Riordan Info Flashcards
1
Q
WHat percentage of mothers diet should come from fat
A
20-30 %
2
Q
Which oil has the lowest number of trans fats?
A
canola
3
Q
Which micro nutrient is most affected by diet?
A
Vit B6 pyridoxine
4
Q
When does bone re mineralization occur for the breastfeeding mother?
A
During the return of menses after breastfeeding
5
Q
What are the average number of calories needed to produce breast milk?
A
500
6
Q
What Gestational week does breast development begin?
A
5th week
7
Q
What is the hormone responsible for mammary development?
A
Progesterone
8
Q
The name for milk secreting units made of secretory cells and myoepethial cells
A
Alveoli
9
Q
Which nerve supplies sensation to breast and nipple
A
4th intercostal nerve
10
Q
Average number of openings in the nipple or mammary papilla
A
5-10
11
Q
What is Polymastia?
A
Super numery breasts
12
Q
What is the percentage of nipple inversion
A
3 percent
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)
14
Q
Describe lactogenesis 1
A
Mid pregnancy to day 2 post partum- colostrum
15
Q
Describe lactogenensis 2
A
day 3-8 post partum transitional milk
16
Q
Where is prolactin produced
A
Anterior pituitary
17
Q
Where is oxytocin produced
A
posterior pituitary
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
19
Q
Prolactin levels rise with what infant activity
A
suckling
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
21
Q
What is the hormone that promotes mammary growth as permissive rather then regulatory
A
TSH
22
Q
What is the rate of milk synthesis
A
17-33 mls per hour
23
Q
What gestational week does sucking develop
A
24th week
28 weeks coordinate suck swallow breathe
32 weeks repeated suck bursts
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
25
When do total immunoglobulins reduce during lactation
Immunoglobulins remain relatively constant throughout lactation . As milk volume decreases - concentrations of Immnoglobulins will decrease
26
What is the average gastric emptying time for breastfeeding?
48 mins. ( 78 mis for ABM)
27
Milk volumes at day 5, 5 mos, and at what moth does volume and production start to decline?
Day 5 = 500 mls a day
6 mos= 800mls a day
After 6 mos volume and production declines
28
Which milk components provide half of calories in breast milk?
FAT
29
What fatty acid account for 88% of lips content
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
30
Name fatty acids contributing to fighting virus, bacteria , fungus and decrease atopy.
Short chain fatty acids
31
Which milk element provides most of the carbohydrates in milk.
Lactose ( enhances calcium absorptions, metabolizes to galactose providing energy for the brain)
32
Describe the whey casein ratio of milk during lactation
```
Varies over time.
Initially whey/cassein 90:10
Mature milk-----------------60/40
Late lactation---------------50:50
Remember Way more WHEY
```
33
What are the proteins in Whey?
```
Serum Albumin
alpha lactibumin
Immunoglobulins
Lysozyme
Lactoferrin
REMEMBER: SAILL first letters
```
34
What is the role of nucleotides?
Energy metabolism
Maturation of immune function
natural killer cell activity
protective of GI tract
35
Name 4 fat soluble vitamins stored in fat and not excreted through kidneys
ADEK
36
Sources of Vitamin A
carotenoids ( beta carotene) MILK, eggs, dark colored fruit and veg,
daily allowance IU 2310 for women
37
Source of Vitamin D
Sun and fortified milk with fit D, tuna , salmon
| 400 units per day
38
Mineral content in breastmilk is fairly constant and not impacted by maternal diet. What aids in Fe absorption
High Lactose and Vit C
39
What is lactoferrin
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
40
What 3 components of milk are NOT affected by pasteurization?
Vitamin A, Oligiosaccharides, minerals
41
What 5 components of milk are NOT affected by freezing?
```
IgA,
Lactoferrin,
VitaminA,
Oligosaccharides,
minerals
```
42
Which 3 milk components are totally destroyed in the pasteurization process?
Vitamin C,
Milk Cells,
Lipase
43
What are the bio active components that are protective against disease
fatty acids and lactoferrin- broad spectrum
glycoconjugates- specific pathogens
phagocytes/macrophages- engulf pathogens
Lymphocytes ( T and B cells) anti viral
44
What are the number of milk ducts in a breast?
4-18 ( hartman)
45
Which nerve is responsible for taste sensation posterior 1/3 of the tongue and some motor function?
Glossopharyngeal
46
What is hypermastia?
Extra tissue, often in the axillae
47
What is hyperethelia?
extra nipple, super numerary, ectopic
48
What is micrognathia?
small chin ( pierre robin syndrome)
49
What is metherergine?
Meds given to control post partum uterine bleeding that when given may decrease milk supply as it decreases prolactin levels
50
Name breastmilk antinflammatory factors.
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
51
Antibodies in breastmilk are known as.
