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General Information- breastfeeding > Riordan Info > Flashcards

Riordan Info Flashcards

1
Q

WHat percentage of mothers diet should come from fat

A

20-30 %

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2
Q

Which oil has the lowest number of trans fats?

A

canola

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3
Q

Which micro nutrient is most affected by diet?

A

Vit B6 pyridoxine

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4
Q

When does bone re mineralization occur for the breastfeeding mother?

A

During the return of menses after breastfeeding

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5
Q

What are the average number of calories needed to produce breast milk?

A

500

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6
Q

What Gestational week does breast development begin?

A

5th week

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7
Q

What is the hormone responsible for mammary development?

A

Progesterone

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8
Q

The name for milk secreting units made of secretory cells and myoepethial cells

A

Alveoli

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9
Q

Which nerve supplies sensation to breast and nipple

A

4th intercostal nerve

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10
Q

Average number of openings in the nipple or mammary papilla

A

5-10

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11
Q

What is Polymastia?

A

Super numery breasts

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12
Q

What is the percentage of nipple inversion

A

3 percent

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13
Q

During pregnancy when do we see growth and proliferation of the ductal tree and formation of more lobules

A

During the first half. ( second half is secretory and alveoli ( acini) become distended with colostrum)

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14
Q

Describe lactogenesis 1

A

Mid pregnancy to day 2 post partum- colostrum

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15
Q

Describe lactogenensis 2

A

day 3-8 post partum transitional milk

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16
Q

Where is prolactin produced

A

Anterior pituitary

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17
Q

Where is oxytocin produced

A

posterior pituitary

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18
Q

Prolactin release is controlled by___________

A

Hypothalmus ( it is inhibitory- as it inhibits the release of dopamine which will inhibit release of prolactin

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19
Q

Prolactin levels rise with what infant activity

A

suckling

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20
Q

Prolactin levels :non pregnant, 10 days PP, 180 days PP

A

non pregnant 20mg/ml, 10 days 90, 180 days 44.3

at 6mos drops to almost half

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21
Q

What is the hormone that promotes mammary growth as permissive rather then regulatory

A

TSH

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22
Q

What is the rate of milk synthesis

A

17-33 mls per hour

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23
Q

What gestational week does sucking develop

A

24th week
28 weeks coordinate suck swallow breathe
32 weeks repeated suck bursts

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24
Q

Is there more protein in colostrum or mature milk?

A

Colostrum has higher protein and minerals and is lower in carbs fat and some vitamins

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25
Q

When do total immunoglobulins reduce during lactation

A

Immunoglobulins remain relatively constant throughout lactation . As milk volume decreases - concentrations of Immnoglobulins will decrease

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26
Q

What is the average gastric emptying time for breastfeeding?

A

48 mins. ( 78 mis for ABM)

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27
Q

Milk volumes at day 5, 5 mos, and at what moth does volume and production start to decline?

A

Day 5 = 500 mls a day
6 mos= 800mls a day
After 6 mos volume and production declines

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28
Q

Which milk components provide half of calories in breast milk?

A

FAT

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29
Q

What fatty acid account for 88% of lips content

A

PUFA ( polyunsaturated fatty acids ) These are the most variable element in milk and influenced by maternal dietary fat intake. NOt percentage of fat but TYPES of fat

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30
Q

Name fatty acids contributing to fighting virus, bacteria , fungus and decrease atopy.

A

Short chain fatty acids

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31
Q

Which milk element provides most of the carbohydrates in milk.

A

Lactose ( enhances calcium absorptions, metabolizes to galactose providing energy for the brain)

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32
Q

Describe the whey casein ratio of milk during lactation

A 
Varies over time.  
Initially  whey/cassein  90:10
Mature milk-----------------60/40
Late lactation---------------50:50
Remember  Way more WHEY
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33
Q

What are the proteins in Whey?

A 
Serum Albumin
alpha lactibumin
Immunoglobulins
Lysozyme
Lactoferrin
REMEMBER:  SAILL  first letters
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34
Q

What is the role of nucleotides?

