Breast feeding PowerPoint Presentation

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Breast feeding *Neonatology:- Feeding What are the advantages of breast milk or breast feeding? Breast feeding: Availability ; cheep ; decreased incidence of breast cancer : improve mother infant bonding.

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Physiology of location: -preparation of breast for lactation:- a) During pregnancy: estrogen ;progesterone ; placentae lactogen development of acini and duct system b) In puerperium: Milk secretion initiated by prolactin.

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c) Maintenance: 1) prolactin. 2) suckling or breast feedingreflexes are the most powerful stimuli.

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Maternal reflexes:- Initiated by suckling of the nipple.1) Nipple erection reflex.2) Prolactin reflex: sensory stimuli to hypothalamus Anterior-Pituitary prolactin glandular cells of breast acini milk secretion .

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(3) Oxytocin reflex (let down reflex or milk ejection reflex) from post. pit contraction of neuroepithelial cells Surrounding alveoli ejection of milk.

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Neonatal feeding reflexes:- 1) Rooting reflex: touching the check or circumaural area leads to turning the head to the side of the stimulus leading to opening the mouth seeking for the nipple.2) Suckling reflex: tactile stimuli of the nipple or aereolar tissue filling the mouth leading to milking action by tongue against hard palate.

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3) Swallowing reflex: follows suckling or allows interruption to breathing to prevent choking during swallowing.

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Composition of breast milk:- Colostrum: Bright lemon yellow ; alkaline ; viscous fluid secreted during first 5-7 days : compared to mature milk it is : 1) More rich in protein (2.3gm/dl) but less CHO or fat.

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2) Very rich in immunoglobulin especially IgA.3) rich in cholesterol , Na , K , Cl , Zinc , Copper , leucocytes ( macrophages , lymphocytes )Antibacterial ( lactofissin , lactofirrin )more rich in Vit.A than mature milk.

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4) Laxative effect by enhancing GIT motility leading to prevention of meconium blood formation which is the most common cause intestinal destruction. 5) reducing enterohepatic circulation and prevent hyperbilirubinaemia.

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* In summer weather when colostrumn is in small amount and due to hot weather dehydration may occur manifested by fever ; when baby is alert and reddish in colour.R: oral hydration ; if severe degree leading to IV fluids should be given.

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Advantages of breast feeding:-1) Balanced diet.2) Anti-anaemic.3) Anti-allergic.4) Anti-rechitic.5) Anti-infective.

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1) Balanced diet:1- protein: 70% soluble ; easily digested.2- fat: essential long chain ; needed for brain develop.3- high fat: in hind milk satiety .4- high cholesterol: myelination of nervous system.5- high lactose galactose brain growth.

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6- colostrum: increasing zinc prevent necrotizing enterocolitis.7- high content of E,C,D,A and niacin.8- decreasing phosphate prevent neonatal hypoealcemic convulsions.

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2) Anti-anaemic: Lower nisk of iron deficiency during the first 6 months of life because: a- Higher iron content (1.5 times cow's milk).

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b- Better iron absorption due to acidic lawel medium and to the presence of large amounts of vitamins C,E and copper. c- No iron loss in stools ( allergy to cow's milk can lead to repeated microhemorrhages ).

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Physiology:- At birth Hb 17.5-22.5 mg% hematocrit 55% * HbF 70% ( , ) adult Fb 30%

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HbF is high intrauterine due to: 1- lower oxygen solution: oxygen tension in the uterus is 68% in comparison to outside the uterus oxygen tension is 98%. 2- very high metabolic rate needing more oxygen consumption which leads to relative hypoxia  stimulating erythropeiosis of the haly to increase cavaige capacity in the blood.

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* After heath there is gradual decrease in gamma chain and gradual increase in beta chain till full switch off at six months (i.e. thalassaemia becomes apparent). * Sudden drop of erythropiosis (3 months)  rest in bone marrow ; this added to increase growth of the fetus and increase in blood volume ( dilution of blood ) + Aging in RBCs ( fetal Hb RBCs life span is 90 days ). These will lead to paller of the skin  physiological anaemia.

