LCexam Bella

HPL

"Human placental lactogen (HPL), also called human chorionic somatomammotropin, is a placental protein hormone that has both lactogenic and somatotropic effects that may facilitate mammogenesis directly or act by competitively inhibiting prolactin receptors in the mammary tissue during pregnancy to delay milk production until after delivery." HEL

Bottle fed

(fyi broad palate normal) ortho issues and muslces in face speech disorders and narrow palate are more likely

Pyloric stenosis outflow valve of infant's stomach does not properly open to allow contents to pass

-sx: projectile vomiting nurse upright

Galactosemia inherited disease in which liver enzyme that changes galactose to glucose is absent

-tx: total weaning, non-dairy formula -without treatment infant will suffer from lethargy to cerebral impairment to mental retardation duarte version allows some BF

0-6 months

1 inch per month 1/2 inch per month

what percentage of a maternal dose of drug generally pass into breastmilk

1% Consider Lipid solubility of the drug Molecular size of the drug Protein binding in the maternal circulation 1/2 life (x 5)

Four operational targets from the 1990 Innocenti Declaration:

1. Appoint a national breastfeeding coordinator with appropriate authority 2. Ensure that every facility providing maternity services practices "Ten steps to successful breastfeeding" set out in the WHO/UNICEF statement on breastfeeding and maternity. 3. Give effect to the principles and aim of the International Code of Marketing of Breast-milk Substitutes and subsequent relevant Health Assembly resolutions in their entirety. 4. Enact imaginative legislation protecting the breastfeeding rights of working women and establish means for its enforcement.

Heart beat normal/ term

120-160 BPM bradycardia and tachycardia can hinder BF (suck swallow breath)

Latch angle

120-160 degrees optimal

Wet diapers

2-6 diapers in first 48 hours of life 5-25 times per 24 thereafter

Phastic bite and transverse tongue

28 weeks phastic bite (rhythmic opening and closing of jaw) is triggered by gum stimulation and transverse tongue triggered by examiner running finger or stimulus over lower gum

Vit D

30 minutes per week in a diaper or 2 hours per week fully clothed without a hat (LLL), any supplementation via mother, foods high greens, egg yolk ...

Average weight gain should be for an infant from Day 3 to 4mos.

30g per day (1.58oz) per day

Rooting reflex

32 weeks strongest at 40 weeks gone by 3 months

Tanner

5 stages of breast growth Tanner I no glandular tissue: areola follows the skin contours of the chest (prepubertal) (typically age 10 and younger) Tanner II breast bud forms, with small area of surrounding glandular tissue; areola begins to widen (10-11.5) Tanner III breast begins to become more elevated, and extends beyond the borders of the areola, which continues to widen but remains in contour with surrounding breast (11.5-13) Tanner IV increased breast size and elevation; areola and papilla form a secondary mound projecting from the contour of the surrounding breast (13-15) Tanner V breast reaches final adult size; areola returns to contour of the surrounding breast, with a projecting central papilla. (15+)

Innconeti Declaration part 2: Five additional operational targets were added in 2005:

5. Develop, implement, monitor and evaluate a comprehensive policy on infant and young child feeding, in the context of national policies and programs for nutrition, child and reproductive health, and poverty reduction. 6. Ensure that the health and other relevant sectors protect, promote and support exclusive breastfeeding for six months and continued breastfeeding up to two years of age or beyond, while providing women access to the support they require - in the family, community and workplace - to achieve this goal. 7. Promote timely, adequate, safe and appropriate complementary feeding with continued breastfeeding. 8. Provide guidance on feeding infants and young children in exceptionally difficult circumstances, and on the related support required by mothers, families and other caregivers. 9. Consider what new legislation or other suitable measures may be required, as part of a comprehensive policy on infant and young child feeding, to give effect to the principles and aim of the International Code of Marketing of Breast-milk Substitutes and to subsequent relevant Health Assembly resolutions.

% of glandular tissue lies within 30mm of the nipple?

65%

Cerebal Palsy Signs Hypertonia

80% of cases of CP are Hypertonic CP Awkward, uncomfortable movements Muscle resistance when attempting to move Muscle spasms and spastic movements Scissor-like movements in the legs Poor balance Random contractions in the muscles at any given time Gentle massage around lips before nursing, upright position, nipple shield to get tongue down from plate, possible pre-feeding massage do not put pressure on occiput as baby will arch Baby's often have strong gag reflex Other reasons like bilirubin encephalopathy

Nursing patterns (possibly in relation to 2 month old as practice exam was aimed at this age)

A cohort study in Australia demonstrated that 57% of exclusively BF babies took one or both breasts in no particular pattern over a 24 hour period

P Value Null means "common view of something"

A small p-value (typically ≤ 0.05) indicates strong evidence against the null hypothesis, so you reject the null hypothesis. A large p-value (> 0.05) indicates weak evidence against the null hypothesis, so you fail to reject the null hypothesis. p-values very close to the cutoff (0.05) are considered to be marginal (could go either way). Always report the p-value so your readers can draw their own conclusions.

