Lactation

levels of ____ decrease with the delivery of the infant

progesterone and estrogen

removal of ____ allows ___ to stimulate production of alpha-lactalbumin

removal of progesterone → prolactin

what is released from the anterior pituitary and causes milk production?

prolactin

when the breast is stimulated it inhibits ____ from the hypothalamus

inhibits dopamine release → therefore leading to the release of prolactin (bc dopamine is a prolactin inhibiting factor, so inhibit the inhibitor)

what is released from the posterior pituitary gland to stimulate myoepithelial cells to contract and eject milk from the alveolus?

oxytocin

prolactin is released from the ___ and oxytocin is released from the ____

prolactin: anterior pituitary

oxytocin: posterior pituitary

infant suckling leads to stimulation of tactile sensors in the areola leading to the release of ___

oxytocin

the act of suckling causes the inhibition of ____ leading to ___

inhibition of dopamine leading to increased prolactin

what is the first milk produced that gets converted to mature milk

colostrum

what is important for the passage of immunity from mother to infant?

immunoglobulins in the breast milk

what is rich in immunoglobulins (esp secretory IgA) and contains more protein and less fat

colostrum

levels of secretory IgA are highest in ___

colostrum

____ is complex and contains carbs, fats, proteins, cellular products, minerals, hormones, etc.

mature breast milk

what vitamins are low in infants and low in breast milk, so we need to give suppllementation?

vitamin K and D

What is the proper positioning for milk transfer to baby? what is the first step?

first step: latch-on

positioning: ear, shoulder, and hip should all be in line

what is the recommendation for breastfeeding?

exclusive breastfeeding for 1st 6 months, then complementary foods with continued breast feeding after 6 months

what are some of the advantages of breastfeeding for mom and baby? (5)

immunological, nutritional, economical, psychological, and decreased risk of disease

Explain some contraindications for breastfeeding (9)

infant has galactosemia, mom with HIV and not on ART or on ART but high viral load, mother has human T-lymphotropic virus I or II, illicit drug use, ebola virus, untreated bucellosis, certain meds, active HSV infection, monkey pox virus

What are some indictions for a mother to not breastfeed temporarily but can feed expressed milk? (2)

untreated active TB or active varicella that developed between 5 days prior to delivery to 2 days following delivery

What are 3 complications of breast feeding?

breast engorgement, mastitis, and breast abcess

what is this?

pt presents with breasts that are painful and tender and results in firm and swollen breast tissue

breast engorgement

when are some times breast engorgement can occur?

3-7 days after delivery (during peak milk production) OR anytime where there is inadequate drainage of milk from the breast (infrequent or missed feedings, inadequate feedings, or a change in feeding schedule)

what can lead to dysfunctional breast feeding as the infant is unable to latch as well as mastitis if not treated?

breast engorgement

what is the prevention and treatment of breast engorgement?

prevention: frequent suckling

tx: manage sx and frequent breastfeeding of the infant

what is this?

inflammation of the breasts, results form ductal narrowing that leads to inadequate milk drainage

lactational mastitis

Explain mastitis and bacterial infection

if stagnant milk persists this can lead to bacterial infection with local spread to the surrounding tissue leading to → inflectional mastitis

what is this?

edema, inflammation, and compression of additional milk ducts can occur

lactational mastitis

What is this?

sx: swollen, tender region of breast with erythema and fever, can have malaise, chills, flu-like sx

lactational mastitis

what is this?

large area of the breast demonstrating swelling and skin erythema with fever >38.3 degrees C, may also include systemic complaints

bacterial mastitis

when is breast milk culture indicated vs not?

not indicated: mastitis

indicated: abscess

treatment for all pts with lactational mastitis is aimed at what?

ways to maintain flow of breast milk

what are some ways to treat lactational mastitis?

rest and fluids, supportive bra, avoid nipple shields and minimize breast pump usage, pain relief with cold or warm compress, acetaminophen or ibuprofen

_____ would include persistence of sx beyond 24-48 hours or accompanied by systemic symptoms like fever

sign if bacterial infection (bacterial mastitis)

how do we treat bacterial mastitis?

same as regular mastitis but add abx, continue breastfeeding even while taking abx

what abx do we give to treat bacterial mastitis?

10-14 days course of dicloxacillin

What is this?

sx: fever, malaise, and localized painful area of the breast; defined fluctuant area in the breast

breast abscess

how do we manage breast abscess?

serial percutaneous needle aspiration under US guidance to drain abscess, abx, and frequent milk removal from the breast