Please enable JavaScript.
Coggle requires JavaScript to display documents.
Breast feeding (Infectious diseases (HTLV1 (Pathophysiology Can be…
Breast feeding
Infectious
diseases
HSV
Pathophysiology
Risk transmission if breast lesions
Management
Breastfeed if no breast lesions
Varicella
Pathophysiology
Chickenpox
Mother can pass on Ab in her breast milk
Management
Continue to feed to pass on Abs
HTLV1
Pathophysiology
Can be transmitted via breastmilk
Management
AVOID breast feeding
Risk factors
Prolonged breast feeding
HBV
Pathophysiology
Usually already be infected from exposure to maternal blood, amniotic fluid and vaginal secretions at delivery
Breastfeeding doesn't seem to increase risk
Management
Immunise at birth plus IgG
May breastfeed
HIV
Risk factors
Viral load
Duration of breast feeding
Lesions in mouth of infant/breast of mother
Management
AVOID breast feeding
Pathophysiology
Can be transmitted via breastmilk
CMV
Pathophysiology
Can be passed to child, but
does not cause serious illness
Management
Continue to breastfeed
Epidemiology
Commonest virus in human milk
Rubella
Management
Immunise mother post-partum
Continue to breastfeed
Pathophysiology
Can be transmitted in active infection
Infant gains maternal Abs so does not become ill
Physiology
Colostrum
Thick yellow fluid from 20w, small quantities following birth
High conc secretory IgA
Protein rich (gut maturation, immunity)
Milk
Rapidly increases in first few days
More energy efficient than formula
Properties
Anti-infective: IgA, lysozyme, IFN (antiviral), macrophages, lymphocytes
Nutritional: protein, lipids, fat, Ca, phos, Fe, low Na
Breastfeeding reflexes
Rooting, suckling and swallow reflexes to locate nipple
Tactile receptors of nipple send signals to hypothalamus then to anterior and posterior pituitary
PRL from anterior - milk secretion in breast tissue
OX from posterior - contraction of myoepithelia and ejection (let down reflex)
Starting
Initiation
Skin to skin ASAP after birth (inc breast feeding and duration
due to suckling reflex)
Frequency
Varied; demand feeding is encouraged (less weight loss post-partum, easier feeding, increased duration of feeding thereafter, reduced breast engorgement)
Frequent feeding can cause hyperbilirubinemia in early post-partum period
Breast fed babies ~8x/d (6 in day, 2 at night)
Infrequent feeds in first 24h, increases gradually to day 5
Recommendation
WHO recommend exclusive breast feeding to 4-6m,
with continuation until 1-2y
Epidemiology
Initiation rates ~80% at birth
WHO recommend exclusive breastfeeding
for first 6m of life
Advantages
Mother
Contraception
Lactational amenorrohea 99% effective
up to 6m, 97% by 12m
Reduced cancer
Premenopausal BC ovarian cancer
Uterine involution
Thus reduceed PPH risk
Reduced osteoporosis
Baby
Reduced infection
Gastroenteritis (including Giardia),
UTIs, URTI/LRTI, OM
Necrotising enterocolitis (premature infants)
Reduced atopy
Asthma, eczema, hayfever
Reduced cancer
Leukaemia
Reduced CVD
Obesity, DM, HTN
Bonding
Ideal nutrition
For first 4-6m of life
Disadvantages
Baby
Unknown intake
Difficult to gage other than by weight
Weigh every few days for first few weeks, then weekly until well established
Sufficient milk
May be difficult to produce enough for e.g. twins
Tx with fluids, nutrition, medications (DA antagonists, TSH, oxytocin)
Donor breast milk (milk bank) on neonatal units
Supplementing with formula milk
Infection
HIV, HBV, CMV
Nutritional inadequacy
If beyond 6m without introduction of solids
Failure to thrive, rickets
Vitamin K deficiency
Haemorrhagic disease of the newborn
Supplementation needed
Environmental contaminants
Drug, alcohol, caffeine
Mother
Sore/cracked nipples
Incorrect attachment
Rest and analgesia
Reduced flexibility
Family cannot help
Public places
Emotional upset
Difficulty with starting
Drugs
Reducing milk
production
DA agonists
Bromocriptine
Carbergoline
5HT agonists
Ergotamine
Alcohol
a/B agonists
Pseudephineprine
Hormones
Oestrogens
Progestrogens
Tamoxifen
CI in
breastfeeding
Abx
Tetracycline
Chloramphenicol
Sulphonamides
DA agonists
Bromocriptine
Carbergoline
Antipsychotics
Lithium
Other
Amiodarone
Iodides
Cytotoxics
Antineoplastic agents
Methotrexate
5HT agonists/RIs
Ergot alkaloids
Fluoxetine
Recreational
Caffeine
Alcohol
Cocaine
Marijunana
Antihypertensives
ACEI
Acebutalol
Contraindications
HIV+ with detectable viral load
Certain medications
Antimetabolites
Antithyroid drugs
Amiodarone
Opiates
Definition
Nutrition of neonate with
breast milk +/- formula