Breastfeeding/Lactation

Question 1

3 major components of lactation physiology

Answer 1

1. Stages of lactogenesis
2. Endocrine
3. Nursing behavior and milk transfer

Question 2

Lactogenesis I involves which 3 hormones to develop alveolar growth and maturation?

Answer 2

Progesterone
Prolactin
Human placental lactogen (hPL)

Question 3

When can one start secreting milk?

Answer 3

Mid pregnancy

Question 4

When does lactogenesis II begin and end?

Answer 4

Begins: After delivery of placenta, when progesterone levels drop
Ends 5-7 days pp

Question 5

Colostrum has more________ & less ________ that mature milk

Answer 5

Colostrum has more protein & lactose and less fat than mature milk

Question 6

What two hormones play major roles in L2 (lactogenesis II)?

Answer 6

Prolactin
&
Glucocorticoids

Question 7

When does milk usually come in?

Answer 7

2-5 days postpartum

Question 8

How much milk is produced once milk comes in?

Answer 8

500-700cc per day

Question 9

When is engorgement most common?

Answer 9

When milk comes in at 2-5 days pp

Question 10

When does lactogenesis III (aka galactopoiesis) usually begin and end?

Answer 10

Begins 5-7days pp

Ends when mother and infant are ready to discontinue BF

Question 11

What are the “galactopoietic” and “galactokinetic” hormones?

Answer 11

Prolactin-creates milk by stimulating alveolar cells

Oxytocin —kinetic bc it contracts myoepithelial cells to secrete milk

Question 12

What hormone dominates stage IV of lactogenesis?

Answer 12

Lactation inhibitory factor—releases if no feed in 24-48 hrs

Question 13

Define lactogenesis IV

Answer 13

Involution and cessation if BF.
<6 episodes in 24 hrs
<400cc in 24 hrs

Question 14

What metabolic hormones help produce breastmilk?

Answer 14

Cortisol
GH
Insulin
Parathyroid hormone

Question 15

What is the main substrate for milk production?

Answer 15

Glucose

Question 16

T or F: diet effects breastmilk

Answer 16

False

Question 17

What is the threshold for weight loss in a breastfed infant at one week?

Answer 17

10% (7% if formula fed)

& by 14 days, the infant should return to birthweight

Question 18

How can one be sure that ovulation (via LH) is suppressed during BF?

Answer 18

8+ feeds per day for at least 10-20 mins

Question 19

What might inhibit the let down reflex?

Answer 19

Pain, anxiety, insecurity and distractions

Oxytocin has an anti stress effect though!) :

Question 20

What are good signs of milk transfer?

Answer 20

Audible swallowing
Adequate I/Os
Feeling of emptying after feeds

Question 21

Describe foremilk and hindmilk

Answer 21

Foremilk is emptied within 5-10mins and is composed of carbohydrates
Hindmilk is emptied afterwards (which is why it’s important to stick to one breast for one feed) and is composed of lipids & is calorie dense

Question 22

Lactation depends on which 2 processes?

Answer 22

1. Mammogensis (gorwth and delveopment of glandular tissue in breasts)
2. lactogenesis (mammary epithelial cells are converted from nonsecretory to secretory state)

Question 23

Describe the effects of lactation on the breastfeeding person

Answer 23

Decrease HTN, CV dz, PP blood loss, cancers (breast and ovarian), and accelerates uterine involution.
Amenorrhea if 8+ feeds in 24hrs for at least 10-20 mins.

Question 24

Nutritional requirements of lactating women

Answer 24

8-12 glasses of water a day (one glass for every feed)
Extra 500-700 calories a day
Vitamin D, B12 (2.8 mcg/day), DHA may be necessary in certain populations (vegans)

Question 25

Colostrum contains immunoprotective properties, including _____, ______, and __________ ______________.

Answer 25

secretory IgA Oligosaccharides Growth hormones

Question 26

Which has higher water content: colostrum or mature milk?

