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Lactation > Chapter 3 > Flashcards

Chapter 3 Flashcards

1
Q

Active alert

A

Series of frequent body and facial movements, irregular breathing and open eyes

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2
Q

Active sleep

A

State of rapid eye movement body and facial twitches and a regular breathing

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3
Q

Crying

A

State of jerky movements facial color changes muscle tension and rapid breathing

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4
Q

Disengagement cues

A

Cues to communicate with the infant wants to change an activity circumstances or environment

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5
Q

Drowsy

A

State of variable body movement irregular breathing glazed eyes and delayed reaction time

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6
Q

Engagement cues

A

Cues to communicate the infant desire to interact play or feed

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7
Q

Infant behavioral states

A

Group of behaviors that occur together including degree and nature of body movement eye movement respirations and responsiveness

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8
Q

Quiet alert

A

Estate of little body movement open eyes and steady regular breathing

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9
Q

Quiet sleep

A

State a very little body or facial movements except occasional burst of sucking

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10
Q

Regulation entrainment, structure touch (REST)

A

An intervention associated with reduced daily crying and parental stress during early infancy

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11
Q

Repetition to soothe

A

Interventions such as stroking, walking, or speaking softly to infants using the same repeated words or phrases used to come infants

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12
Q

Self – soothing behaviors

A

Bringing hand to mouth and sucking

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13
Q

Sudden unexplained infant death (SUID)

A

The sudden death of an infant less than one year of age they cannot be explained after a thorough investigation has occurred

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14
Q

Six infant behavioral states

A
  1. Crying infants have jerky movement facial color changes muscle tension and rapid breathing do not shed tears (no tears until 2 to 4 months of age). Sometimes hard for early babies to be soothed
  2. Active alert state have moderate to frequent body and facial movements sometimes fussy and sensitive to stimuli common before feeding
  3. Quiet alert state with little body movement eyes open with regular breathing highly responsive best state for interaction and play. Difficult for newborns to maintain the state entire easily
  4. Drowsy infants variable body movement irregular breathing glazed eyes may open and close eyes limited interest in interactions
  5. Active sleep characterized by rabbit eye movement body and facial twit twitches can be awakened easily while dreaming
  6. Quiet sleep with little buddy or facial movements except occasional bursa sac in May start off with movement or loud noises but typically do not wake
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15
Q

Regulate behavioural state

A

Hard for newbors to do
As soon as can will self soothe (bring hand to mouth)
Variety to waken: process of trying different positions, touch or sounds to wake - can be hard if baby was stressed during birth or medications

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16
Q

Variety to weaken

A

Variety to waken: process of trying different positions, touch or sounds to wake - can be hard if baby was stressed during birth or medications

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17
Q

Repetition to soothe

A

Babies overstimulated or distress respond well to sustained low level repetitive stimulation. Stroking rocking or speaking softly to infants repeating the same words or sound can calm them

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18
Q

Engagement cues

A

Desired interact play or feed. Examples relax face, smooth body movements, smiling and feeding cues

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19
Q

Disengagement cues

A

When need a change in activity, circumstances or environment. Turning or arching away when overwhelmed, pushing away crying, Steph hands and arms, grimacing, Yanny or fall asleep

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20
Q

Feeding cues

A

Clenching fingers and fist over chest and tummy, flexing arms and legs, mouthing or rooting, quickening breathing, sucking noises and motions

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21
Q

Satiation

A

Extend arms and legs turn or push away from the breast, arch back, slow or stop sucking, or fall asleep. If happens early and feed and infant not gaining enough weight further evaluation of milk transfer is warranted

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22
Q

Modified cues

A

Healthy full-term infant can modify kids both my caregiver responsiveness and overtime is infants motor control and communication skills improve. When caregiver not responsive these kids are over written, infants ability to self regulate intake maybe compromise leading to pour weight gain or obesity

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23
Q

Crying as communication

A

Common and normal part of infancy. Powerful way to communicate to stress and to drive caregiver activity. Cry for many reasons the many caregivers believe their infants cry mainly for food. May lead to weaning too soon from breast. Cry when uncomfortable needing to be burped or sick or hungry. May cry when need to change your environment when overstimulated or too many new faces. Many quiet time to be close to parent or break from stimulation.

