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Flashcards in Lactation Deck (89)
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Why lactation can be names exterior gestation?

  • it provides a continuity in terms of security and nourishment between the mother and infant.


What should be done 1 hour after parturition?

  • It is recommended that infants are placed in contact with the mother's breast as soon as possible (e.g. the magic hour).
  • It is also recommended that the infant be placed on the mother's bare chest, as the warmth and smell are comforting to the baby (e.g. skin-to-skin contact).


how hormones change after labour

estrogen and progesterone decrease significabtly to allow breastfeeding, prolactin and oxytocin increase


How support should be given to a lactating mother?

  • A support system is crucial for successful long-term breastfeeding (i.e. the husband and close family must be supportive of the mother's decision to nurse), as psychological inhibitions may decrease the flow of milk.
    • Breastfeeding must be learnt, which may be done through lactation experts.


What conditions can cause in lower milk production?



How breastfeeding can induce the bond between the baby and the mother

  • Oxytocin increases maternal-child bonding and may be referred to as a satisfaction or pleasure hormone.


what happens to reproductive sysem of mother after labour and then on

  • Breastfeeding suppresses ovulation by the decreased levels of estrogen and progesterone, and the increased levels of prolactin.
    • The rate of breastfeeding must be maintained to prevent ovulation.
    • Commonly, when the baby starts to sleep through the night, they have reached a developmental stage where the mother should think of other methods of contraception.

Breastfeeding stimulates the contraction of the uterus, resulting in involution of the uterus through oxytocin release, which renders the uterus to its original size


Advantages of breastfeeding

  • Breastfeeding may aid in proper jaw and tooth development.
  • It is bacteriologically safe and always fresh and contains a variety of anti-infectious agents and immune cells.
  • Breast milk is nutritionally superior.
  • It is associated with a lower risk of food allergies.
  • Recent studies have demonstrated that breastfeeding during infancy decreased the rates of respiratory illnesses up till the age of seven years old.
    • The early introduction of foods (i.e. below 15 weeks) increased the likelihood of wheezing during childhood.



milk constituents

  • Milk is a complex fluid containing over 200 known constituents. The increasing sophistication of analytical techniques increases the number of milk components discovered.
  • Compartments of milk include micelles, membrane-bound globules, live cells, protein and non-protein nitrogen compounds, carbohydrates, lipids, vitamins, minerals, and trace elements.


3 sources of milk components ( where they are produced)

  • Milk components may be (1) transferred from the maternal plasma, (2) synthesized from maternal secretory (alveolar) cells from maternal plasma precursors, and (3) synthesized from other mammary cells in situ (i.e. in the original site).



3 phases of milk production

  1. Colustrum (5 to 7 days)
  2. Transitional milk  (7 d to 3-4 weeks)
  3. Mature milk


Describe colustrum ( how does it differ from mature milk, color, quantity, what vitamin is especially high

  • In comparison to mature milk, colustrum is (1) high in protein and mineral (sodium, potassium, chloride) content, and (2) lower energy, fat, and lactose content.
  • The quantity of colustrum is very small (2-10 mL feeding per day), and is an intense transparent yellow fluid, containing 10 times the carotenoid content of mature milk.


How transitional milk differ from colustrum

The quantity of protein decreases to a consistent level, while there is an increase in lactose and fat in transitional milk


What is mature milk composition and how and when it can differ and what advice is given to women in regards to mature milk ejection

  • Mature milk changes according to the changing infant's needs (i.e. the time of day, or depending on the age of the child).
  • For example, early morning milk may contain more water and lactose due to increased hydration needs of the child (foremilk). Conversely, hindmilk is higher in fat and calories
    • Women are advised to empty one breast before moving on to the next one to provide the infant with a greater quantity of hindmilk, and, thus, a greater quantity of fat to aid in brain development.


immunological properties of human breast milk and what stage of milk has the highest

  • Breast milk may have a direct action against pathogens, modulate the immune response, and promote the growth and maturation of the GI tract.
    • An immature GI tract (i.e. mucosal barrier) may permit the passage of unwanted compounds.
  • Immunological factors are produced throughout lactation, and certain factors are highest in colustrum.


why cow's milk is not recommended for the first 9 moth of life

Most immune factors are not found in infant formula, and lower concentrations are found in cow's milk


what enzyme protect protein structure in milk

  • Whey proteins are structurally different than caseins, and are resistant against proteolysis and acid denaturation, as they contain anti-proteases (e.g. sulfhydryl oxidases).
    • Anti-proteases may protect bioactive proteins, enzymes, and immunoglobulins by preserving their disulfide bonds.