A

Energy metabolism
Maturation of immune function
natural killer cell activity
protective of GI tract

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35
Q

Name 4 fat soluble vitamins stored in fat and not excreted through kidneys

A

ADEK

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36
Q

Sources of Vitamin A

A

carotenoids ( beta carotene) MILK, eggs, dark colored fruit and veg,
daily allowance IU 2310 for women

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37
Q

Source of Vitamin D

A

Sun and fortified milk with fit D, tuna , salmon

400 units per day

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38
Q

Mineral content in breastmilk is fairly constant and not impacted by maternal diet. What aids in Fe absorption

A

High Lactose and Vit C

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39
Q

What is lactoferrin

A

An iron binding protein with strong antibacterial action against any microorganisms that need iron to grow. Helps to regulate the absorption of iron in the intestine

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40
Q

What 3 components of milk are NOT affected by pasteurization?

A

Vitamin A, Oligiosaccharides, minerals

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41
Q

What 5 components of milk are NOT affected by freezing?

A 
IgA,
 Lactoferrin,
 VitaminA, 
Oligosaccharides, 
minerals
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42
Q

Which 3 milk components are totally destroyed in the pasteurization process?

A

Vitamin C,
Milk Cells,
Lipase

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43
Q

What are the bio active components that are protective against disease

A

fatty acids and lactoferrin- broad spectrum
glycoconjugates- specific pathogens
phagocytes/macrophages- engulf pathogens
Lymphocytes ( T and B cells) anti viral

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44
Q

What are the number of milk ducts in a breast?

A

4-18 ( hartman)

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45
Q

Which nerve is responsible for taste sensation posterior 1/3 of the tongue and some motor function?

A

Glossopharyngeal

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46
Q

What is hypermastia?

A

Extra tissue, often in the axillae

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47
Q

What is hyperethelia?

A

extra nipple, super numerary, ectopic

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48
Q

What is micrognathia?

A

small chin ( pierre robin syndrome)

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49
Q

What is metherergine?

A

Meds given to control post partum uterine bleeding that when given may decrease milk supply as it decreases prolactin levels

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50
Q

Name breastmilk antinflammatory factors.

A

Prostaglandins- ( protect cells and may help with gut motility
Cytokines- bind to specific cell receptor and activate the immune system
Anti oxidants ( Vit A, C,E enzymes

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51
Q

Antibodies in breastmilk are known as.

A

IgA, IgE, IgG, IgM ( most abundant is IgA and fights pathogens from the environment)

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52
Q

What is the role of lactoferrin

A

A natural antibiotic prevents gut bacteria. Higher in colostrum it prevents bacteria from getting iron ( bacterai needs iron to thrive)

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53
Q

A protein found in breast milk which can destroy cancer cells

A

Alpha - lactalbumin ( HAMLET)

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54
Q

What is the main carbohydrate in milk?

A

Lactose ( ferments to lactic acid promoting growth of bifidobacteria and lactobacilli

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55
Q

name 3 enzymes in breast milk

A

Amylase- helps with digestionof polysaccharides
Lipase- hydrolyzes fat
lysozyme - polypeptide and a component of whey has antibacterial and anti inflammatory properties

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56
Q

What is the role of cholecystokinin/

A

sedation and satiation

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57
Q

What is the lipid associated with visual acuity and cognitive ability and the amount in breastmilk is dependent on moms diet

A

Long chain PUFA’s ( polyunsaturated fatty acid)

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58
Q

Lipid responsible for largest source of calories

A

Triglycerides ( breaks down into free fatty acids and glycerol

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59
Q

What is the purpose of Oligosaccharides

A

block antigens from attaching to the epithelium of the GI tract ( 130 types)

60
Q

Proteins in breast milk

A

Casein, Whey, alphalactalbumin, lactoferrin, lysozyme serum albumin, IgA, IgM, IgG

61
Q

What is the percentages of protein, fat and carbs in human milk?