Jaundice early on likely pathological cause is

ABO incompatibility

An infant that is exclusively breastfed and sitting unassisted is around 6 months old. How many hours on average will baby sleep in a 24 hour period

About 13 - 14 in a 24 hour period

physiologic jaundice pathologic jaundice

Appears after 24 hours peaks on the 2nd or 4th day then begins to go away between day 5 and 7. exaggerated by multiple factors such as: prematurity; bruising; delayed stooling; and inadequate intake, causing high levels of bilirubin that could lead to neurological damage. Occurs before 24 hours. Bilirubin level rises rapidly and persists more than 7-10 days. Based on history, clinical appearance, and bilirubin levels. ABO incompatibility is common cause

Colstrum

Arabella Hancock sticky, honey like, could be clear, orange yellow - all variations of normal. Often appears yellow as beta carotene present 2-3mg/fat compared to 4-5mg fat/100ml mature milk intake a=verge 7ml range 3-32ml High protein 90 when 10 casein - promote rapid growth higher sodium, choride, potassium and fat soluable vitamin e.g A (3 times higher on day 3, E and carotenoids. lower lactose as primary source immunologic, contains interferon a strong antiviral, fibronectin which makes phagocytes more aggressive so that they ingest microbes when not tagged by an antibody, contains PSTI - pancreatic secretory trypsin inhibitor in greater concentrations than mature milk protects pancreas and stimulates cell migration and proliferation and reduces cell apoptosis, protects and repairs newborn intestines. Newborn infant is deficient in CD14 which activates the immune system and protects against invasion. Oligosaccharide: an undigested element found in lactose that protects against disease, concentrations change over course of 3 days and serve as a decoy ti inhibit attachment of pathogenic organisms (along with IgA, Lactoferrin protect against sepsis etc) promotes lactobacillus bifidus (this organism discourages growth of other bacteria) and facilitates passage of meconium Lactoferrin binds to iron which makes it unavailable to pathogens. Giving a child iron rich foods before 6 months can overwhelm the lactoferrin leaving the iron available to pathogenic bacteria. Also aids absorption of iron. Protects against many but notably polio, Coxsackie b, several staph ecoli, IgA is highest in first 25 hours level up to 15 times higher than at other stage of lactation. coat gut, rapid gut closure, IgA, IgM, IgG (GAM). Infant can't can't produce this until 6 months - only availale in mothers milk cultural: some cultures believe it to be harmful and so do not give it to infant, instead waiting for mature milk :(

Dose related

BM is dose related for the infant exstends well past time of breastfeeding

Teach hand expression

Before pumping even in emergency situation

The ________ Consensus Conference met to develop a protocl for LAM in 1988

Belagio

acrocyanosis

Bluish discoloration of the hands and feet in the newborn; also known as peripheral cyanosis. Normal after birth but should not persist beyond 24 hours.

Bait and switch method

Bottle fed baby to breast feeding. Start with bottle, then move to nipple shield breast

Breast Shells

Breast shells with wide backs protect injured skin from rubbing on mothers bra or clothing

6-12 months 1.75 - 2.75 ounces per week ‡ 2 - 4 ounces per week 6-12 months length

By one year, the typical breastfed baby will weigh about 2 1/2 - 3 times birth weight. 1/2 inch per month 1/4 inch per month

Visual clue: Thin/loose skin, yellow, crying baby

Check for retained placenta... (odd exam question)

Facial nerve

Cranial nerves (CN) involved with sucking I (1) - Olfactory Sense of smell which affects perception of taste V (5) = Trigeminal VII (7) = facial IX (9) = Glossopharyngeal X (10) = Vagus XI (11) = Accessory/motor XII (12) = Hypoglossal/motor 1 Olfactory nerve sense of smell which also effects perception of taste V-Trigeminal Nerve (x 3 "tri" branches) LARGEST cranial nerve. Sensory and Motor! channels sensory information from the mouth (suck) soft palate (swallow) and nose (breathe). Maxillary branch gathers sensory input from cheeks, nose upper lip teeth Mandibular: Gathers sensory input from skin over lower jaw lip and teeth Opthalmic sensory not involved in suck swallow breath innerverates muscles that control swallowing VII-Facial Nerve (sensory and motor) Sensory fibers on "anterior part of tongue for sweet, salty and sour tastes. Motor fibers "involved with facial expressions and salivary glands." IX-Glossopharyngeal Nerve Sensory fibers of posterior third of tongue (bitter taste), Motor fibers go to the muscles used in swallowing, the the salivary glands and innervate the gag reflex X-Vagus Nerve (sensory, somatic, and autonomic) "Sensory, somatic, and autonomic. Function sensory information from palate, uvula, pharynx, larynx,esophagus,visceral organs. Motor connections to larynx and pharynx and heart. Autonomic nervous system functions: involved in heart rate, smooth muscle activity in gut, glands that alter gastric motility XI-Accessory Nerve Cranial nerve that has an internal branch which innervates voluntary swallowing muscles of the soft palate and pharynx, and an external branch, which controls muscles associated with the pectoral girdle XII-Hypoglossal Primary nerve of the tongue. Contraction of muscles of the tongue, involved with bolus preparation (peristaltic action) and therefore sucking and swallowing