Whey proteins contain multiple disulfide bonds, providing a rigid structure that is difficult to digest by proteases, allowing them to bypass the stomach without being completely digested


what antibodies are present in milk, against what

  • Antibodies are abundant in milk, and are directed against bacteria, bacterial toxins, viruses, fungi, and food proteins that may cause allergies.
    • Antibodies passed to the infant through human breast milk provides passive immunity.
    • IgA, IgM, IgE, and IgI are contained within the mammary gland, while IgG is contained in the maternal plasma.
    • Antibodies provide bacterial and viral neutralizing capacities, which inhibit colonization of the gut.


what antobodies are the most abundant and where they come from

  • IgA forms 90% of the secretory antibodies and arise from the B-cells of the maternal small intestine and respiratory tract, travelling through the maternal blood to form mature milk in the mammary gland.
    • IgA is protective against many pathogens, as the B-cells originate from maternal sites where there is high exposure to pathogens.

IgA within the GI tract is resistant to proteolysis, acting on the mucosal surfaces of the GI tract


what is bifidus factor

  • The bifidus factor is a nitrogen-containing carbohydrate, which promotes the growth of lactobacilli, an important probiotic bacterium that may antagonize the survival of enterobacteria, decreasing the risk of diarrheal diseases in childhood (e.g. salmonella, E. coli).

Studies have demonstrated that breastfed babies have a lower risk of developing diarrhea during childhood, due to the promotion of lactobacilli by the bifidus factor


role of lactobacilli in infants

  • Lactobacilli is the dominant bacteria in the lower GI of breastfed infants, where they secrete organic acids that inhibit the growth of pathogenic bacteria.


what is necrotizing enterocolotis 

  • Necrotizing enterocolitis is an infection that destroys intestinal tissue, causing acute inflammation of intestinal mucosa. It is the most common intestinal disease in premature babies.
  • Necrotizing enterocolitis may also occur in full-term babies born with a health issue, such as a heart defect, or if there was a disruption of oxygen or blood flow to the intestine, causing necrosis of the intestinal tissue.
  • In rare cases, necrotizing enterocolitis may lead to perforation, in which case waste products and bacteria within the intestine enter the bloodstream or the abdominal cavity.
  • Necrotizing enterocolitis may be due to bacterial growth that erodes the intestinal wall, or a decreased quantity of oxygen or blood flow.
  • Breastfeeding may reduce the risk of developing necrotizing enterocolitis.


how else breastmilk protect the baby ( which is not found in cow's milk)

  • Breast milk contains anti-staphylococcus factor, and lysozymes, which breakdown bacteria by destroying proteoglycans embedded in the cell wall of the bacteria.
    • Lysozymes are not found in cow's milk.


what is found in breast milk that protects against bacteria that need Fe for survival

  • Lactoferrin, a whey protein, is produced by milk lymphocytes and inhibits siderophilic bacteria, which are bacteria that require iron for survival.
    • Apo-lactoferrin (unconjugated) competes for iron and forms 80% of the lactoferrin found breast milk. Holo-lactoferrin are conjugated with iron.


use of lactoperoxidases, lipases and interferins in breast milk

  • Lactoperoxidases kill Streptococci and enteric bacteria.
  • Lipases enhance fat breakdown in the gut, and their products (free fatty acids and monoacylglycerols) have anti-viral properties.

Interferons produced by milk lymphocytes inhibit intracellular viral replication


Use of vitamin B12-binding protein , neutrophils, complement proteins and fibronectin in human milk

  • Neutrophils (90% of white blood cells in milk) are responsible for phagocytosis and intracellular killing of microbes, and macrophages (10% of white blood cells in milk) synthesize complement proteins, lactoferrin, lysozymes and carry-out phagocytosis.
  • Complement proteins are responsible for the attack of the plasma membrane of pathogens, aid in inflammatory processes, and promote opsonisation (molecular mechanism whereby molecules, microbes, or apoptotic cells are chemically modified to have a stronger attraction to the cell surface receptors on phagocytes and NK cells)
  • Fibronectin increases phagocytosis.


growth factors in human breast milk

Cortisol, thyroxine, insulin, prostaglandins, polyamines, insulin-like growth factor


Role of cortisol, thyroxine and insulin 

  • stimulate the synthesis of intestinal enzymes and the maturation of the gut mucosa.


Role of prostaglandins

  • Prostaglandins stimulate mucus secretion and cell division, which is important as the mucosal barrier of the infant is extremely immature, and it must grow as it is the first line of defense within the GI tract.


Polyamines, what are they and what they are needed for

  • Polyamines (e.g. spermine and spermidine), containing two or more primary amino groups, are growth factors that increase cell replication.