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breastmilk
composition of human milk
67
Other
Not Applicable
11/02/2010

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Cards

Term
Hypoplastic breasts
Definition
extend from 3rd to 5th rib (instead of 2nd to 6th) and have a space between them of 1.5 inches - correllated to low milk supply
Term
Montgomery glands
Definition
ductular openings on areola, become more prominent in pregnancy
Term
Where is the nipple found?  How many openings?  
Definition

4th intercostal space

4-18, average of 9 openings

Term
What do you do with a mom who has a true inverted nipple?
Definition

Pump and bottle feed - she will likely need to supplement

 

If not true inverted (umbilicated): an inverted syringe will help pull them out

Term
supernumery nipples
Definition
extra nipples along the "milk" lines, from axilla to groin
Term
what to do when moms has inverted nipples (not "true" inversion)?
Definition
Try for 5 min on each side and if doesn't work, pump for 10 minutes (and try again?).  
Term
breast compostion (glandular and fat)
Definition
2/3 glandular, 1/3 fat
Term
Cooper's ligaments
Definition
fibrous bands which divide adipose (fat) and glandular tissue of breast ... keeps breast together - no other gland needs this
Term
Tail of Spence
Definition

extra tissue that extends to axilla (armpit), swelling recedes in 3-4 days, ice OK, cabbage OK

 

if has nipple ducts - polymastia

Term
Which intercostal nerves supply the nerves to the breast?
Definition

4, 5, and 6

 

4 enters the breast from behind and supplies greatest amount of sensation

Term
which is most and least sensitive (nipple, areola, skin)
Definition
most: areola  least: nipple
Term
what do you look for in a breast assessment?
Definition

size, shape, symmetry, elasticity of skin

 

look for lumps, inflammation, swelling (edema)

Term
hypermastia or gigantimastia?
Definition
when breasts become extremely large during pregnancy, flat nipple, returns with next preg, need to supplement
Term
describe the internal features of the breast
Definition

Breast is divided in sections or lobes around the nipple

 

Each lobe is divided into smaller divisions called lobuli

 

Each lobuli is comprised of many alveoli, sites where breastmilk is stored

 

Within each alveoli there are secretory units called lactocytes (aka mammary secretory epithelial cells) where milk is synthesized

 


 


Term
what coats the drainage tract from the aveoli to the nipple?  
Definition
myoepithelial cells - they contract when stimulated by oxytocin and propel the breastmilk toward the nipple
Term
Name the six parts of the breast starting with the lactocytes
Definition
Lactocytes, aveoli, small ductile channel, larger ducts, large mammary ducts, nipple openings
Term
How do breasts increase in size after puberty?
Definition
laying down of adipose tissue
Term
What hormone might be to blame if a woman has trouble keeping a pregnancy and her breast are underdeveloped (leading to difficulty in breastfeeding)?
Definition
progesterone
Term
explain the roles of estrogen, progesterone, serum prolactin,  serum placental lactogen in role of breast development in pregnancy
Definition

estrogen-causes ductile system to proliferate

progesterone-increases size of lobes, lobules, and alveoli

serum prolactin-nipple growth

serum placental lactogen-areolar growth

Term
What happens to the breasts in the first trimester of pregnancy?
Definition

rapid growth and branching of ductile system

weight increases 400 to 600 grams

Term

What happens to the breasts in the last trimester of pregnancy?

Definition
distention of the alveoli with early colostrum, alveolar proliferation
Term
When is lactogenesis I?
Definition
16th week of pregnancy to when the milk "comes in"
Term
When is lactogenesis II?
Definition

When copious milk secretions start 24-102 hours after birth (requires the withdrawl of progesterone, and maybe removal of milk from breasts)

 

MAY BE DELAYED IF MOM HAS TYPE I DIABETES (insulin dependent)

Term
galactopoiesis
Definition
the maintenance of the established milk production (supply and demand, will continue as long as milk is removed)
Term
What do the FILs do?  (feedback inhibitors of lactation)
Definition
suppress lactation if milk is not removed from the breast, so less prolactin and oxytocin are produced
Term
what is special about weaning milk
Definition

increased sodium and increased immunoglobins

 