Baby with Down Syndrome (hypotonic issues)

Dancer hold, cup feeding / sns - low muscle tone makes the action of BF hard so may need SNS

Intraductal Papilloma

Duct papillomas 'benign growh' mostly found in women older than 35. Bleeding may start during the first weeks of nursing (bright red blood)

Maternal Role Attainment Theory

Four stages: anticipatory, formal, informal, and personal.

Hyoid Bone

Free floating u shaped bone, connects structures involved in the anatomy and physiology of suck, swallow, breathe and head, neck control. Moves up and froward when swallowing.

• Early term: 37 0/7 weeks through 38 6/7 weeks • Full term: 39 0/7 weeks through 40 6/7 weeks • Late term: 41 0/7 weeks through 41 6/7 weeks • Postterm: 42 0/7 weeks and beyond

Full term babies can be SGA or large LGA

Relactation

Getting baby first to be interested in breast is first step to relactation - skin to skin etc

Milk Storage

Glass containers, polyethylene bags reduced IgA by 60% Stored human milk may have an altered taste due to the action of lipase on fat Warm room 80-90°F / 27-32°C 3-4 hours Room temperature 61-79°F / 16-26°C 4-8 hours (ideal: 3-4 hours) Insulated cooler / ice packs 59°F / 15°C 24 hours Refrigerated Milk (Store at back, away from door) Refrigerator (fresh milk) 32-39°F / 0-4°C 3-8 days (ideal: 72 hrs) Refrigerator (thawed milk) 32-39°F / 0-4°C 24 hours Frozen Milk (Do not refreeze! Store at back, away from door/sides) Freezer compartment inside refrigerator (older-style) Varies 2 weeks Self-contained freezer unit of a refrigerator/freezer <39°F / <4°C 6 months Separate deep freeze 0°F / -18°C 12 months (ideal: 6 months

Drug considerations

If baby is less than 24 hours - will not get much if mom needs short term Also consider if more than short term that initially junctions in breast are open "intracelluar spaces between lactocytes"

Preventing engorgement / immediate skin to skin bf in first hour

Immediate breastfeeding in the first hour ensures normal lactogensis stage II and prevents engorgment

arteries in breast

Internal thoracic, axillary, a branch of subclavian, lateral thorac

0-4 months 5.5 - 8.5 ounces per week 5 - 7 ounces per week †

It is acceptable for some babies to gain 4-5 ounces per week.‡

CMV

Killed by flash heating to 72 and method maintains integrity of milk properties.

Lactation Risk Categories

L1 Safest Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant. L2 Safer Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant; And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote. L3 Moderately Safe There are no controlled studies in breastfeeding women, however the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant. L4 Possibly Hazardous There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits of use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective). L5 Contraindicated Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.

Unilateral Cleft

Many can BF without assistive devices but around 1/3 (around 30 percent) will need to be supplemented - ideally with mothers expressed milk.

Galactocele

May appear as raised area but without redness

Lack of pigmented Areola

May indicate underlying pathological issue - mother in picture did not experience breast changes in pregnancy, had no visible areola (just spots) and did not produce any milk pp.

Fasting

Mothers are not required to do so for Ramadam (personal choice) does not effect milk nutritional status but Some MOTHERS have been found to be low in some vitamins and minerals afterwards.

T-Test

NB Two for T The two-sample t-test (Snedecor and Cochran, 1989) is used to determine if two population means are equal. A common application is to test if a new process or treatment is superior to a current process or treatment.

