Chapter 7
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