A

Protein 0.8%
Fat 4.5%
Carbs 7.1%

62
Q

An amino acid associated with early brain maturation and retinal development.

A

Taurine

63
Q

What % of breastmilk is water?

A

87.5%

64
Q

When does cholecystokinin peak

A

Immediately after a feed then 30-60 mins later in the GI tract

65
Q

Name 6 factors influencing drug transfer into milk

A

Maternal plasma concentration ( most important)
Molecular Weight ( heavier wts don’t pass)
Protein binding
Fat content, lipid solubility
Ion trapping
Oral bioavailability

66
Q

When do drug levels peak in breastmilk

A

When their is a high concentration in the maternal plasma compartment

67
Q

How does protein binding affect drug transfer into breast milk?

A

Drug transfer is higher in unbound drugs. The higher the protein binding capacity, the less drug transfer

68
Q

Describe drug transfer as it relates to fat content

A

There is a higher transfer with lipid soluble meds as they can immerse themselves in the lipid faction of the milk and become concentrated

69
Q

How does ion trapping affect med absorption?

A

Weak bases may beome polarized that once int eh milk they become trapped and do not diffuse back into the maternal plasma ( weak ACIDS become trapped in plasma and do not transfer into milk)

70
Q

Is medication transfer higher or lower in the first week of birth?

A

Higher, but since the baby’s milk intake is low, the drug amt is also low

71
Q

How do drugs transfer in and out of the mothers milk compartment

A

passive diffusion

72
Q

What is bioavailability?

A

The amt of drug that reaches the baby systemic circulation . Oral meds are often metabolized by the liver and never enter the plasma

73
Q

Name 5 ways to minimize drug absorption.

A
  1. Choose shorter half life meds
  2. Meds that are safe for the pediatric population
  3. meds with HIgh protein binding capacity
    4.meds with poor blood /brain penetration
    5 Meds with higher molecular wt
74
Q

Name some milk inhibitors

A

progesterone, ergot alkaloids, estrogen, pseudoephedrine

75
Q

Analgesics permitted for mom

A 
Methadone
morphine
codeine
fentanly
NOT  MEPERIDINE ( demerol)
76
Q

What is the general rule for radio isotopes?

A

They often have a brief half life and mothers usually only need to pump and dump for 12-24 hours

77
Q

What are precautions for breastfeeding with herpes simplex

A

The greastes concern is at birth

Breast lesions can carry the virus and be transmitted to baby. if lesion is on the breast- do not breastfeed

78
Q

Chickenpox and breastfeeding

A

If mother contracts while breastfeeding - continue to nurse
If mother contracts within 48 hrs of birth - isolate from baby and pump and dup until no longer infectious
antibodies usually appear in 48 hours

79
Q

Discuss CMV and breastfeeding

A

1 Preemies most at risk

  1. pasteurization will inactivate the virus
  2. Freezing does NOT inactivate virus
  3. Can be transmitted through human milk and a means of passive immunity for the healthy baby
  4. Not screened at Milk Banks since pasteurization will kill virus
80
Q

Can a mom nurse if she has rubella/

A

OK to breastfeed. Virus can be transmitted through breast milk but no evidence to show infant will become ill

81
Q

CAn a mom nurse if she has Hep B

A

Yes. breastfeeding does not appear to increase infection . Vaccine should be given to baby within 12 hours of birth but can start feeding immediately at birth

82
Q

Can a mom nurse if she has Hep C

A

Yes breastfeeding does not confer risk

83
Q

Can a mom nurse if she had HTLV ( human lymphotropic virus)

A

NO should not. this is a rare linked to T cell leukemia

84
Q

Can mom nurse if she has West NIle virus?