"Nestlé Kills Babies". 1974

Nestlé filed libel charges against the publisher

Spina Bifida & Chiari crisis

Neural Rube defect (12-14 week scan) Have oral sensitivity A myelomeningocele (pronounced my-e-lo-MENING-o-seal) is a defect of the backbone (spine) and spinal cord. Before birth, the baby's backbone, spinal cord and the structure they float in (spinal canal) do not form or close normally. A myelomeningocele is the most serious form of spina bifida. Suregery for this sometimes happens in utero from 24 weeks to repair Chiari crisis: brain stem malfunction causing life threatening apnea and bradycardia - symptoms weak or absent dry, stridor (grating sound/airway issue), apnea color changes

NO weight loss past DOL 8

Normal weight loss peaks day 2-3. 5-7% is normal. ideally gaining by 5 - 6 days. start to regain birthweight or gain weight by day 8- continued loss is v concerning. birthweight is expected by Day 10 - 14

Maternal Depression

Postpartum Blues characterized by emotional changes, insomnia, appetite loss and feelings of being overwhelmed - affects 30-80% women. Transient condition peaks of day 5 postpartum (on average) and resolves by day 10. Postpartum depression / AKA PPMD Postpartum mood disorder - 10-20% of mothers in first year of childbirth (thought to be much greater as some studies show that 50% of women with PPD are undiagnosed) Risk factors include prior history of depression, recent stressful life events, lack of social support, unintended pregnancy, and women that are economically stressed/disadvantaged, sexual abuse survivors Major depressive epsidoe impairs social and occupational functioning, symptoms cause significant distress and can include suicidal thought, symptoms may persist beyond 14 days and can last several months to a year if not treated. CNM suggests from 1 week - most sources I come across say from 2 weeks...? Cognitive therapy is first line for mild to moderate cases BF improves outcomes - possible due to Oxytocin release/bonding etc Most common drug of choice to use (if appropriate to type of symptom) sertraline others to be checked via Hale or similar. *Some* of the the drug considerations: absorption rate, molecular size, half life, binding, solubility of drug in water and lipids. Not to forget stage of lactation and junctions in breast!! Postpartum Psychosis is a psychiatric emergency- symptoms paranoia hallucinations, delusions suicidal thoughts with high risk of suicide or infantcide. It can occur in 1-3 of every 1000 has rapid onset. Women with biploar are at risk as are mothers with previous history of pp psychosis. **pp psychosis: women with bipolar are far more likely to develop it if they are unmedicated or sleep deprived. Care plans should include strong partner or family support. Refer to medical professionals and social workers, support with care plan effect on infant: scored lower on motor development tests

Buprenorphine (medical treatment for opoid addicts)

Prenatally and continue throughout breastfeeding 'Opoid's Burp'

Bilateral Cleft (and CPL)

Prone position

Reducing milk output through pumping

Pump until first let down and then stop

Reflexes for feeding

Rooting, sucking, swallowing, gag, cough

Swallowing

Seen as early as 12 weeks gestation

Sucking

Seen as early as 24 weeks gestation, innate reflex by 3 months changes from reflexive to voluntary

Gag reflex

Seen as early as 26 weeks

Haberman feeder positioning for complete cleft posterior placed small tongue

Sit forward position, feeder places pressure on tongue and brings it to an anterior position

2 month old

Social and Emotional Begins to smile at people Can briefly calm herself (may bring hands to mouth and suck on hand) Tries to look at parent Language/Communication Coos, makes gurgling sounds Turns head toward sounds Baby raising head and chest when lying on stomach Cognitive (learning, thinking, problem-solving) Pays attention to faces Begins to follow things with eyes and recognize people at a distance Begins to act bored (cries, fussy) if activity doesn't change Movement/Physical Development Can hold head up and begins to push up when lying on tummy Makes smoother movements with arms and legs

1 year

Social and Emotional Is shy or nervous with strangers Cries when mom or dad leaves Has favorite things and people Shows fear in some situations Hands you a book when he wants to hear a story Repeats sounds or actions to get attention Puts out arm or leg to help with dressing Plays games such as "peek-a-boo" and "pat-a-cake" Language/Communication Responds to simple spoken requests Uses simple gestures, like shaking head "no" or waving "bye-bye" Makes sounds with changes in tone (sounds more like speech) Says "mama" and "dada" and exclamations like "uh-oh!" Tries to say words you say Toddler sitting with mom playing xylophone Cognitive (learning, thinking, problem-solving) Explores things in different ways, like shaking, banging, throwing Finds hidden things easily Looks at the right picture or thing when it's named Copies gestures Starts to use things correctly; for example, drinks from a cup, brushes hair Bangs two things together Puts things in a container, takes things out of a container Lets things go without help Pokes with index (pointer) finger Follows simple directions like "pick up the toy" Movement/Physical Development Gets to a sitting position without help Pulls up to stand, walks holding on to furniture ("cruising") May take a few steps without holding on May stand alone

