunisation
Sepsis
136
What are the rarer causes of early jaundice?
Other blood group incompatibilites
Red cell enzyme defects (eg. G6PD deficiency)
Red cell membrane defects (eg. Hereditary spherocytosis)
137
When should hepatitis be considered as a cause of early jaundice? What may it occur in?
If substantial increase in conjugated bilirubin (>15% of total)
May occur in Rh babies +/- in-utero transfusions
138
How is early pathological jaundice investigated?
```
Total and conjugated [bilirubin]
Maternal blood group and Ab titres (if Rh -ve)
Baby's blood group
Direct Coombs Test and elution test:
- Detects anti-A/B
Full blood exam:
- Evidence of haemolysis
- Unusually shaped RBCs
- Infection
CRP
```
139
When does 'too high' jaundice occur?
24 hours - 10 days
140
What can be considered 'too high' jaundice?
If serum [bilirubin] is high requiring treatment
141
What can cause 'too high' jaundice?
```
Dehydration/Poor milk supply
Haemolysis
Breakdown of extravasated blood
Polycythaemia
Infection (more likely)
Increased enterohepatic circulation (gut obstruction)
```
142
What is 'too long' jaundice?
>10 days of age
| Esp. >2 weeks
143
What must be assessed in 'too long' jaundice?
Is the elevated bilirubin:
- Mostly unconjugated (>85%)
- Consisting of substantially increased conjugated (>15%)
144
What can cause persistent unconjugated hyperbilirubinaemia?
```
Breast milk jaundice (diagnosis of exclusion)
Continued poor milk intake
Haemolysis:
- Severe is usual
- G6PD deficiency
Infection
Hypothyroidism
```
145
Who is G6PD deficiency more common in?
Mediterranean
Asian
African
Males (X-linked)
146
What are some causes of persistent conjugated hyperbilirubinaemia?
```
Hepatitis:
- Infectious
- Metabolic disorder (eg. Galactosaemia)
Biliary atresia:
- Obstructive jaundice
- Pale (clay) colour stools
- Dark urine
- Fatal if untreated
```
147
What happens if unconjugated bilirubin crosses the BBB?
```
Kernicterus - Death of brain cells
Yellow staining (particularly in grey matter)
```
148
What do the following describe:
- Lethargy
- Poor feeding
- Temperature instability
- Hypotonia
- Opisthotonus (head, neck and back arching)
- Spasticity
- Seizures
- Jaundice
Acute bilirubin encephalopathy
149
What increases the risk of developing kernicterus?
```
Increased unconjugated bilirubin:
- Conc >340 micro-mol/L
Preterm at lower conc. (300 micro-mol/L)
Asphyxia
Acidosis
Hypoxia
Hypothermia
Meningitis
Sepsis
Reduced albumin binding
```
150
When would IV Ig be used in jaundice?
If isoimmune haemolytic disease and rising bilirubin despite phototherapy
Indicated for Rh/ABO disease if SBR rises by >8.5 micro=mol/L OR bilirubin within 30-50 micro-mol of exchange transfusion
151
How can evidence of traction birth injury (eg. Erb's palsy) be checked?
Neck
Shoulders
Clavicles
152
What may a single palmar crease indicate?
Down's syndrome
153
What may a hyperdynamic pulse in a newborn indicate?
Patent ductus arteriosus
154
How may spina bidifa occulta or sinus be hidden?
Flesh creases
Dimples
Hair tufts
155
At what gestation can a cardiac anomaly scan be done?
12-20 weeks
156
At what gestation can a microcephaly scan be done?
Usually after 22 weeks
157
At what gestation can a short limb scan be done?
Usually after 22 weeks
158
How long does PCR DNA testing take?
2-3 days
159
How long does southern blotting DNA testing take?
2-3 weeks
160
In FISH sex-determination, what chromosome is used as a control?
18
161
In what parental chromosome abnormalities may a preimplantation genetic diagnosis be recommended?
Robertsonian translocation
| Reciprocal translocation
162
In what X-linked disorder may a preimplantation genetic diagnosis be recommended?
For reimplantation of female embryos
163
In what single gene disorders may a preimplantation genetic diagnosis be recommended?
Spinal muscular dystrophy
CF
Huntington's disease
164
What drugs do not cross the placenta?
Large molecular weight:
| - eg. Unfractioned heparin
165
What drugs cross the placenta more quick;y?
Small
| Lipid-soluble
166
How do plasma volume and fat stores affect pharmacokinetics?
Both increased so increase volume of distribution
167
How does protein binding affect pharmacokinetics?
Reduced in pregnancy so increased free drug
168
How does liver metabolism of some drugs (eg. Phenytoin) affect pharmacokinetics?
Increased metabolism in pregnancy
169
How does increased GFR affect pharmacokinetics?
Increased elimination of renally-excreted drugs
170
What drug concentrations and doses should be altered during pregnancy and after delivery?
Lithium
| Digoxin
171
During the second trimester, what may pregnancy women be more sensitive to?