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Antioxidants can be given in first 3 months vit.E,A,C to increase iron and calcium absorption. * Iron should not be given in first 3 months.

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Vit.E and C are very important as baliy may need oxygen resusetation , as it can cause : 1- increased rate of RBCs destruction or increases physiological anaemia. Vit.E causes stabilization of RBCs cells leading to decrease in the incidence of physiological anaemia.

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2- Injuries to eye: reterolental fibroplasia and retinopathy of retinal blood vessels. Vit.E causes decrease in all these complications. 3- Broncho-pulmonary dysplasia : vit.E stalulises the pulmonary cells.

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* During the first 3 months iron is not needed as bone marrow not synthesizing RBCs in first few months. Supplying iron causes damage to RBCs  increasing hemolysis  increasing anaemia. * Breast milk contains lactoferriten which absorbs iron from bacteria  decreasing effect of infection. * Iron supplement flourishes the growth of bacteria  increasing rate of bacterial infection

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3) Anti-allergic: It protects against allergic diseases such as infantile eczema , allergic rhinitis , asthma and allergic gastroenteropathy.

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Mechanism: As in the intestinal tract there are minute pores which can pass high molecular protein directly into the circulation leading to antibodies formation i.e. complement formation in GIT  vasculitis  oozing of blood  anaemia ( on long run ).

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Breast milk has secretory immunoglobulin A (IgA) which lines the GIT and closing the pases leading to no leakage of lactoproteins into the circulation and no formation of antibodies.

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In the skin complement fixation leads to Eczema. In the nose: Rhinorrhoea. In R.T.  hyperactive airways  asthma , wheezing.

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4) Anti-ricketic: Breast milk lower incidence of richetic due to : a- higher content of biologically active vit.D. b- Ideal Cal/phosph ratio helps optimal absorption of both. (Ca/P ratio = 2:1).

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c- higher lactose content enhances calcium absorption from the gut. d- no calcium loss in stools in the form of calcium palmitate (insoluble)

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Early rickets:- Early signs or symptoms: Sweating; irritability; sleeplessness. - No exposure to direct sunlight.

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Craniotapes:- "up to 9 months only“ It is used to determine the hardness of the skull. It can be present in premature infants i.e. softness at the periphery of bones. * Ricketsial softness is at the centre; near the ossification centres.

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Requirement:- Full term baby needs 400IU/day Preterm 1000IU/day Egg yolk once daily supplies vit.D from 7th month. * Sever malnutrition leads to rickets in older children.

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5) Anti-infection property: i.e. protection from GIT and respiratory infections:- Breast milk has a living property ; it contains living cells from the mother i.e. Pyer's batches in the mother circulating blood reach the bowel of the baby ( supplying it with macrophages and lymphocytes ). They reach the baby Pyer's batches in the intestine and increasing it's cell-mediated immunity.

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Characteristics:- 1- Contains bacterial and viral antibodies (immunoglobulins). 2- Secretory IgA  protectine coating of GIT mucosa. 3- Lactoferrin (iron-binding protein) inhibits growth of E-coli by depriving it from iron. 4- Lactose and bifidus factor promote growth of protecting flora (lactobacilli).

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5- Lipase cells giardia lamblia and entamebia histolytics. 6- Milk macrophages phagocytose and kill bacteria and fungi. 7- Milk macrophages synthesize complement , lysozyme and lactoferrin. 8- Milk B-lymphocytes secrete IgA. 9- Milk T-lymphocytes involved in cell-mediated immunity.

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6) Anti-inflammatory:- Contains - tocopherol ; antioxidants , cytoprotectine agents.

