POSTPARTUM test #3 study guide Flashcards
(142 cards)
- Review the evidence for breastfeeding
Infant: Higher infant morbidity and mortality in formula-fed infants as they do not receive antibodies from breast milk. Risk of contamination of the formula during manufacturing. Risk of malnutrition or GI problems due to over- or under- dilution when mother prepares the formula.
- Compare the risk and costs of using manufactured infant milk compared to human breast milk to the infant and the family.
Mother: higher risk of osteoporosis, premenopausal breast cancer, and ovarian cancer. More likely to develop type 2 diabetes than breastfeeding mothers. Less rapid weight loss.
Costs: approximately 150 cans of ready-to-feed in the first 6 months of full artificial feeding (a lot of money!!). Higher healthcare costs as child is sick more often, more days of missed work for mother/family.
- Define the Healthy People 2020 objectives for breastfeeding.
Increase the proportion of infants who are breastfed to 81.9%
Increase the proportion of infants who are breastfed at 6 months to 60.6%
Increase the proportion of infants who are breastfed at 1 year to 34.1%
Increase the proportion of infants who are breastfed exclusively through 3 months to 46.2%
Increase the proportion of infants who are breastfed exclusively through 3 months to 25.5%
- Review the Baby Friendly Hospital Initiative.
1) Written breast feeding policy routinely communicated to staff
2) Train all staff in skills necessary to implement this policy
3) Inform all pregnant woman about the benefits and management of breast feeding
4) Help mother’s initiate breastfeeding within 30 minutes of birth
5) show mothers how to breastfeed even if separated from infant
6) Give infants no food or drink other than breastmilk unless medically indicated
7) practice rooming in 24 hours a day
8) Encourage breastfeeding on demand
9) No pacifiers
10) Foster Breastfeeding support groups
Lactogenesis:
transition from pregnancy to lactation. lactogenesis I (mid-pregnancy to day 2PP): initiation of milk synthesis, differentiation of alveolar cells from secretory cells, prolactin stimulates mammary secretory cells to produce milk. Lactogenesis II (day 3 to 8 PP): triggered by rapid drop in mother’s progesterone levels, onset of copious secretion of milk, fullness and warmth in breasts, switch from endocrine to autocrine control. Significant fall in breastmilk levels of sodium, chloride, and protein, and a rise in lactose and milk lipids.
Galactopoiesis:
maintenance of the established milk production. Based on the supply-demand response. (emptying of breast)
Progesterone
Progesterone can cause delay of the effects of prolactin f placental fragments retained after birth Prolactin initiating and maintaining milk production.
breast changes
during pregnancy increased breast mass and cell differentiation (peptides: angiotensin 11 gonadotropin-releasing hormone (GnRH) and vasopressin all stimulate prolactin.
Anterior Pituitary
releases prolactin 7-20 x in 24 hours peak 200-400ng/ml at term-secreted in greater amounts during sleep following circadian rhythms
lactogenesis II
mild secretions shifts from endocrine to autocrine control controlled by the hypothalmus: infant suckles-hypothalmus inhibits release of dopamine (a prolactin-inhibiting factor), this drop in dopamine stimulates the release of prolactin (surge-doubles)=milk production.
prolactin
Need at least 8 feedings a day to prevent decrease in prolactin before the next feeding. Prolactin levels will remain elevated for as long as the mother breastfeeds even if it is years. Prolactin is present in breast milk and thought to benefit the infant. Prolactin enhances development of B & T lymphocytes
Posterior pituitary/oxytocin-milk ejection, uterine involution
Cortisol-main glucocorticoid-
synergisitc with prolactin secreeted by adrenal glands help regulate water transport across the cell membrane during lactation-a High cortisol level will delay lactogenesis
Thyroid Stimulating Hormorne-permissive-promotion of mammary growth and lactation increases on 3-5 postpartum days.
- Review the immune and anti-allergic properties in breast milk.
Breastfeeding promotes intestinal ecosystem-bifidobacteria and lactobacilli (pro and prebiotics)
- Review the key concepts at the end of chapter 5 discussing drug therapy and breastfeeding.