IgA, IgE, IgG, IgM ( most abundant is IgA and fights pathogens from the environment)
52
What is the role of lactoferrin
A natural antibiotic prevents gut bacteria. Higher in colostrum it prevents bacteria from getting iron ( bacterai needs iron to thrive)
53
A protein found in breast milk which can destroy cancer cells
Alpha - lactalbumin ( HAMLET)
54
What is the main carbohydrate in milk?
Lactose ( ferments to lactic acid promoting growth of bifidobacteria and lactobacilli
55
name 3 enzymes in breast milk
Amylase- helps with digestionof polysaccharides
Lipase- hydrolyzes fat
lysozyme - polypeptide and a component of whey has antibacterial and anti inflammatory properties
56
What is the role of cholecystokinin/
sedation and satiation
57
What is the lipid associated with visual acuity and cognitive ability and the amount in breastmilk is dependent on moms diet
Long chain PUFA's ( polyunsaturated fatty acid)
58
Lipid responsible for largest source of calories
Triglycerides ( breaks down into free fatty acids and glycerol
59
What is the purpose of Oligosaccharides
block antigens from attaching to the epithelium of the GI tract ( 130 types)
60
Proteins in breast milk
Casein, Whey, alphalactalbumin, lactoferrin, lysozyme serum albumin, IgA, IgM, IgG
61
What is the percentages of protein, fat and carbs in human milk?
Protein 0.8%
Fat 4.5%
Carbs 7.1%
62
An amino acid associated with early brain maturation and retinal development.
Taurine
63
What % of breastmilk is water?
87.5%
64
When does cholecystokinin peak
Immediately after a feed then 30-60 mins later in the GI tract
65
Name 6 factors influencing drug transfer into milk
Maternal plasma concentration ( most important)
Molecular Weight ( heavier wts don't pass)
Protein binding
Fat content, lipid solubility
Ion trapping
Oral bioavailability
66
When do drug levels peak in breastmilk
When their is a high concentration in the maternal plasma compartment
67
How does protein binding affect drug transfer into breast milk?
Drug transfer is higher in unbound drugs. The higher the protein binding capacity, the less drug transfer
68
Describe drug transfer as it relates to fat content
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
How does ion trapping affect med absorption?
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
Is medication transfer higher or lower in the first week of birth?
Higher, but since the baby's milk intake is low, the drug amt is also low
71
How do drugs transfer in and out of the mothers milk compartment
passive diffusion
72
What is bioavailability?
The amt of drug that reaches the baby systemic circulation . Oral meds are often metabolized by the liver and never enter the plasma
73
Name 5 ways to minimize drug absorption.
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
Name some milk inhibitors
progesterone, ergot alkaloids, estrogen, pseudoephedrine
75
Analgesics permitted for mom
```
Methadone
morphine
codeine
fentanly
NOT MEPERIDINE ( demerol)
```
76
What is the general rule for radio isotopes?
They often have a brief half life and mothers usually only need to pump and dump for 12-24 hours
77
What are precautions for breastfeeding with herpes simplex
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
Chickenpox and breastfeeding
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
Discuss CMV and breastfeeding
1 Preemies most at risk
2. pasteurization will inactivate the virus
3. Freezing does NOT inactivate virus
4. Can be transmitted through human milk and a means of passive immunity for the healthy baby
5. Not screened at Milk Banks since pasteurization will kill virus
80
Can a mom nurse if she has rubella/
OK to breastfeed. Virus can be transmitted through breast milk but no evidence to show infant will become ill
81
CAn a mom nurse if she has Hep B
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
Can a mom nurse if she has Hep C
Yes breastfeeding does not confer risk
83
Can a mom nurse if she had HTLV ( human lymphotropic virus)
NO should not. this is a rare linked to T cell leukemia
84
Can mom nurse if she has West NIle virus?
Although can be transmitted through breastmilk there is no indication to not breastfeed
85
Describe sx of hypoglycemia in the newborn
irritability, jueetry, exagerated reflexes, lethargy, listless, rapid breathing, hypothermia, poor suck, refusal to feed.
Factors __ mother with diabetes, post maturity, SGA, LGA, Sepis
86
Average milk intake from day 1 - 6 mos
```
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
3 reasons for nipple pain
Mechanical
Infection
Dermatological
88
what is the suck swallow ratio in active feeding
2-3 sucks per swallow
89
How does the whey casine ratio affect stool formation
The increase in casein results in thicker more formed stools
90
What are the types of mastitis
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
What is breastmilk jaundice?
Starts at day 5 and it is a normal phenomenon due to increase in intestinal absorption of bilirubin.
92
average amt of milk produced by twin mother
850 mls
93
What is the minimal amt of milk needed for a 6 day old and a pump dependent mom
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
What is the average infant suck pressure
50-155 and about 60 per minute
95
What does the Symphony cycle
120/min in stim phase then 54-78 in expression. Vacuum is 50-200
96
Preterm milk is high in
SigA, protein, sodium chloride and iron
97
What is a good amt of milk a mom should be pumping for her pre term infant by the end of 2nd week
800-1000 mls
98
What is the formula for calculating syntessi of rate of milk per hour.
