NUSC Exam 2 Study Guide

What is the optimal duration for breastfeeding (exclusive and total time)?

Exclusively for 6 months, then until 2 years or beyond

How are exclusive breastfeeding rates for infants 0-5 months in relation to the world average?

48% of infants are exclusively breastfed under 6 months globally

Grape like clusters that contain the secretory cells for secreting milk (where milk is made):

Alveoli in mammary glands

Which hormone is released from the pituitary gland and stimulates milk to eject into ducts?

Oxytocin that act on myoepithelial cells

What benefits does breastfeeding provide to the mother?

Prevents breast and ovarian cancer and diabetes

Calorie burning

Lower depression risk

Uterine healing

Stronger bond

What benefits does breastfeeding provide to the baby?

Could save lives

Longer breastfeeding durations associated with higher scores on intelligence tests

Reduces risk of non communicable diseases and decreases prevalence of overweight or obese in life

Helps avoid diarrhea episodes and respiratory infection

Which hormone is released from the pituitary gland and stimulates milk production from secretory cells?

Prolactin

Colostrum: amount consumed, macronutrient distribution, electrolytes

secreted during the first few days postpartum

Very high in proteins, low carbs and fat

Yellow color

Highest concentration of immune cell components and antibodies

Low amount consumed

Mature milk: amount consumed, macronutrient distribution, electrolytes

Primary energy source

Low in protein, high in carbs and fat

Lower in antibodies and immune cells because diluted by volume

Hindmilk

received at the end of a breastfeeding session

contains more fat and calories

needed for growth and development

thicker and creamier

Foremilk

received at the beginning of a feeding session, it helps baby’s thirst and contains lactose and proteins, but few fat and calories

Benefits/differences between breast milk and formula

Breast milk adapt’s to infants needs and provides live antibodies. It is easier to digest and provides immune boosting factors

Instant formula is manufactured, but provides consistent nutritional alternative that offers caregiver flexibility. Infant formulas are fortified with vitamin D

DHA requirements and benefits during lactation

200-300 mg/day

increases membrane fluidity (brains, eyes, CNS)

enlarges lipoprotein particles

better transmission of signals

essential for retinal development

associated with higher IQ

found in seafood

2 servings fatty fish/week

protein requirements during lactation

additional 25 g of protein

calorie requirements during lactation

energy needs varies by activity level

600ml/day=700 cal

+330 kcal/day for the 1st 6 months and +400 kcal/day afterward

prevention strategies for engorgement

nurse frequently—newborns may nurse every 1-2 hrs

prevention strategies for letdown failure

relaxation techniques

massaging

moist heat

prevent strategies for plugged ducts

complete emptying of breasts and changing position of infant while feeding

lecithin to emulsify fat in milk

prevention strategies for infection

feed on demand

don’t skip feedings

drain the breast

alternate sides

recommendations for alcohol

wait 2-3 hours after drink

recommendations for nicotine and tobacco

can transfer into breast milk. so avoid

wait at least 95 mins after smoking

nicotine can lower prolactin and oxytocin levels

caffeine recommendations

limit daily intake, only 1% in plasma

can make baby more active

artificial sweeteners recommendations

small amounts of sweeteners can alter taste of breast milk and could mild digestive sensitivity

amount of time breastmilk can be stored in the fridge and freezer

fridge 4 days

freezer 6 months

hormones affecting milk production and lactogenesis

prolactin

insulin

progesterone

oxytocin

hormones altered in breast milk

leptin

insulin

ghrelin

vitamin D recs

400 IU

vitamin K recs for infants

single dose injection .5-1 mg

frequency of feeding for infants

10-12 times per day

letdown failure

when milk does not eject from the breast

very uncommon

oxytocin nasal spray may be prescribed

hyperactive letdown

streams of milk from from breast

mother should express milk until the flow slows then allow infant to nurse

engorgement

breast are overfilled

results with supply and demand process not yet established

infection

mastitis is inflammation of the breast

1-33% of women

may be infective or non infective

common at 2-3 weeks postpartum

low milk supply

diet, stress, not emptying breasts, not feeding enough, use of estrogen
galatogogue drug used to increase prolactin levels

gag reflex

prevents infant from taking things into lungs

oral search reflex

infant opens mouth wide when close to breast and thrusts tongue forward

rooting reflex

infant turns to side when stimulated on that side

hormones impacting lactation

estrogen

progesterone

human growth hormone

human placenta lactogen

prolacftin

oxytocin

estrogen on lactation

ductal growth

mammary glands differentiation with menstruation

progesterone on lactation

alveolar development

after onset menses and during pregnancy

human growth hormone on lactation

development of terminal end buds

mammary gland development

human placenta lactogen on lactation

alveolar devleopment

pregnancy

prolactin on lactation

alveolar development and milk secretion

pregnancy and breastfeeding]

inhibits ovulation

oxytocin on lactation

letdown

from onset of milk secretion to weaning

prevents hemorrhaging

lowers BP

stages of lactogenesis

1: milk formation begins
2: increased blood flow to breast; milk comes in

3: milk composition is stable

casein

facilitates calcium absorption

gives milk white appearance

whey

immunoglobulins, enzymes

some minerals, hormones, and vitamin binding proteins

more in early milk

both whey and casein in late milk

non protein nitrogen

~20-25% nitrogen in human milk

used to make nonessential amino acids

benefits of protein in milk

growth factors

binding prtoeins

bifidus factor

enzymes

lactose

dominant carb

enhances calcium absorption

oligosaccharides

medium length carb

second dominant

prevents binding of pathogenic microorganisms to gut, preventing infection and diarrhea

vitamin A

content in colostrum is double that of mature milk

yellow color from beta carotene

vitamin E

level linked to milks’ fat content

not adequate

vitamin K prevents

blood clotting

water soluble vitamins reflect

mothers diet

most likely deficient water soluble vitamin

b6

vitamin b12 and folate

bound to whey

trace minerals in milk

zinc: bound to protein and highly available. rare defect in mammary gland uptake of zinc may cause zinc deficiency that appears as a diaper rash

flouride: influenced by mothers diet

high lactose content of foremilk may

cause diarrhea or greenish stools

vitamin d in milk

prevents and treats rickets

provides ling long benefits

benefits of WIC

free breast pump

counseling

food assistance

food packages

who is eligible for WIC?

breastfeeding women

pregnant women

children

low income

exercise and breastfeeding

moderate exercise

aerobic activity enhances fatty acid mobilization

restriction in energy intake enhances prolactin

tooth decay

caries can occur in children who are breastfed

risk factor frequency after 1 year

all children should be seen 6 months after 1st tooth or at 1 yr

cholesterol

higher in human milk

appears to be related to lower blood cholesterol levels later in life

effect of maternal diet on fat composition

fatty acid profile reflects mothers diet

low dat diet with adequate carbs and protein, milk is increased in medium chain fatty acids

how do HMOs influence cognitive development?

prebiotics diminish gut imbalance and reduces inflammation from immature intestine to developing brain

increased formation of short chain fatty acids which are substrates for brain signaling