Chapter 7

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What causes late jaundice? What is the sign of late jaundice?

- A substance inside the milk that INCREASES INTESTINAL ABSORPTION OF BILIRUBIN - Individual variations in ability of infant to process bilirubin - greater than 16 mg/dL for over 24 hours

how to minimize the effect of maternal medications

- AVOID long acting forms - Schedule doses carefully - Evaluate the infant - Chose drug that produces least amount inside milk

Late Jaundice takes place when? and is known as ?

- After day 5 Known as breast milk jaundice

Symptoms in mother of hyperlactation

Breasts not drained completely or plugged ducts Leaking between feedings Pain during letdown

Why is the production of bilirubin in the neonate double that of an adult?

Due to the breakdown of fetal erythrocytes

Two types of Jaundice in breast feeding infants

Early and Late

Management of mastitis

Effective milk removal

What is the most frequent cause of infant readmission into hospitals?

Elevated Bilirubin

Permanent neurological damage can arise if there is ...

Elevated Bilirubin that is not resolved

Characterized by breast overfilled with milk

Engorgement

T O F: It is not possible to breastfeed twins, triplets and etc.

FALSE

T o F: A low allergen maternal diet is NOT associated with reduction is distressed behavior of the infant

FALSE

T o F: Breastfeeding does not provide advantages that outweigh risks from potential pollutants

FALSE; Breastfeeding DOES provide advantages that outweigh the risks from potential pollutants

What intervention can be used with Pathological Jaundice?

Phototherapy

What is Milk Banking Referring to

providing human milk to infants who cannot be breastfed by their own mothers

Variables to consider with taking medication:

Pharmacokinetic Properties Time-averaged breast milk/plasma drug concentration Drug exposure index, dose, strength Age, feeding pattern, health

what percentage of breastfeeding women experience mastitis?

33%

Where are most medications excreted?

Breastmilk

Herbs that may increase milk supply

Fenugreek

Cause of Physiological Jaundice include

- Breakdown of RBC which releases bilirubin - Immature Liver

Causes of pathologic jaundice

- Macrocosmic infants - Intestinal Obstruction - Hypothyroidism - Hemolytic Disease - Erythrocyte Disorders

When should a mother avoid breastfeeding?

- if infant has rare metabolic disorder - Infected by HIV - Has TB - Prescribed meds/cancer meds/antiretroviral meds - Undergoing therapies

What percentage of caffeine intake is found in maternal plasma?

1%

How much higher is the concentration of nicotine in mothers breast milk than blood?

1.5 - 3 x higher

Transmission rates of HIV from mother to fetus are.... of prolonged breast feeding rates?

5-20% 35-40%

How long should one avoid oral contraceptives?

6 weeks-6 months post partum

Late pre term deliveries account for what percent of all single preterm births?

75%

How to prevent and treat Jaundice?

AAP reccoments phototherapy (American Academy of pediatrics)

Characterized as a stream of milk coming from the breast

Hyperactive Letdown

What can caffeine intake possibly cause in an infant?

Hyperactivity Fussiness Interference in sleep

What are the views on herbs during breast feeding?

Avoid taking them Seen as drugs Many considered not appropriate during lactation

Characterized as when the milk volume produced exceeds intake

Hyperlactation

What kind of drugs may reduce breast milk volume?

Combined Oral Contraceptives

The impact of alcohol on lactation:

Decrease oxytocin and letdown Affects odor of milk Decreases volume consumed by infant Interferes with infant sleep pattern

What are 3 risk factors for mothers in developing Hyperbillirubinemia/Kernicterus?

Diabetes Rh Sensitization East Asian/ Mediterranean Race

In a typical newborn, PHYSIOLOGICAL bilirubin levels rise/and peek when?

First 3-4 days and peek on the 5th day

What percentage of infants are prone to developing Jaundice for - Full Term Babies - Pre Term Babies

Full Term - 40% Pre Term - 80%

Pathological bilirubin substances are usually ______ mg/dL

Greater than 8 mg/dL

Early Jaundice is characterized by .... Two other names for it are?