Key concepts:
Avoid medications that are not absolutely necessary
Choose drugs with less toxicity and those commonly used in infants
Maternal plasma levels of the drug at time of breastfeeding: Choose drugs with published studies
Molecular weight of the medication
Oral bioavailability of the medication in mother and infant: choose ones with poor oral bioavailability to reduce oral absorption in infants
Evaluate the infant’s medications, to see if there are drug interactions-evaluate the infant: age, stability, condition-can they handle exposure to this medication (pre-term infants have impaired clearance mechanism so they are at risk)
If a drug enters CNS-crosses blood/brain barrier-it will likely enter breastmilk
medications & breastfeeding
protein-binding of the medication
passive diffusion of drugs into milk
First 2-3 das of life breast tissue is porous-meds cross easily by passive diffusion, but after intercellular junction closes this decreases.
Must take into consideration-the absolute amount of colostrum ingested by infant is low 50-60 ml/day thus clinical dose of medication is low
<10 meds that are selectively transported into human milk are best.
Avoid Breastfeeding during peaks of medication, effective for drugs with short half-lives. Choose drugs with shorter half-lives over those with longer half-lives
Drugs that may inhibit milk production-progestins, estrogens, ethanol, bromocriptin, ergotamine, cabergoline, pseudoephedrine(even nasal). Especially prior to establishment of milk supply. Advise mother to watch for changes in breast milk production
No ASA in Breastfeeding women d/t Reye’s syndrome
Risk vs benefit assessment before prescribing
only a few medications are unsafe under any circumstances
A relative dose of less than 10 percent is generally considered compatible with breastfeeding
HIV & Breastfeeding
Use of anti-retroviral drugs and avoiding breastfeeding reduced risk of trasmission of HIV to less than 2%. CDC recommends against breastfeeding by HIV-infected women living in developed countries. New studies show that exclusive breastfeeding by women in 3rd world countries has improved survival rates, reduces transmission of HIV by keeping gut flora intact-decreased diarrhea and should be encouraged over formula-introduces bacteria and other contaminants which causes inflammatory responses and damages the mucosa-HIV penetrates GI mucosa-once the decision to not exclusively breastfed, woman must stop as it is no longer protective.
HBV & Breastfeeding
virus is present in breastmilk, but also antibodies so Safe to breastfeed. Transmission of HBV would occur during delivery, 5-15% before birth, not BF-unless acute infection with no antibodies, potential risk with bleeding nipples. Infant should receive Hep B Immunoglobulin within 12 hours of birth and be tested after completion of the series. Lack of BF places infant at greater risk of contracting the disease.
HCV & Breastfeeding
virus is present in breast milk, but infant May breastfeed-unless acute infection with no antibodies. potential risk with cracked, bleeding nipples. Perinatal transmission 6%
HSV & Breastfeeding
: Mother’s milk may be free of virus, ocasionally HSV-1 can be cultured from breastmilk (rare). If mother has herpetic lesions on breasts, do not breastfeed. Active lesions should be covered to prevent contact with infant. Advise about hand-washing before breastfeeding. (see table in p.203) If primary infection during pregnancy-50% transmission only 1-3% if recurrent. Congential infection most serious infections in neonates.
CMV & Breastfeeding
CMV virus can be found in breastmilk, but no serious illness or clinical symptoms in neonates secondary to breastfeeding. Breastfeeding will confer passive immunity. Danger of CMV infection is in potential transmission to the fetus or newborn of woman who has a primary infection during pregnancy. Pasteurization of milk appears to inactivate CMV
• Varicella
Can breastfeed. If mother contracts varicella while breastfeeding, continue BF - will give baby passive immunity-antibodies develop in 48 hours and will decrease the severity of illness in infant. However, If mother contracts varicella in 1st trimester=neurological problems, if within days of delivery can be life threatening-manage with airborne and contact infection control precautions-it says isolate the infant from the mother if the infant doesn’t have lesions and protect the infant from the mother’s lesions. Mother is to pump-not clear about feeding or dumping until antibodies present at 48 hours. However if the infant has lesions it says isolate couplet together and continue breastfeeding.
• Rubella-
OK to breastfeed. Greatest risk is during 1st trimester= congenital defects. If mother is immunized to rubella postpartum the breast feeding infant will develop antibodies to rubella.
• Human Lymphotropic Virus HTLV-1
No breastfeeding Endemic in Caribbean islands, parts of Japan and Africa-linked with adult T-cell leukemia and lymphoma. The longer they breastfeed the larger the risk.