18 months

Social and Emotional Likes to hand things to others as play May have temper tantrums May be afraid of strangers Shows affection to familiar people Plays simple pretend, such as feeding a doll May cling to caregivers in new situations Points to show others something interesting Explores alone but with parent close by Toddler eating you from a blue bowl Language/Communication Says several single words Says and shakes head "no" Points to show someone what he wants Cognitive (learning, thinking, problem-solving) Knows what ordinary things are for; for example, telephone, brush, spoon Points to get the attention of others Shows interest in a doll or stuffed animal by pretending to feed Points to one body part Scribbles on his own Can follow 1-step verbal commands without any gestures; for example, sits when you say "sit down" Movement/Physical Development Walks alone May walk up steps and run Pulls toys while walking Can help undress herself Drinks from a cup Eats with a spoon

9 months

Social and Emotional May be afraid of strangers May be clingy with familiar adults Has favorite toys Language/Communication Understands "no" Makes a lot of different sounds like "mamamama" and "bababababa" Copies sounds and gestures of others Uses fingers to point at things Cognitive (learning, thinking, problem-solving) Watches the path of something as it falls Looks for things she sees you hide Plays peek-a-boo Puts things in his mouth Moves things smoothly from one hand to the other Picks up things like cereal o's between thumb and index finger Movement/Physical Development Stands, holding on Can get into sitting position Sits without support Pulls to stand Crawls

Weaning

Sodium increases and immunoglobulins are the last to go. Lactose is the first to go as involution happens.

Anticipatory

The anticipatory stage is the social and psychological adaptation to the maternal role. This includes learning expectations and can involve fantasizing about the role.

4-6 months 3.25 - 4.5 ounces per week 4 - 5 ounces per week

The average breastfed baby doubles birth weight by 3-4 months.

The World Alliance for Breastfeeding Action has five Core Partners that guide and assist the organisation to achieve its goals.

The five Core Partners are Wellstart International, Academy of Breastfeeding Medicine (ABM), La Leche League International (LLLI), International Baby Food Action Network (IBFAN), and ILCA

Formal

The formal stage is the assumption of the maternal role at birth. In this stage, behaviors are guided by others in the mother's social system or network, and relying on the advice of others in making decisions.

Informal

The informal stage is when the mother develops her own methods of mothering which are not conveyed by a social system. She finds what works for her and the child.

What 3 nerves supply the breast?

The intercostal nerves: IV, V and VI 4th intercostal important for let down and sensation to nipple and areola. fourth intercostal nerve enter the breast at Right breast at 8 o'clock, Left breast at 4 o'clock. fourth intercostal nerve enter the areola? Right areola 7 o'clock, Left areola 5 o'clock. Main role of sensory nerves to release of oxytocin for the milk ejection reflex.

Personal

The personal stage is the joy of motherhood. In this stage, the mother finds harmony, confidence, and competence in the maternal role. In some cases, she may find herself ready for or looking forward to another child

Where would the scar of an inframammary incision be located?

Under fold of breast

Hydrocephalus

Upright positions avoid contact on head

Water soluble vitamins in Human Milk

Vit C, B1, 2, Niacin, B6 folate b12biotin - mothers diet effects these (freezing lowers C )

Beneficence

a concept in research ethics which states that researchers should have the welfare of the research participant as a goal of any clinical trial or other research study.

Milk Plasma Ratio

a ratatio greater than 1.0 suggests that the drug may be sequestered in breast milk in high concentrations. "A M/P ratio of 4.0 means that the concentration of the medication in breast milk is four times higher than it is in maternal plasma (Riordan & Auerbach, 1998)" whereas a M/P ratio less than 1.0 is considered low and is indicative that only low drug concentrations will be transferred into breast milk. Although it is best to choose drugs with low M/P ratios, a high M/P ratio does not necessarily contraindicate the use of a particular medication by a breastfeeding mother (Hale, 2002). Even medication that has a high M/P ratio, if the maternal plasma concentration of the drug is small then the dose of drug entering breast milk will likely be small enough to be considered subclinical The pKa of a drug is the pH at which a drug exists equally in ionic and nonionic states. Drugs that have a pKa higher than 7.2 may be sequestered in breast milk to a slightly higher degree than those with a lower pKa (Hale, 2002). Since drugs that have a higher pKa tend to have higher M/P ratios, medications with a lower pKa should be chosen for breastfeeding women (Hale, 2002)

What ingredients of milk changes during the weaning process? Other weaning facts

a. increase in sodium and protein secretory epithelial cells undergo apoptosis and mammary gland membranes degrade

Pierre Robin (receeding chin)

absence of gag reflex, displacement of tongue and jaw Australian hold

gastric half-emptying time of an infant fed artificial infant formula to an infant fed breastmilk.

add times

Amoxycillin

although not contraindicated can result in loose / diarrhea stools

Oligerosaccaride

an undigested element found in lactose that protects against disease

Feeding amounts

appox 2.5oz per ppound of weight

Lumps that do not change in size before or after nursing

are ominous

Stools

at least 4 yellow bowl movements per 24 by DOL 4

in a non-breastfeeding mom, when do prolactin levels return to normal?

b. 2 weeks

Supernumary nipples can sometimes

be sensitive at times of mestration

4 week old milk consumption

between 25-26.5 oz per day (750-800ml)

Tongue position

between juncture of hard and soft palate

Lactoferrin

binds to iron which makes it unavailable to pathogens. Giving a child iron rich foods before 6 months can overwhelm the lactoferrin leaving the iron available to pathogenic bacteria.