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
What diseases are screened Human Milk Bank
HIV 1 and 2, HTLV 1and 2, Hep b, Hep C, Syphillis
100
Holder pasteurization what temp
62.5degee centegrade x 30 min ( 145 deg F
101
what is breast storage capacity
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
How does the whey casein ration affect stool formation
Increase in casein results in thicker more formed stools
103
What is an invaginated nipple
Cannot be everted
104
Risk factors for mastitis
```
stress
fatigue
cracked nipples
plugged ducts
copious milk supply or redueced feeds
engorgement
stasis
```
105
Types of mastitis
Cellulits - interlobular connective tissue infected by bacteria usually through cracked nipples
Adenitis- blocked ducts with less severe sx-- get the milk to flow
106
The most common organism to cause mastitis
Staph Aureus-- if no responding to abx rule out inflammatory carcinoma
107
What is mastopexy
Breast lift - may lose nipple sensation
108
What is a galactocele?
A milk filled lacteal cyst caused by a plugged duct. It will usually atrophy without treatment
109
What is an intraductal papilloma
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
What is breast milk jaundice
With an onset around day 5 this is a normal phenomenon du to the increase in intestinal absorption fo bilirubin
111
Causes of jaundice
```
Blood group incompatibility
Birth trauma ( cephlahematoma example)
poor feeding
genetic disorder
prematurity
maternal diabetes
UTI
hypothyroidism
Asian population predisposed
```
112
What are the number of milk ducts in the breast
4-18 ( hartman)
113
What is the oral muscle responsible for taste and motor function for digestion
glossopharyngeal
114
What is the name of the extra mastitis tissue likely found in the axillae
Hyper mastia
115
What is hyperethelia
extra nipple
116
What is macromastia
Large breasts
117
What is the greastest risk for sagging breast - pregnancy or breastfeeding
pregnancy
118
Common amt of milk for mohters of twins
850mls a day ( seems low check this out)
119
The minimal amt of milk for a 6 day old pump dependent mom?
450 mls /day
120
What is the average infant suck pressure
50-155 and about 60 per minute
121
What does the symphony pressure and cycle
at 120 /min in stim phase and about 54-78 during expression.
| The vacuum is 50-200.
122
Preterm milk has high amts of_______
Sig A,
protein
sodium chloride
Fe
123
What amt of milk pumped now assure a good supply for a preterm infant as he grows
800-1000 mls by the end of the second week
124
What is the formula for calculating syntheses of rate of milk per hour
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
Donor milk should be screened for
HIV 1&@ HTLV, Hep B, Hep C and syphillis
126
What is the temp for holder pasteurization and how long do you maintain the temp
62.5 degrees C and hold for 30 mins then reduce temp with ice or cool bath
127
At what temp is CMV destroyed during pasteurization
62.5 C
128
What are the effects of pasteurization on milk
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
When do brestfeeding women begin to lose body fat?
15th day post partum
130
Is maternal wt loss greaster in the first or second half of the first 12 mos PP
Greater in the 2nd 6 mos.
131
Is there a relationship between amt of mohter calcium intake and breastmilk calcium concentration?
NO
132
What additional vitms should vegetarian take
Vit B12 or B complex ( vegan(
133
Common allergens or sensitivites
Dairy, soy peanuts, corn citrus and wheat
134
What is the half life of caffeine
Newborn 60-130 hours
| 3-5 mos 14 hours
135
Why might diabetic have a delay in lactognesis 2?
They have lower prolactin concentration in type 1
136
Are diabetic mothers more susceptible to mastitis
YES
137
During lactation will a type 1 diabetic mother need less or more insulin to regulate her glucose
Often need less insulin as there is a continuous conversion of glucose to galactose and lactose
138
Why might PCOS and theta lutein cysts have a negative effect on milk production
High testosterone levels may interfere with hormones of lactation
139
Why should mother with cystic fibrosis breastfeed
They are chronic carriers of bacteria and their breastmilk if protective for their infants
140
If a mom has MS, when may her sx recur after delivery
apporx 3 mos PP . HOever , the EFA;s in breastmilk may protect infants from developing MS
141
What medication for depression has a long half life
Fluoxetine (Prozac) better choice is ZOLOFT or Paxil
142
If a mohter had a spinal injury she should be able to nurse if the injury was below which vertebrae
the 6th cervical lumbar vertebrae
143
Tor F anti epileptic drugs are not a containdication to breastfeed
True
144
A baby often develops stranger anxiety at what age?
around 8 mos ( separation anxiety ususlly peaks at 14 - 20 mos)
145
If a baby was dx with PKU , can he breastfeed
YES breast milk has less phenallaline then formula. HOWEVER, the baby is often fed with a low phallaline formula and breast milk