process of weaning is called involution

Term
what should be suggested to moms over 35?
Definition
insurance pumping and herbs because alveoli are starting to be replaced by stroma (connective tissue)
Term
name three things that colostrum does
Definition
seals the gut, laxative effect; clears meconium, teaches baby suck and swallow, less jaundice
Term
Colostrum is higher in:
Definition
sodium, potassium, chloride, protein, fat-soluble vit and minerals, immunoglobins
Term
Colostrum lower in:
Definition
fat, lactose
Term
describe transitional milk
Definition
days 6-13 postpartum, rise in lactose increase milk volume, beginning to change from yellow to white
Term
Markers of lactogenesis II
Definition
increase of lactose and citrate, decrease of protein and sodium
Term
how many calories per ounce does mature milk have?
Definition
20 kcal/oz
Term
The longer a mom breastfeeds, the higher or lower the fat content of the milk is?
Definition
higher
Term
what happens to caloric content of milk at the end of a feeding?
Definition
gets higher
Term
the milk in the second year of lactation has a increase or decrease of fat and calories?
Definition
increase
Term
what effect does high weight gain in pregnancy have on milk?
Definition
higher fat content
Term
true/false: human milk has highest lactose content of all animals
Definition
true
Term
What enzyme breaks down lactose into glucose and galactose (brain food)?
Definition
brush border enzyme lactase
Term
What does lactose do for an infant?
Definition

increase calcium absorbtion, prevent rickets, CNS development

 

Not dependent on mother's diet!

Term
What do oligosacchrides do for babies?
Definition

(carbohydrate) probiotic for baby, promotes growth of bifidus factor, helps prevent infections

 

it is not digested, all along the GI tract

Term
what increases the fat in milk?
Definition
lots of things affect it, but the shorter the duration between feeds, the higher the fat
Term
what affects fat composition of milk?
Definition
stage of lactation, gestational age, parity, and diet of mother (most important)
Term
Protein (whey) decreases or increases as lactation progresses?
Definition
decreases
Term
how does the ratio of whey to casein change over time?
Definition

early 90:10

mature milk 60:40

late lactation 50:50

 

most formulas are 60:40

Term
Casein breaks down into casomorphins - what do the do for babies and why is the amount in formula dangerous?
Definition
Make baby sleepy and too much might increase SIDS
Term
What are the big three proteins that contribute to the bacteriostatic and batericidal properties of breastmilk?
Definition
lactoferrin, lysozome, sIgA
Term
How many cal/day does a 2 week old need compared to a 6 mo old?
Definition

124 kcal/kg/day vs. 96 kcal/kg/day

 

So caloric needs go down as baby gets bigger!  

 

a 9lb baby needs 17 oz/day

a 17lb baby needs about 25oz/day

Term
difference between iron absorbtion of breastfed baby and formula fed baby
Definition

49% for breastfed baby, can go 6 mo without need of supplementation

 

4% for formula baby, but the more in formula, lower IQ

Term
Does maternal diet affect composition of minerals like calcium, phosphorus and magnesium, iron, copper and zinc?
Definition
No (unless hemmorage makes mom extremely iron deficient)
Term
difference between fat soluble and water soluble vitamins in composition of milk related to mother's status
Definition

fat soluble stored in mom, not as fragile as water soluble

 

water soluble changes depending on mom, easy to increase through mother supplementation

Term
preterm milk - what's higher?
Definition

immunoprotective factors (good for immature GI tract)

protein

nitrogen

long, medium, short chain fatty acids

sodium chloride

magnesium

iron

growth factors 

hormones

anti inflammatory factors

Term
preterm milk - what stays the same?
Definition

volume

calories

fat (not really sure)

lactose

linolenic acid

potassium

calcium

phosphorus

copper

vit b12

zinc

Term
gestational age of preterm, late preterm, early term, term, and postterm
Definition

preterm <34 weeks

late preterm 34-37 (6/7)

early term 37 (0/7) - 38 (6/7)

term 39-41 (6/7)

postterm>42 weeks

Term
what to look for infant assessment?
Definition
when crying, look at palate, tongue, approach/avoidance behavior, tone
Term
what is the best time to breastfeed?
Definition
quiet awake state
Term
what do babies with high tone need?
Definition
more calories, they are hard to cuddle, maybe mom smoked or took antidepressants when preg
Term
what is diuresis
Definition
a lot of water loss from baby after birth because of IV fluids (24 hour weight is closer to true birth weight)
Term
normal output by day 4
Definition
3 stools, 6 wet diapers
Term
why would you treat a "full term" baby like a preemie?
Definition
when showing signs of immaturity (hands open)
Term
what is the driving force of a baby in the first few months of life?
Definition
attachment
Term
three steps of nursing
Definition
1. ready to nurse 2. position of infant with nose to nipple 3. wide gape, grasp nipple
Term
peristaltic movements
Definition
using tongue to compress the teat up against baby's palate to squeeze milk out
Term
angle of gape
Definition
130 degrees
Term
what 4 things are required for successful lactation?
Definition
stimulation of breasts (quality feeding or pumping), breast tissue, hormone levels, receptor sites
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