Subgalael

bleeding at suture lines

Obesity

blunted prolactin response roll towel under breast, breast on pillow etc

Finger feeding

can aid with suck as doesn't interfere with oral skills - not an international choice perhaps

Lidocaine and other epidural drugs

can effect how infant kneeds and moves when placed skin to skin

Doll demonstration

can empower mother good teaching skill

Signs of infant "satisfaction"

closed lips at rest , relaxed hands

intracranial Intraventricular hemorrhage of the newborn Intraventricular hemorrhage (IVH)

common in infants born <30 weeks, no way to stop VH is more common in premature babies with: Respiratory distress syndrome Unstable blood pressure Other medical conditions at birth Less than half of babies with lower-grade bleeding have long term problems. severe bleedingleads to developmental delays and problems controlling movement. 1/3 babies with severe bleeding may die.

Lyozyme

continues to rise post 6 months, increases monthly so 3 month has more than 1 month. other components vary less

Compression stripe

deepen latch

a tool to assess the degree of maternal satisfaction with your Lactation Clinics should be both reliable and valid.

degree of consistency or dependability with which your tool measures the attribute it is designed to measure is most important feature. To be reliable it will need to be repeatable every time which makes it valid

maleficence,

describes a practice which opposes the welfare of any research participant.

Nipple shields

enable transfer, but may blunt prolactin response *according to test exam * when a mother's milk isn't fully copious that it should be done 4-6 times per day but can be slowly discontinued once milk supply is established. consider if baby's suck is compromised and this is reaso for shield - e.g. TT which would explain need for pumping

Ductal system proliferates with _____, while increases in size of lobes, lobules, and alveoli is due to ________. Nipples Areolar

estrogen and progesterone Prolactin HPL Remember on exam it asked which hormone has biggest influence over xxx growth on pregnancy and answer was HPL

hyperadenia

excess mammary tissue e.g. in axilla

MOST important when considering weaning

fading of tongue protrusion

Mature milk

fat levels are 28% higher at 1 year + so increases

Pregnancy weight gain

fat stores established during pregnancy are more easily mobilized during lactation and can therefore maintain the fat levels in breastmilk. Average weight gain in normal pre preg weight 25-35 expected.

A syringe may be modified (off label use) to aid a mother with

flat/ inverted nipples before nursing

The International Board of Lactation Consultant Examiners

formed to credential profession in 1985

Mature milk

from week 1 / 7 days, as composition changes and whey to casein balances out more infants stools become firmer (around 6 months 60 whey, 40, casein)

meperidine (pethidine)

has significant effect on infant if administered prenatal or first few days pp (junctions open?)

Plugged Ducts

have the infant lie flat on the bed and have the mother lean over him to nurse on the right side.

Preterm Milk / babies

higher in protein sodium and chloride and white cells like macrophages/neutrophils. Lysosome isn't killed by pasteurizing. Can't digest iron well BUT fats are most difficult for premature babies to digest. Premature babies are most widely recipients of donor milk. Iga oligosaccharides and lactoferrin protect against septicemia - lysosomes not as important for prevention. Bacteria in milk is lower one hour after collection as macrophages and neutrophils phagocyte. Vision is the last sensory system to develop during gestation and so is most affected by preterm nutrtion. Long chain fatty acids! IgA is highest in first 25 hours level up to 15 times higher than at other stage of lactation. Glass is best for storage of milk. Hard plastic is second.

Gestational diabetes

if BF for at least 3 months liklihood of diabetes 1 reduced

Paegts disease of nipple

if a person had something that looked like thrush that didn't respond with multiple treatment then needs to be checked by provider in case of Paget's etc

Family centered care is important for parents of NICU infants

if baby has eye patched parents can ask for them to be removed during visit. Due to immature liver and digestible systems and low levels of glucuronic acid have higher rate of physiological jaundice.