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24
Q

Response to crime

A

Respond quickly crying may be minimized. And past excessive crime was referred to as colic. Colic highly subjective and cultural norms. Persistent crying is rarely associated with an organic cause. May be associated with dysfunctional patterns of interactions with caregivers. Often thought to be related to G.I. issues but rarely supported

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25
Q

Repetitive, sustain stimuli to reduce crime

A

Use assist repetition to soothe such as rocking, singing, or stroking may reduce infants level of stimulation and calm. Carrying is particularly effective for calming infant

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26
Q

Active sleep

A

Dreaming occurs during active sleep, resulting and rapid eye movement, body and facial twitches and a regular breathing
Blood flow to the brain is increased and neuororesponses in brain increase
Easily awakened during active sleep may be important to prevent SIDS

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27
Q

Quiet sleep

A

Exhibit little body or facial movement other than short burst of sucking and startle responses. Breathing regular. More difficult to rouse. Sleep deeply and can resist environmental stimuli. Restorative state. Plays role in memory development.

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28
Q

Sleep patterns

A

Newborns sleeping average of 16 to 17 hours. May wake with each cycle or every one to three hours
Older infants sleep about 13 to 14 hours per 24 hour period
Infants sleep differently than adults adults. Adults sleep cycles are 90 to 110 minutes long but infant sleep cycles are 60 minutes long
Between three and five months if it’s begin sleep and quiet not active sleep like adults and night waking decreases the sleep states become more consistent in percentage of total sleep span and quiet sleep increases from 50% in newborns to 60% by three months to five months to 70 to 75% at one year of age

29
Q

Sleep stretches

A

By 2 to 6 weeks of age most infant sleep 2 to 4 hours at one time. 6 to 8 weeks of age sleep becomes more concentrated during the night time because they are more awake during the day
Three months of age sleep wake periods consolidate and circadian rhythms follow light dark cycle as is cortisol and melatonin become endogenously produced. Infants are able to sleep about 4 to 5 hours at one time and typically the longest stretches at night
Six months baby may be able to sleep up to six or eight hours at one time

30
Q

Benefits of periodic waking

A

Ability to arouse during sleep important to signal hunger, discomfort, or temperature control
As infants get older require less adult intervention at night they develop ability to return to sleep after waking
Young infants with long periods of quiet sleep are greater risk for SIDS possibly because arousal threshold increase with time spent in quiet sleep

31
Q

Unexplained frequent waking

A

Refer to appropriate medical professional. May be due to physical immaturity such as prematurity, lack of brain maturation. Ineffective or poor feeding may result in lower intake and shorter intervals between feedings. Lack of alertness during feedings can lead to difficulty with infant coordination of sex while of breath. Discomfort by common illnesses or injuries may cause an infant to wake more often. Increase in stimulation from having a television on or other Internet interruptions. Breast-feeding parents caffeine intake may disrupt infant sleep. 6 to 8 cups of caffeinated beverage by mother can influence sleep

32
Q

Acid – base disassociation constant (PK a)

A

Factor that determines likelihood of a drug been trapped in milk compartment called ion trapping

Acid – base disassociation constant (PKA) of a drug determines likelihood of being trapped in milk compartment, called ion trapping high PKA of 7.2 may be trapped in an alveolar milk and not able to exit. Rarely important clinically

33
Q

Bio availability

A

Measure of how much medication reaches the plasma
6. Volume of distribution of a drug determines ability to stay in plasma compartment. High volume of distribution easily transferred out of plasma to other deep compartments.