Answer 26

Mature milk

Question 27

Describe immunologic properties of breastmilk

Answer 27

Colonizes newborn gut with lactobacillus and bifidobacterium organisms through fermentation of nondigestible oligosaccharides. (70% of developing immune system is found within the GI system) Prebiotics Probiotics Long-chain polyunsaturated fatty acids IgA Nucleotides (anti-inflammatory properties) Decreases allergic responses

Question 28

When is drug transfer to breastmilk more difficult?

Answer 28

Once milk production is established because alveolar cells expand, and intracellular gaps close. (So drugs pass more readily in the immediate PP period)

Question 29

What drug properties are less likely to transfer to milk?

Answer 29

1. Highly protein bound (ibuprofen) 2. Readily move from plasma to tissue, thereby lowering the chance to diffuse into milk 3. Higher molecular weight (heparin, insulin) 4. Ionized drugs 5. Lipophilic drugs 6. shorter half-life

Question 30

What drugs inhibit (or may inhibit) lactation?

Answer 30

``` Estrogen >30mcg/day Progestins (no known amount) Testosterone Antihistamines Pseudoephedrine (sudefed) Cabergoline (destinex) Bromocriptine (parlodel Ergotamine (cafergot) Tomoxifen (Nalvadex) ```

Question 31

Mechanical ways to suppress lactation

Answer 31

``` Breast binders (tight bra) ice packs (avoid heat) ```

Question 32

Drugs that enhance milk production

Answer 32

Fenugreek Metoclopramide Domperidone

Question 33

Conditions that may adversely affect BF

Answer 33

PCOS DM Thyroid disorder Breast surgery, infection, or pain

Question 34

What should you assess in the BF infant?

Answer 34

``` Weight head (cephalohematoma?) Neck: Full ROM? Mouth (thrush?) Color (jaundice?) ```

Question 35

Nutritional requirements for a term newborn

Answer 35

100-110kCal/kg per day First days of life: 0.5-1 oz/feed "always be fed on cue" with no breaks longer than 4-5 hours

Question 36

When should one introduce solid foods?

Answer 36

No earlier than 6 months of age

Question 37

What should breastfed infants be supplemented with?

Answer 37

400 IU Vitamin D

Question 38

Community resources available to breast-feeding mothers

Answer 38

La Leche League International World Alliance for BF Action Academy of BF Medicine Human Milk Banking Association of North America International Lactation Consultants Association

Question 39

Treatment for blocked duct or nipple blebs

Answer 39

Mupirocin 2% ointment, if recurrent/persistent, c/s & tx w/ Fluconazole (Diflucan) 200-400 mg followed by 100-200 mg QID x 2-3 wks

Question 40

Tx for infectious mastitis | DCCE

Answer 40

``` Dicloxacillin (Dynapen) 500 mg Cephalexin (Reflex) 500 mg Clindamicin 300 mg Erythromycin 250-500 mg (all tx QID for 10-14 days, or 30d for recurrent & perform c/s) ```

Question 41

Tx for nipple infections (MB)

Answer 41

Mupirocin 2%-15g Polymyxin (bacitracin) (apply after each feed)

Question 42

Tx for ductal infections (CB)

Answer 42

c/s & tx for at least 14 days or until s/sx resolve for at least 7d Clindamycin 300 mg QID Bactrim 500 mg BID

Question 43

Outpatient & inpatient tx for puerperal abscess (DC/NCV)

Answer 43

``` OUTPATIENT: QID & 10-14 d of: Dicloxacillin (Dynapen) 500 mg Clindamycin (Cleocin) 300 mg INPATIENT: IV Nafcillin 2g q 4hr IV Cefazolin 1g q6hr IV Vacomycin 1g q12 hr ```

Question 44

Mgmt/tx of nipple pain

Answer 44

1st: Breast milk, breast shield 2nd: Lanolin (must wipe away before feed),