A

Although can be transmitted through breastmilk there is no indication to not breastfeed

85
Q

Describe sx of hypoglycemia in the newborn

A

irritability, jueetry, exagerated reflexes, lethargy, listless, rapid breathing, hypothermia, poor suck, refusal to feed.
Factors __ mother with diabetes, post maturity, SGA, LGA, Sepis

86
Q

Average milk intake from day 1 - 6 mos

A 
Day 1- about 30 mls
day 2  about 100 mls
day 3- 200mls
day 4- 400 mls  ( 10 oz)
day 5  600 mls`(20 oz)
day 6- 6 mos 750 mls  ( 24 oz)
87
Q

3 reasons for nipple pain

A

Mechanical
Infection
Dermatological

88
Q

what is the suck swallow ratio in active feeding

A

2-3 sucks per swallow

89
Q

How does the whey casine ratio affect stool formation

A

The increase in casein results in thicker more formed stools

90
Q

What are the types of mastitis

A

cellulitis- interlobular connective tissue infectd by bacteria through cracked nipples
Adenitis - blocked ducts with less severe sx - need to get the milk to flow

91
Q

What is breastmilk jaundice?

A

Starts at day 5 and it is a normal phenomenon due to increase in intestinal absorption of bilirubin.

92
Q

average amt of milk produced by twin mother

A

850 mls

93
Q

What is the minimal amt of milk needed for a 6 day old and a pump dependent mom

A

450 mls or 15 oz ( not sure where I got this - a test question i guess but if we look at a previous question the amt average needed for a 6 day old in a previous questions was 750 mls)

94
Q

What is the average infant suck pressure

A

50-155 and about 60 per minute

95
Q

What does the Symphony cycle

A

120/min in stim phase then 54-78 in expression. Vacuum is 50-200

96
Q

Preterm milk is high in

A

SigA, protein, sodium chloride and iron

97
Q

What is a good amt of milk a mom should be pumping for her pre term infant by the end of 2nd week

A

800-1000 mls

98
Q

What is the formula for calculating syntessi of rate of milk per hour.

A

Calculate pump volume for one session. Divide by number of hours since last pump. Hartman ( 90 volume divided by 3 hours would be 30 cc per hour)

99
Q

What diseases are screened Human Milk Bank

A

HIV 1 and 2, HTLV 1and 2, Hep b, Hep C, Syphillis

100
Q

Holder pasteurization what temp

A

62.5degee centegrade x 30 min ( 145 deg F

101
Q

what is breast storage capacity

A

the amount of milk breast can retain before involution occurs. Feedback of inhibitor of lactation on mammary secretory epithelial cells results in lower milk synthesis. Distended alveoli disrupts milk synthesis resulting in involution and apoptosis

102
Q

How does the whey casein ration affect stool formation

A

Increase in casein results in thicker more formed stools

103
Q

What is an invaginated nipple

A

Cannot be everted

104
Q

Risk factors for mastitis

A 
stress
fatigue
cracked nipples
plugged ducts
copious milk supply or redueced feeds
engorgement
stasis
105
Q

Types of mastitis

A

Cellulits - interlobular connective tissue infected by bacteria usually through cracked nipples
Adenitis- blocked ducts with less severe sx– get the milk to flow

106
Q

The most common organism to cause mastitis

A

Staph Aureus– if no responding to abx rule out inflammatory carcinoma

107
Q

What is mastopexy

A

Breast lift - may lose nipple sensation

108
Q

What is a galactocele?

A

A milk filled lacteal cyst caused by a plugged duct. It will usually atrophy without treatment

109
Q

What is an intraductal papilloma

A

A non cancerous growth in the milk duct that may cause some bleeding. It usually self resolves and often found on one breast only

110
Q

What is breast milk jaundice

A

With an onset around day 5 this is a normal phenomenon du to the increase in intestinal absorption fo bilirubin

111
Q

Causes of jaundice

A 
Blood group incompatibility
Birth trauma ( cephlahematoma example)
poor feeding
genetic disorder
prematurity
maternal diabetes
UTI
hypothyroidism
Asian population predisposed
112
Q

What are the number of milk ducts in the breast

A

4-18 ( hartman)

113
Q

What is the oral muscle responsible for taste and motor function for digestion

A

glossopharyngeal

114
Q

What is the name of the extra mastitis tissue likely found in the axillae

A

Hyper mastia

115
Q

What is hyperethelia

A

extra nipple

116
Q

What is macromastia

A

Large breasts

117
Q

What is the greastest risk for sagging breast - pregnancy or breastfeeding

A

pregnancy

118
Q

Common amt of milk for mohters of twins

A

850mls a day ( seems low check this out)

119
Q

The minimal amt of milk for a 6 day old pump dependent mom?