34
Q

Dalton

A

Unit expressing the molecular weight of proteins, equivalent to atomic mass unit

Molecular size of drug largely determines transfer to human milk. Higher molecular weight, less enters milk. Drugs greater than 800 Dalton‘s have difficulty entering milk. Mady leak through membranes. Large molecular sizes (25,000–200,000 daltons) are virtually excluded. Includes heparin, insulin, interferon, low molecular weight heparin, most new biologic drugs.

35
Q

Diffusion, kinetics of entering into huma milk

A

Transfer of molecules of a substance between plasma compartment and milk compartment
4 days postpartum large gaps in alveolar cells, may allow enhanced drug entry
4 to 6 days, Al the LR cells enlarge shutting off intercellular gaps and the amount of drug entry into milk is reduced
Because alveolar epithelium has tight junctions most drugs dissolve through the bilayer membrane of the alveolar cells before enter milk
It is difficult for most drugs to dissolve through by layer lipid membranes because many are ionic or polar
CNS drugs can more easily enter milk because often are ideal for entry. Ideal includes higher lipid solubility, smaller molecular weight, and higher plasma levels
Drugs in maternal plasma compartment are in complete equilibrium with milk compartment

36
Q

Lipid solubility

A

Capability of substance to dissolve in lipids, fats, or oils
1. Lipid solubility is a factor. More lipid soluble a drug is greater likelihood it will penetrate the alveolar compartment

However many drugs have high volumes of distribution which generally means sequestered and peripheral compartments such as adipose tissue, brain, and other lipid rich compartments. This will reduce drug in milk because drug is removed from the plasma

37
Q

Milk – to– plasma ratio

A

Tool to evaluate relative concentration of medication and plasma compared to milk compartment
Acid – base disassociation constant (PKA) of a drug determines likelihood of being trapped in milk compartment, called ion trapping high PKA of 7.2 may be trapped in an alveolar milk and not able to exit. Rarely important clinically

38
Q

Protein binding

A

Degree to which a drug binds to proteins within blood plasma. The less bound a drug is the more efficiently it can transfer cell membranes or diffuse

Drugs with high protein blinding largely sequestered in plasma and have difficulty entering milk. NSAIDs classic examples with greater than 95% protein binding and low levels in milk.
8. Bio availability of a med is a measure of how much medication reaches plasma. Some are destroyed in G.I. tract. Others not absorbed in small intestine. Some are significantly metabolized in gut wall. Prefer drugs with low bioavailability.

39
Q

Relative infant dose (RID)

A

Most important clinical parameter to determine safety of drug entering milk. To calculate actual dose (Dinf) mass knowactual concentration of medication in milk and volume of milk that is transferred
Cavg (area under curver) accurately estimates average daily intake by infant and more accurate than C max estimates

RID = dose infant ((mg/kg)/day)/dose mother ((mg/kg)/day)
Rule of thumb - if RID is greater than 10% may be a problem
Often order of magnitude higher in utero - why methadone exposure in utero problem

40
Q

Maternal Factors Affect Drug Transfer

A

2-4 days minimal since so little colostrum
Two weeks to six months clinical dose may be significant due to volume of milk is high
12 or more months postpartum volume of milk is lower so amount of drug transferred it’s lower
Infant metabolism mature and highly functional by 9 to 12 months
Sustained release formulations may need to be cautious because plasma and milk levels may be higher and sustained over longer periods of time
Breast-feeding at peak may produce high milk levels. Short half-life may be possible to breast-feed. Drugs with short half-life less than four hours can feed then take medication. Won’t work with drugs with her flight longer than four hours.
Oral biavailability of drug determines plasma levels and overall risk to breast-feeding infant.
Tropical formulations usually not absorbed impose no problem.
New biological drugs have high molecular weight of more than 150,000 daltons. Produce very low milk levels.
Inhaled medications for asthma have very low plasma level.

