Pediatrics
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| Human milk decreases incidence of: | diarrhea, resp illnesses, OM, bacteremia, bacterial meningitis, necrotizing enterocolitis; poss less allergic sx/eczema
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| Breastfeeding confers which antibodies? | IgA
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| BF advantages to mother: decreased risk of: | postpartum hemorrhage, ovarian/ premenopausal BrCa; possibly osteoporosis
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| Breastfeeding results in a longer interval of: | amenorrhea
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| Primary lactation failure is: | rare
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| Breast milk composition | highly bioavailable protein; essential FA; LC unsat FA; relatively low Na; low but highly bioavailable Ca, Fe, Zn
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| Adequate milk intake is assessed by: | infant's voiding/ stooling patterns; well-hydrated infant voids 6-8 / day
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| By 5 to 7 days, loose yellow stools should be passed how often: | at least 4 times/day
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| Bilirubin: BF vs formula | higher bili in BF infants; bili level inversely related to feeding frequency
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| Condition in infants w/ insufficient milk intake & poor wt gain => increase in unconjugated bili 2/2 exaggerated enteropathic circulation of bilirubin: | Breastfeeding jaundice
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| Condition in older breastfed infant in which prolonged elevated serum bili is 2/2 unknown factor in milk that enhances intestinal absorption of bilirubin: | Breast milk jaundice; dx of exclusion
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| In exclusively breastfed infants, supplement diet with: | Vitamin D (200 IU/day, start at 2 months)
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| Mom with fever, chills, and malaise = | mastitis (usually due to S aureus)
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| Mastitis tx | Dicloxicillan; Oxacillin; 1G ceph; erythromycin; Fungal: Diflucan
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| Chronic illness: effect on BF | HIV: CI for BF; TB, syph, VZV: poss restart after tx
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| Breastfeeding is contraindicated for: | HIV. Active TB. Mom on meds: radioactive iodine, antimetabolites, lithium, tetracycline, antithyroid drugs, recreational drugs
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| Drugs that are allowed when breastfeeding | Methadone. Antidepressants: Zoloft preferred, Prozac okay
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| Decision to breastfeed is usually made when? | Before delivery; often when mom feels quickening
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| Function of Estrogen: | stimulates ductal system to grow; levels drop at delivery
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| Function of Progesterone: | Increase in pregnancy; growth and size of alveoli/lobes; drop at delivery/triggers milk
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| Function of Human Placental Lactogen: | instrumental in breast/ nipple/ areolar growth; before birth
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| Function of Prolactin: | Increase contributes to accelerated growth of alveoli
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| Function of Oxytocin: | contracts smooth mx layer of cells surrounding the alveoli to squeeze milk into ductal system
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| breast milk volume | Colostrum (precursor; pro & Ab rich): 5-10 mL/ feeding; milk: 750ml–1000 ml/24 hrs by 10-14 days pp
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| Lactation: timing | Baby to breast within 1-2 hrs postpartum. Encourage feeding 8-12 times/24 hrs; average feeding 20-40 min active sucking/ swallowing (15-20 min each breast)
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| Frequent feedings stimulate the body to transition: | colostrum to milk by day 3-4
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| Foremilk & hindmilk | Foremilk: high vol, low fat; fat content rises as feeding progresses; Hindmilk: low vol, high fat
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| Easiest positions in the early post-partum period | Football or crosslap holds
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| 4 breastfeeding positions: | cradle, crosslap, football (clutch)(good for C/S), reclining
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| Breast milk for premature infant | Initiate pumping within 6-8 hrs pp; pump q3 hr around the clock while establishing supply;at 2 wks, goal = 20-25 oz/ 24 hr
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| Engorgement sx | Gradual onset, immediately pp; bilateral; general heat, swelling, pain; mom temp <38.4;
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| Engorgement tx | Heat prior to feeding; ice after; cabbage leaves?
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| Mastitis sx | gradual or sudden onset (after 10 days); local edema, heat, erythema, pain; unilateral; temp >38.4; flulike sx
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| Pinkish-red appearance with shiny nipples/areola; white plaques on nipples; persistently sore; think: | yeast
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| Gradual onset, unilateral; no heat, swelling may shift; mild local pain; temp <38.4; think: | Plugged duct; tx: heat/ massage/ nurse; infant's chin pointed toward plugged duct; lecithin?
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| If breast augmentation, lactation success depends on: | surgical technique used; potential for nerve disruption/ pressure from implant; f/u & observe for engorgement
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