A

450 mls /day

120
Q

What is the average infant suck pressure

A

50-155 and about 60 per minute

121
Q

What does the symphony pressure and cycle

A

at 120 /min in stim phase and about 54-78 during expression.

The vacuum is 50-200.

122
Q

Preterm milk has high amts of_______

A

Sig A,
protein
sodium chloride
Fe

123
Q

What amt of milk pumped now assure a good supply for a preterm infant as he grows

A

800-1000 mls by the end of the second week

124
Q

What is the formula for calculating syntheses of rate of milk per hour

A

Calculate the pump volume at one session and then divide by number of hours since the last pump
ie pumped 90 mls divide by 3 hours since last pump making 30 cc per hour ( hartman)

125
Q

Donor milk should be screened for

A

HIV 1&@ HTLV, Hep B, Hep C and syphillis

126
Q

What is the temp for holder pasteurization and how long do you maintain the temp

A

62.5 degrees C and hold for 30 mins then reduce temp with ice or cool bath

127
Q

At what temp is CMV destroyed during pasteurization

A

62.5 C

128
Q

What are the effects of pasteurization on milk

A

Destroys E Coli, HIV, Staph BUT the effect of heat treating and freezing are cumulative as it decreases the size of fat globules and increases the surface for lipase activity which can affect digestibility

129
Q

When do brestfeeding women begin to lose body fat?

A

15th day post partum

130
Q

Is maternal wt loss greaster in the first or second half of the first 12 mos PP

A

Greater in the 2nd 6 mos.

131
Q

Is there a relationship between amt of mohter calcium intake and breastmilk calcium concentration?

A

NO

132
Q

What additional vitms should vegetarian take

A

Vit B12 or B complex ( vegan(

133
Q

Common allergens or sensitivites

A

Dairy, soy peanuts, corn citrus and wheat

134
Q

What is the half life of caffeine

A

Newborn 60-130 hours

3-5 mos 14 hours

135
Q

Why might diabetic have a delay in lactognesis 2?

A

They have lower prolactin concentration in type 1

136
Q

Are diabetic mothers more susceptible to mastitis

A

YES

137
Q

During lactation will a type 1 diabetic mother need less or more insulin to regulate her glucose

A

Often need less insulin as there is a continuous conversion of glucose to galactose and lactose

138
Q

Why might PCOS and theta lutein cysts have a negative effect on milk production

A

High testosterone levels may interfere with hormones of lactation

139
Q

Why should mother with cystic fibrosis breastfeed

A

They are chronic carriers of bacteria and their breastmilk if protective for their infants

140
Q

If a mom has MS, when may her sx recur after delivery

A

apporx 3 mos PP . HOever , the EFA;s in breastmilk may protect infants from developing MS

141
Q

What medication for depression has a long half life

A

Fluoxetine (Prozac) better choice is ZOLOFT or Paxil

142
Q

If a mohter had a spinal injury she should be able to nurse if the injury was below which vertebrae

A

the 6th cervical lumbar vertebrae

143
Q

Tor F anti epileptic drugs are not a containdication to breastfeed

A

True

144
Q

A baby often develops stranger anxiety at what age?

A

around 8 mos ( separation anxiety ususlly peaks at 14 - 20 mos)

145
Q

If a baby was dx with PKU , can he breastfeed

A

YES breast milk has less phenallaline then formula. HOWEVER, the baby is often fed with a low phallaline formula and breast milk

General Information- breastfeeding (10 decks)

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