41
Q

Predicting rest of medication to infant

A

Infant metabolic status. Low risk are infants older 6 to 18 months. Moderate risk are infants younger than four months who have additional risk factors such as complications for delivery, G.I. anomalies, hepatitis, other metabolic problems. High risk are unstable neonate, preterm infants, or infants with poor renal function
Compare normal oral dose use an infant with a transferred via milk. If less than risk pose by drug is and milk is small.
It’s medication or absorb by infant. If not risk is minimal

42
Q

Medications with local G.I. effects

A

Changes in gut flora and diarrhea reported by antibiotic use.
Chronic use of anti-cholinergic drugs and opiates can induce severe constipation

43
Q

Breastfeedingg following use of highly potent or toxic drugs

A

Higher the toxicity of drug greater risk. Using anti-cancer, antimetabolite, and other highly noxious drugs should follow guidelines for pumping and discarding contaminated milk for 5 to 7 half-lives. Milk cannot be saved

44
Q

Radioactive drugs

A

Radioactive iodine: Must closely evaluate prior to using milk that is contaminated with radioactive iodine.
If treated with this isotope should discontinue breast-feeding and sees lactation prior to its use to prevent high radiation exposure to breast tissue. Close contact with infants or adults should be avoided for up to 10 days after treatment.

Technetium-99 and others - can use since short half - life. Pump milk can be stored for 2 to 4 days and use later as radioisotope will have completely decayed by then.

Radio contrast agents used in CT scans pose little risk to breast-fed infants. Drug is rapidly cleared and has a half-life of 1 to 2 hours.

45
Q

Acetaminophen

A

Approved for use it infants so little concerned about using during lactation

46
Q

Aspirin

A

Low-dose aspirin post little threat to breast-fed infant. Waiting period of two hours would likely remove any risk.

47
Q

Ibuprofen

A

RID is very low. Deliver drug as far below FDA recommended dose that can be given to infant

48
Q

Celecoxib

A

RID is low and short term used for chronic use may be problematic

49
Q

Diphenhydramine

A

Small but unreported levels thought to be secreted into milk. Sedating anti-histamine should be used only for short duration during lactation. Nonsedating antihistamine’s preferred

50
Q

Vaccines

A

General vaccines are safe while breast-feeding. Yellow fever vaccine is not recommended.

51
Q

Tetracycline

A

Transfer rate of tetracycline is low however absorption may be significant over time. Safe to use for up to three weeks. Long-term illness such as for acne is not recommended during lactation do the possibility of dental staining in the infant and reduced linear growth rate

52
Q

A cyclover

A

Used to treat herpes Symplex virus, varicella zoster and other viral infections. No absorption following topical application.

53
Q

Penicillin

A

Safe during lactation. Ampicillin has an RID of 0.2 to 0.5%. Commonly used in neonate with no pediatric concerns

54
Q

Cephalosporin

A

Commonly used first generation antibiotic. Minimal concentration secreted into human milk. Can be used without safety concerns

55
Q

Flora quinolones

A

New ones suggest that ofloxacin in milk are lowest. Generally quite low. Little risk from exposure

56
Q

Metronidazole

A

Reported RIDs moderate approximately 10 to 13%. Making a metallic taste to milk. If high dose of 2 g recommend to stop breast-feeding for 12 to 24 hours

57
Q

Macrolides

A

Erythromyacin increases risk of hypertrophic pyloric stenosis. Prefer to use erythromycin instead

58
Q

Fluconazole

A

R I D is 12% but safe as far less than clinical does prescribe for infants.

59
Q

Antifungal

A

Topical are safe as minimal amounts are absorbed

60
Q

SSRI

A

Strongly recommended for maternal depression. Oral transfer into milk quite minimal. Neonatal withdrawal symptoms reported and 30% or less of infants exposed in utero. Symptoms include poor adaptation, irritability, jitteriness and poor gaze control in neonates exposed to paroxetine, sertraline, and less so fluoxetine
Much less transfers into milk than placenta so safe drugs during breast-feeding

61
Q

Warfarin

A

Highly protein bound and very little secreted into human milk. Supplementation with vitamin K will negate any small amount of warfarin.