Inadequate feeding/insufficient feeding .... - Breastfeeding Jaundice - NonBreast feeding Jaundice

Physiological bilirubin substance is usually....

LESS than 12 mg/dL for Americans white and black 10-14 mg/dL for Asian and Native Americans

Characterized as milk not ejecting from the breast

Letdown Failure

What are the risks of late PRE term infants?

Low glycogen and fat stores poor temperature control cardiorespirtory inability poor suck-swallow coordination

What is the most common reason for cessation of breastfeeding? --What causes this

Low milk supply -- Ineffective emptying or stress

How to manage plugged duct?

Massage Warm Compresses Empty breasts completely Change position of infant while feeding

Characterized as inflammation of the breast; infective or non-infective

Mastitis

What is GALACTAGOGUE?

Medicine -- Herbal Substance believed to increase milk supply

What causes Plugged Duct?

Milk staying within ducts

What is the term that is characterized by yellowing of the skin?

Neonatal Jaundice

Do flat or inverted nipples affect breastfeeding?

No

Bilirubin is a by product of ...

Normal Physiologic Degradation of Hemoglobin

How to prevent Engorgement

Nurse frequently -- cabbage leaves reduce discomfort

How to manage low milk supply?

Nurse or pump every 2 - 3 hours GALACTAGOGUE

Where does the mothers nipple approximate on the infant?

On the hard and soft palate

How to manage Letdown Failure

Oxytocin Nasal Spray Relaxation Techniques

What may form when experiencing a plugged duct?

Painful knot may form in breast

What is phototherapy?

Placing infant under fluorescent lights that assist in removing bilirubin from the skin ; The light is absorbed by the bilirubin, which converts it into a water soluble solution and is eliminated (without liver conjugating it)

Characterized by localized blockage of milk resulting from milk stasis

Plugged Duct

How to prevent sore nipples

Position infant properly onto the breast

Who is most likely to receive breast fed milk from milk banks?

Pre mature and sick infants

What are several risk factors for infants in developing Hyperbillirubinemia/Kernicterus?

Premature Later Pre Term Blood group incompatibility Hemolytic Disease

How to manage hyperlactation

Reduce production; Nurse baby on one side only Cabbage leaves Cold compresses

What does early jaundice lead to?

Reduced milk volume levels/ Poor feeding

In a typical newborn, pathological bilirubin levels ....

Rises earlier, faster and lasts longer (within 24 hours)

How to manage flat or inverted nipples?

Roll nipple in between fingers or use breast pump prior to feeding

Kernicterus is characterized by ...

Severe Jaundice that causes brain damage

What causes mastitis?

Sore or cracked nipples/ Missing feeding / Mother slept through the night

Common breast feeding conditions include:

Sore, Flat, Inverted Nipples Letdown Failure Hyperactive Letdown Hyperlactation Engorgement Plugged Ducts /Mastitis Low Milk Supply

Symptoms in infant of hyperlactation

Spitting up Poor Weight Gain Difficulty maintaining latch

Herbs that may decrease milk supply:

St Johns Wort

T O F: At least 4 months of exclusive breastfeeding protects against dermatitis and wheezing

TRUE

T O F: Human milk is used as medical therapy for older children and adults with certain medical conditions

TRUE

T O F: Infants born prior to full term (LATE PRE TERM;34-37 weeks) will be immature when breastfeeding and may make it complicated

TRUE

T O F: Most breastfed children will become jaundiced

TRUE

T O F Human milk should be fortified properly for an infant born weighing less than 1.5 kg

True

How to manage Hyperactive Letdown

Wait for flow to slow down Express milk until flow slows

What drug is transferred and concentrated in breast milk/metabolized by nursing infant?

Weed

What drug may alter DNA/RNA formation and neurotransmitter systems needed for growth

Weed

When can caffeine possibly accumulate in infants?

When younger than 3-4 months


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