IBLCE was formed in

in March 1985 with a loan from LLLI. I wrote the paperwork. The first exam was also administered in 1985

Stages of grief - The five stages, denial, anger, bargaining, depression and acceptance

include denial and ending in acceptance and back and forth could take 3 or 4 years to resolve and accept although never forget

Fentanyl

indcited to cause issues pp and early weaning

What is the most beneficial part of birth spacing:

infant well being

Velum

is another word for soft palate

Small bruises around areola

is baby's latch off centre

The mean yield of colostrum for the first 24 h after birth:

is: 37 ml (1.25 ounces)

Question trickery!!! Breastmilk and weaning

it does not diminish in nutrients baby just requires additional from food. Watch out for this trick. Past 2 years MOST important reason for doing so is immunities not bond.

hypoxia

lack of oxygen (e.g at birth could result in cerebral palsy)

Breast reduction

look for scars, if nipple removed or near 4th intercostal then when was surgery done, looking at 5 years agofor reinnervation and recanillization

deep vein thrombosis - consider

low molecular weight heparin (standard tx for DVT) and warfarin are safe. Mother should avoid sitting for long periods Pumping may be needed if seprarated

Dancer hand

low tone (hypotonia) and for premature infants with less developed buccal fat pads

Antiseizure medication

majority ok to breastfeed - neurological benefits to infant ore important

Bifidus factor

makes infant stool smell yeastlike

Pumping for mastitis / abscess next to nipple

may be needed if breast abscess is so close to the nipple that baby can't feed /attach.

Extreme nipple pain with no clinical signs

may indicate sexual abuse past/present

Baby's breath after drinking BM

may smell like mother's food (e.g cantaloupe question)

nonmaleficence

means non-harming or inflicting the least harm possible to reach a beneficial outcome

4 month old

milestones milk intake 2/3 in course of day Social and Emotional Smiles spontaneously, especially at people Likes to play with people and might cry when playing stops Copies some movements and facial expressions, like smiling or frowning Language/Communication Begins to babble Babbles with expression and copies sounds he hears Cries in different ways to show hunger, pain, or being tired No image available for this milestone baby on floor with toy Cognitive (learning, thinking, problem-solving) Lets you know if he is happy or sad Responds to affection Reaches for toy with one hand Uses hands and eyes together, such as seeing a toy and reaching for it Follows moving things with eyes from side to side Watches faces closely Recognizes familiar people and things at a distance Movement/Physical Development Holds head steady, unsupported Pushes down on legs when feet are on a hard surface May be able to roll over from tummy to back Can hold a toy and shake it and swing at dangling toys Brings hands to mouth When lying on stomach, pushes up to elbows

Ovarian theca lutein cysts

mom may have high level of testosterone

Multiples

mother bonds with unit before individual children

Hypoglossal

motor of tongue

Urine Volume

normal neonate has 6- 44ml of urine in bladder at birth

Nipple area leaking milk

normal some ducts form on areloa

Blood blister (small red/dark red dot on nipple)

often caused by improper latch and sucking make sure nipple is further back in the infant's mouth - correct latch

A picture of 7-12 months nursing

one foot in mums face, pncher grip on clothing gymnastic nursing

Growth chart considerations

parents and history of growth? siblings, genetics? Is baby gaining consistently Is baby meeting developmental milestones? Is baby alert, happy, active? Is baby showing other signs of adequate milk intake?

Large Fibrous nipples

particular issue if small baby, check correct flanges if pumping - look for pinching/redness circular

Signs of postmaturity

peeling skin

external gestation

period of time from birth up to point baby has control over etremeity of movement in all 4 limbs - around 9 months

Breast Before pregnancy,

predominantly adipose tissue without extensive glandular or ductal development.

Sudden sensitive nipples missed menstration

pregnancy hormones can cause this

teenagers

pregnancy hormones will prepare body physically for breastfeeding just as any other preg woman. at risk for other issues education, support, preterm ...

PAF-AH Platelet activating factor acetylhydrolase

preventative against NEC, it hydrolyzes PAF to produce an inactive form

Scabbing on top part of nipple

probably TT

Bed sharing

promoted in safe circumstances

SIDS

risk higher at 2-4 months, supine postion good, smoking an issue co-sleeping a problem in unsafe situation whereby drugs alcohol etc used or unsafe surafce like sofa, waterbed, loose blankets etc

Cup feeding international choice for supplemental device

safe and easy to clean, affordable, may not prevent nipple confusion, is a learned skill

sucking thumb in utero

seen as early as 9-10 wks

Degree of breast fullness

short term indicator if milk supply

Pump

should have cycles 40-60 p.m

Bottlefeeding premature infants

shown to be stressful - CUP is better

Around 2-3 months is the time babies will lift their head well, and support with forearms

so from 10-14 weeks expect baby able to lay on stomach and push up to focus on something - also using forearms.