62
Q

Anti-seizure medication

A

Lamotrigine appears safe.
Valproic acid (V PA) does transferring to human milk and could reduce neurobehavioral development in breast-fed infant and should be avoided.
Topiramate should be closely monitored for sedation. Occasional blood levels recommended

63
Q

Anti-hypertensive

A

Calcium channel blockers are considered safe for use in breast-feeding with little transfer. Beta blockers atenolol and acebutulol are the only beta blockers that require caution.

64
Q

Ace inhibitors, Diuretics

A 
Concern for this class of drugs is through tic risk of extremely pre-term infant being exposed to these medications. ACE inhibitors because kidney does not fully mature until after birth there is some concern.
Little with diuretics gets through - OK
65
Q

Pain drugs

A

Hydrocodone - generally safe for short term use
Codeine - have impacted babies (apnea and death) not recommended
Morphine - can be safe for short time if infant monitored for sedation
Hydromorphone It’s a potent narcotic 7-10 times more potent than morphine. Appears to be safe with an RID of .67%
Tramadol although FDA no longer recommends this drug during lactation there are no reported complications in a breast-fed infant

66
Q

Drugs of abuse

A

Alcohol has been shown to inhibit oxytocin release and decreased milk delivery to the infant. Will metabolize a standard drink in about two hours. Waiting period of two hours per drink is recommended

Tobacco – study show linear relation amongst smoking and breast-fed parent, nicotine levels in the milk and urine cotinine in the breast-fed infant. Secondhand smoke can contribute to otitis media, respiratory tract infections SIDS and asthma

Marijuana research limited. Milk levels are reported low but milk to plasma ratio has been reported as high. Significant evidence that exposure to THC in pregnancy or chronic use in adolescence in early adulthood may result in changes to the Endocannabinoid system in the brain which regulates mood, reward and goal directed behavior. Unpublished data from Hales laboratory suggest capital RID for smoke marijuana is approximately 2. 4%

Opiate drugs – commonly used in breast-feeding mothers but must be used with caution because respiratory depression can occur with high doses. Morphine considered best choice because poorly absorbed in infants. Derivatives such as heroin, fentanyl, should be avoided when used in high doses in abusive situations

Cocaine levels in milk may be excessive and users should avoid cocaine while breast-feeding. A waiting period of 24 hours following the use of cocaine is recommended during which milk is pumped and discarded. Drug tests will remain positive for more than five days after use of this drug.

67
Q

Galactogogues

A

Fenugreek is most commonly used for up for increasing milk production. Although no adverse effects are noted herbal products not control by FDA. Not recommended to improve milk production.

Domperidone numerous studies have documented domperidone helps milk production. Stimulates prolactin production to a major degree. Will only work if have low prolactin levels. After prolong therapy withdrawal. Recommended to prevent a drop in prolactin levels. In some cases can induce arrhythmia.

Metclopramide: a dopamine receptor blocker has multiple functions and primarily used to increase tone of the lower esophageal sphincter. Sometimes used to stimulate prolactin release. Has problems with side effects including depression. FDA warned the therapy longer than three months may be associated with tardive dyskinesia. Exposure should be limited to more than one month. Must taper Jose

68
Q

Key points

A

Doing colostral. Transfer of drugs into milk is higher but total does it slower because limited volume of colostrum
Medication’s and her milk only from mothers blood. Dreadnought absorbed into plasma compartment drug will not enter milk
All drugs enter milk but most at clinically insignificant levels. Determine levels in milk using RIDor orrelative infant dose
Recommend discontinuing breastfeedingg a drug poses a major risk for infection.
Cautious of high vitamin doses. Do not use high doses of iodine.
Keep breast-feeding patients healthy to avoid need for medicine

Lactation (9 decks)

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