Anti-hypertensives can result in hypotension
172
When and how much folic acid is given?
400micrograms daily for 3 months prior to and during the first 3 months of pregnancy
173
When is the risk of the greatest teratogenicity?
During weeks 4-11
174
When does organogenesis occur?
1st trimester
175
What can ACEi/ARBs teratogenicity cause?
Renal hypoplasia
176
What can androgen teratogenicity cause?
Virilisation of female foetus
177
What can antiepileptic teratogenicity cause?
Cardiac, facial, limb and neural tube defects
178
What can cytotoxic teratogenicity cause?
Multiple defects
| Abortion
179
What can lithium teratogenicity cause?
Cardiovascular defects
180
What can methotrexate teratogenicity cause?
Skeletal defects
181
What can retinoid teratogenicity cause?
Ear, cardiovascular and skeletal defects
182
What can warfarin teratogenicity cause?
Limb and facial defects
183
What drugs can depress the respiratory system?
Opiates
184
Withdrawal symptoms can occur after birth in the neonate from what drugs?
Opiates
| SSRIs
185
What can frequent seizures during pregnancy result in?
```
Reduced verbal IQ
Hypoxia
Bradycardia
Antenatal death
Maternal death
```
186
What foetal defects can phenytoin cause?
Cleft lip and palate
187
Is insulin safe in pregnancy?
Yes
188
What does poor diabetic control increase the risk of?
Congenital malformations
| IUD
189
What hypoglycaemics are not safe in pregnancy?
Sulfonylureas (switch to insulin)
190
How is hypertension in pregnancy treated?
Labetalol
Methyldopa
(Nifedipine MR)
191
What effect can beta-blockers have in late pregnancy?
Growth restriction
192
How can nausea and vomiting in pregnancy be treated?
Cyclizine
193
How are UTIs treated in pregnancy?
```
1st and 2nd trimester:
- Nitrofurantoin
- Cefalexin
3rd trimester:
- Trimethoprim
```
194
How can pain be treated in pregnancy?
Paracetamol
195
How can heartburn be treated in pregnancy?
Antacids
196
What was diethylstilbestrol used for? What long term effects did it have?
Prevent recurrent miscarriages
Caused:
- Vaginal adenocarcinoma in girls aged 15-20
- Urological malignancy in boys
197
How much more likely is VTE in pregnancy?
10x
198
What is the leading cause of maternal death in pregnancy?
VTW
199
What are the risk factors for VTE?
```
Obesity
Age >35
Smoking
Parity >3
Previous DVT
C-section
```
200
How many risk factors for VTE in pregnancy need to be present to warrant what therapy?
>=2
| LMWH
201
When is VTE prophylaxis given in pregnancy?
At delivery and up to 7 days post-partum
202
How is DVT/PE treated in pregnancy?
LMWH
203
Why is warfarin avoided in early pregnancy?
Teratogenic
204
Why is warfarin avoided in late pregnancy?
Risk of haemorrhage during delivery
205
What drugs are more likely to enter the breastmilk?
Small molecules
| Lipophilic drugs
206
What is foremilk rich in?
Proteins
207
What is hindmilk richer in?
Fat
208
What do longer feeds result in in terms of the constituents of breastmilk?
Higher amounts of fat soluble drunks
209
What drugs are actively concentrated in the breast milk? What effect does this have?
Phenobarbitone/Phenobarbitol:
| - Sucking difficulties
210
What can breastmilk amiodarone cause?
Neonatal hypothyroidism
211
What can breastmilk cytotoxics cause?
Bone marrow suppression
212
What can breastmilk benzodiazepines cause?
Drowsiness
213
What can breastmilk bromocriptine cause?
Suppress lactation
214
How can foetal alcohol syndrome be suspected clinically?
```
Short palpebral fissures
Flat midface
Short nose
Indistinct philtrum
Thin upper lip
```
215
What features is foetal alcohol syndrome associated with?
Epicanthal folds
Low nasal bridge
Minor ear anomalies
Micrognathia
216
What immunity benefits does breastfeeding provide?
Better vaccine response
Reduced childhood cancer
Fewer UTIs
Fewer ear infections
217
What does cholesterol/fat in human milk promote?
Growth of nerve tissue - Higher IQ
218
What mouth benefits does breastfeeding provide?
Less need for orthodontics
| Increased facial muscle development
219
What respiratory benefits does breastfeeding provide?
Fewer/less severe URTIs
Less wheezing
Less pneumonia and flu
220
What GI benefits does breastfeeding provide?
Less diarrhoea
Fewer GI infections
Reduced risk of food allergies
Less risk of UC and CD
221
What cardiac benefits does breastfeeding provide?
Lower cholesterol
| Lower heart rate
222
How does an increase in 2 BMI points affect the risk of breast cancer?
5% increase
223
Why does obesity increase the risk of endometrial cancer?
?Hyperoestrogenaemia
224
What other female cancers does obesity increase the risk of?
Oesophageal adenocarcinoma
Pancreatic
Breast (post-menopausal)