Finger feeding

stimulate rooting reflex, move finger into mouth until fingertip is just before the junction of the hard & soft palate

Preterm positioning

support shoulders as weak necks

Sensory integration issues light touch, sudden sounds, bright lights, mother can startle or overwhelm them

sx: sensory defensiveness by arching/hypertonia -tx: breastfeed in quiet place and pay attention to postural stability, side lying position

Secretory differentiation i

term 'lactogenesis I' mid preganancy

After a breast abscess is surgically drained.

the bacteria that caused it is walled off in the breast and will drain out through the incision.

Mammogenesis

the process of growth and development of the mammary gland in preparation for milk production. begins when the mammary gland is exposed to estrogen at puberty completed during the third trimester of pregnancy rising concentrations of estrogen, progesterone, and prolactin during pregnancy means that the breast increases in water, electrolyte, and fat content Increase in volume and increase = increased vascular supply to the breast - mammary veins become prominent - blood flow increases twofold - Size and pigmentation of the nipples also increase under the influence of rising estrogen concentrations. The sebaceous glands of Montgomery on the periphery of the areolae greatly enlarge; during lactation, they produce a secretion important for nipple conditioning and lubrication. The initial stimulation of mammary epithelium occurs during the first few weeks of pregnancy. By the second trimester, colostrum, the first milk, appears in the alveoli of the acinar glands in small quantities, reflecting the beginning of protein synthesis under the influence of prolactin. By the third trimester, the alveoli contain significant amounts of colostrum, the epithelial cells are laden with fat droplets, and the adipose tissue of the breast has been markedly reduced and replaced by functioning glandular units.

Hematemesis

throwing up blood

Tail of Spence also known as Axilla tail of Spence (named after James Spence)

tissue of the breast that extends into the axilla, can be swollen - needs to be able to drain. Have a mother nurse and see if swelling goes down

Why is it so important to communicate to a mum about frequent removal of milk in the first 1-24 hours after birth?

to increase/lay down prolactin receptors, removing will lead to refilling, oxytocin release leading to uterine contractions, prevention or management of engorgement

The World Alliance for Breastfeeding Action (WABA) was formed in 1991

to promote a strong/cohesive breastfeeding movement

Phenylketonuria genetic disorder where lack enzyme that changes phenylalanine to a form that the body can use

tx: immediate dietary restriction of phenylalanine, give breastmilk and supplement of phenylalanine free milk, avoid: eggs/meat/cheese/cow's milk -without treatment can cause skin rashes, convulsions, and mental impairment -wean slowly with phenylalanine monitoring along the way

Pagets disease

type of nipple cancer

6 month

up to 6 months 2/3 of babies nurse at night Social and Emotional Knows familiar faces and begins to know if someone is a stranger Likes to play with others, especially parents Responds to other people's emotions and often seems happy Likes to look at self in a mirror Language/Communication Responds to sounds by making sounds Strings vowels together when babbling ("ah," "eh," "oh") and likes taking turns with parent while making sounds Responds to own name Makes sounds to show joy and displeasure Begins to say consonant sounds (jabbering with "m," "b") mother enjoying 7 month old infant Cognitive (learning, thinking, problem-solving) Looks around at things nearby Brings things to mouth Shows curiosity about things and tries to get things that are out of reach Begins to pass things from one hand to the other Movement/Physical Development Rolls over in both directions (front to back, back to front) Begins to sit without support When standing, supports weight on legs and might bounce Rocks back and forth, sometimes crawling backward before moving forward nursing strikes, distraction during nursing sessions, teething disruptions, biting, slowed weight gain (distraction, more activity, low calorie solids displacing breastmilk), low milk supply prior to moms period if she has her cycle back, moms have lots of questions/concerns about sleep at this stage, return of menses

Rusty pipe syndrome

vascular engorgement", occurs just after delivery and bilateral common, Rusty pipes would be a darker brown, signaling older blood The syndrome occurs during the early stages of lactogenesis, is not associated with any discomfort and is thought to be caused by increased vascularization of rapidly developing alveolar, which are easily traumatized, resulting in blood escaping into the breast secretions"...

The biggest alert to indicate inadequate calorie intake is

weight ( not length, milestones or head circumference)

A Likert scale

would answer agree or disagree

Before 37 weeks is premature • Late preterm is 35-37 weeks • Moderately preterm (32-36 weeks) • Very preterm (<32 weeks). • Threshold of viability (23+0 weeks to 24+6 weeks of gestation) where medical care available and advanced • (LBW) under 5.5/8 2500g • (VLBW) infants under 31b (birth weight of less than 1500 g). • (ELBW) under 21b 30z (1000g)

• Most preterm infants weigh less than 5.5 pounds (2500g) if the rate of intrauterine growth is normal the infant is deemed AGA (appropriate for gestational age), if slowed known as IUGR (Intrauterine growth restriction) and then baby is SGA.