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Management of breast feeding:- 1) Preparation of prospective mother: a- emotional support. b- education on benefits of B.F. and Technique. c- good maternal health and nutrition. d- avoidance of drugs that interfere with breast feeding i.e. ergometrine ; sedatives ; analgesics.

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2) Early initiating of breast feeding: Within first 30-60 minutes after delivery : a- Psychological bonding by skin contact is maximal. b- Rooting and suckling reflexes are maximal. c- Suckling stimulates milk secretion or let down reflex. d- Colostrum has nutritious anti-infective characters.

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Technique of breast feeding:- 1- Both hands and nipple should be clean. 2- Baby should be , warm ; not wet. 3- Mother relaxed (sitting or lying on her side). 4- Support of the breast during feeding.

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Criteria of good position:- 1- infant body is close to the mother. 2- infant body is turned to the mother. 3- infant whole body is supported (not only head or neck). 4- infant neck is straight or bent slightly back.

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5- how to carry and protect (as above). 6- Rooting reflex : by touching the baby cheek or lower lip with the nipple. 7- when mouth is open the nipple or lower part of the areola are pushed well back in the infant's mouth against it's palate ; so that hard palate compress and massage the milk senuses which lie beneath the areola.

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8- mother should be shown how to attach her baby to the breast:- The 4 criteria of good attachment: 1)) infant chain is touching the breast. 2)) infant mouth is widely open. 3)) lower lip is turned outwards. 4)) more aleady tissue above than below the mouth.

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9- Baby's face must not be buried in the breast (interfere with nasal breathing). 10- Continue feeding till baby releases nipple. 11- Mouth especially corners are wiped. 12- Baby is held vertically and tapped gently 2-3 times on the back to drive any swallowed air. 13- Baby placed in bed either lying on its right side or prone.

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Criteria for Adequate Breast feeding :- Baby feeds at least 8 times \ 24 hrs. 2) Baby is calm satisfied after feeds. 3) Baby sleeps well 2-4 hours after nuring. 4) Normal motion no constipation. Stools are semiformed ; must asd yellow in color soft to semiliquid : fermentive odor ; alid neation frequency one motion after each feed to one motion every 2-3 days.

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5) Normal amount of urine :- 6 or more / 24 hours. 6) Normal weight gain (20-30 gm/ day or 150-210 gm / week Can be assessed by :- a) Wt. charls. b) Test weighing :- infant is weighed at 4 days internal :- 1) at a fixed times of the day 2)under same circumstances ; same clothes ; before feeding * If the weight gain is 100 gm or more than amount of breast feeding is adequate.

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II) Criteria of under feeding in breast – fed infants :- Wt gain ; slow , irregular or statiorary fallowed by weight most consistent evidence. 2) Decreased amount of urine. 3) Crying unsatisfied after emptying both breasts. 4) Suckling of fists between the feeds.

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5) Stays in breast for a long period > 30 min. 6) Sleeplessness or v. short sleep. 7) Air swalloweing collics, vomiting, hunger stools. 8) constipation or hunger stool ( frequent, small, green color).

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3) Criteria of overfeeding in breast – fed infant :- Frequent regurgitation , vomiting collics. 2) Large bulky stools undigested curds. 3) Abdomined distesion colics. 4) Skin eruption sore buttorks. 5) Polyuria. 6) Excessive sweating at head.

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7) Baby overweight. Management :- nursing at regular intewals. (4 hrly ) b) small amount of boiled water levere feeds. c) Eliminate excess matemal diet. d) Removal of excess breast milk manually.

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Contraindication for breast feeding

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Temp contraindication :- 3) Eclanpsia 4) Delilty :- malign cardiac dis severe malnutrition. 5) Underdeveloped heasts or severly invented nipples.

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6) Pregnency :- not contraindication it's wise to stop lact. After 5th month of peg. Because mother can 4 afford the confined rutivints to the fetus. Humanytion of Cow's milk :- 50 ml milk boiling constant steaving to breek down large fat globules + 50 ml boiled water gradually inceases milk water ratio.