Pharm - Lactation Flashcards
State the AAP and ACOG recommendations for duration of exclusive breastfeeding
Exclusive breastfeeding for about 6 months with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.
What are the AAP recommendations for feeding pre-term infants?
The potent benefits of human milk are such that all preterm infants should receive human milk (fresh, frozen, or from donor).
*milk should be fortified appropriately for infant born weighing less than 1.5kg
Benefits of breastfeeding to the mother
•Decreased postpartum blood loss and more rapid involution of the uterus
•Women with cumulative lactation history of 12-23 months had significant reduction in HTN, hyperlipidemia, CV disease and DM
•Cumulative duration of breastfeeding of >12 months associated with 28% decrease in breast cancer (esp. premenopausal) and ovarian cancer.
**Each year of breastfeeding = 4.3% reduction in breast cancer
GI breastfeeding benefits in term infant
o Stimulates GI growth/motility - enhance maturity of GI tract
o Protective/decreases risk of necrotizing enterocolitis (NEC) and other infections
o Episodes of gastroenteritis/hospitalization for diarrhea decreased reduction in incidence of nonspecific gut infection (after 2 months)
Respiratory breastfeeding benefits in term infant
o Respiratory illnesses reduced in frequency and/or duration
o Incidence of OM and recurrent OM reduced (esp. in <2y/o)
o Significant reduction in severity of RSV bronchitis
Long-term breastfeeding benefits in term infant
o Reduce acute illnesses even after breastfeeding discontinued
o Reduction in incidence of OM, serious colds, throat infections
o Reduction in SIDS, asthma, atopic dermatitis, eczema
o Reduction in celiac disease, risk of childhood IBD
o Lower rates of obesity (4% for every month of breastfeeding)
o Reduction in DM 1&2
Breastfeeding benefits in pre-term infant
- Lower rates of sepsis
- Reduction in incidence of NEC, fewer hospital readmissions in 1 year
- Lower mortality, lower long-term growth failure and neurodevelopmental disabilities
- Improved clinical feeding tolerance, lower retinopathy or prematurity
- Lower rates of metabolic syndrome, lower BP and LDL cholesterol
- Improved neurodevelopment: higher IQ, greater white matter and total brain volume, higher mental, motor, behavior ratings at 18 and 30 months
Contraindications to breastfeeding
-infant
Infants with metabolic disorders - classic galactosemia, phenylketonuria (alternate breastfeeding with modified formula)
Contraindications to breastfeeding
-maternal, infectious
Infectious: active (infectious) untreated TB, HIV positive
Contraindications to breastfeeding
-maternal, substances
Substances = alcohol, nicotine, illicit drug use
• Use of street drugs like PCP, cocaine, cannabis, etc. - effect neurobehavioral development
Contraindications to breastfeeding
-maternal, alcohol
• Avoid/limit alcohol: can blunt prolactin response to suckling and affect infant motor development.
o Limit 2oz liquor, 8oz wine, 2 beers wait ≥ 2 hours from intake before breastfeeding
Contraindications to breastfeeding
-maternal, smoking
• Discourage smoking: increased incidence in infant respiratory allergy and SIDS.
o Also decreases milk supply and increases risk of poor weight gain
Identify the daily caloric requirements and DHA requirements for breastfeeding women
- Increased need of ~500 kcal/day with modest increase in normal balanced diet
- Include 200-300mg omega-3 long-chain polyunsaturated fatty acids (DHA)
Identify the signs of effective breastfeeding (5)
- Frequent feedings 8-12 times daily
- Infant should have ~6-8 wet diapers/24-hr period once breast feeding established
- Bowel movements every 24 hours
- Average daily weight gain of 15-30 grams
- Infant regained birth weight by day 10 of life
What is the most appropriate treatment for blocked milk duct?
- bleb should be removed with needle or rubbing with cloth
- frequent breastfeeding, warm compresses/showers, massaging affected area toward nipple
What is the most appropriate treatment for mastitis?
•Improve breastfeeding technique, referral to lactation specialist may be needed drain breast milk through breastfeeding or milk pumped and discarded o NSAIDS for pain/swelling o Cold compresses o Breastfeeding does not have to stop o Antibiotics
What are the antibiotics used to treat mastitis?
MC = dicloxacillin, cephalexin, clindamycin dicloxacillin if no MRSA risk
- TMP/SMX or clindamycin if MRSA suspected
- Vancomycin in severe infections
What are the complications of mastitis?
breast abscess and cessation of breastfeeding
What is the most appropriate treatment for sore/cracked nipples?
• Keep nipples dry, change nursing pads often, NL saline rinse
o Continue to express milk to avoid blocked ducts and mastitis
o Use of medical grade lanolin ointment (Lansinoh, Purelan) or hydrogel dressing (ComfortGel, Soothies)
-If needed, topical abx like Bactroban or Polysporin: apply sparingly after feeding
- Can use acetaminophen/ibuprofen
Factors to consider when evaluating drug use during lactation (part 1)
- Need for the drug by the mother (risk vs benefit) weight against risk to infant
- Potential effects of drug on milk production
- Amount of drug excreted into human milk
- Extent/oral absorption by infant
- Potential adverse effects on infant
Factors to consider when evaluating drug use during lactation (part 2)
• Age of infant: most adverse effects associated with drug exposure via breast milk happen more in neonates < 2months and more rarely in > 6 months
• Pharmacokinetic factors: drugs with longer half-lives are more likely to accumulate
o Lipid soluble ones pass into breast milk really easily
• Was infant introduced to it in utero or is this a novel treatment?
• Single dose vs. short term use vs. chronic use
• Preterm vs. mature, healthy infant
State the major effect of psychotropic agents on a nursing infant
Prolonged half-life –> immature liver and renal function of infant –> potential effect on neural tissue
List the pain medications that a breastfeeding mother CAN use.
- Narcotic - consider butorphanol or hydromorphone (Dilaudid)
- Ibuprofen/Acetaminophen can be used
- Short term use of Celecoxib and Naproxen is okay (AVOID all other NSAIDs)
- Low dose aspirin acceptable (higher dose avoided)
What medications should be avoided by breastfeeding mothers d/t negative effect on the infant?
-psychotropic
- bupropion
- diazepam
- fluoxetine
- citalopram
- lithium
- lamotrigine
- venlafaxine
What medications should be avoided by breastfeeding mothers d/t negative effect on the infant?
-pain
- codeine
- hydrocodone
- oxycodone
- pentazocine
- meperidine
What medications should be avoided by breastfeeding mothers d/t negative effect on the infant?
-smoking cessation
- buproprion
- Chantix
What medications should be avoided by breastfeeding mothers d/t negative effect on the infant?
-others
- Amphetamines
- Chemotherapy
- Ergotamine
- Statins
- Marijuana
