Chapter 25 NB Nutrition Breastfeeding Audio

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Chapter 25 Nutrition/ Breastfeeding

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Chapter 25 Pamela Dennis RNC-OB MSN:

Chapter 25 Pamela Dennis RNC-OB MSN Newborn Nutrition and Feeding

Recommended Infant Nutrition:

Recommended Infant Nutrition American Academy of Pediatrics (AAP) recommends infants be breastfed exclusively for first 6 months of life Breastfeeding should continue for at least 12 months If infants are weaned before 12 months, they should receive iron-fortified infant formula

Benefits of Breastfeeding:

Benefits of Breastfeeding Human milk designed specifically for human infants; nutritionally superior to any alternative Breast milk considered living tissue because it contains almost as many live cells as blood Bacteriologically safe and always fresh Nutrients in breast milk more easily absorbed than those in formula

Contraindications of Breastfeeding :

Contraindications of Breastfeeding Maternal cancer therapy or diagnostic and therapeutic radioactive isotopes Active tuberculosis not under treatment Human immunodeficiency virus Maternal herpes simplex lesion on a breast Galactosemia in infant

Contraindications of Breastfeeding—cont’d :

Contraindications of Breastfeeding—cont’d Cytomegalovirus Maternal substance abuse Maternal human T-cell leukemia virus type 1 Some medications may exert an untoward effect on breastfeeding infant Consult with practitioner or refer to Thomas Hale (2008)

Choosing an Infant Feeding Method :

Choosing an Infant Feeding Method Choosing infant feeding method Factual information about nutrition and immunologic needs met by human milk Potential benefits to infant and mother Inherent risks with infant formulas Nurse must provide information to parents in nonjudgmental manner and respect their decision

Choosing an Infant Feeding Method—cont’d :

Choosing an Infant Feeding Method—cont’d Cultural influences on infant feeding Cultural beliefs and practices are significant influences on infant feeding methods As many as 50 to 120 cultures do not give colostrum and only feed when the milk comes in U.S. born Hispanic women are less likely to initiate breastfeeding Muslim and Jewish cultures value breastfeeding

Nutrient Needs:

Nutrient Needs Energy Carbohydrate Fat Protein Water Vitamins Vitamin D Vitamin K Minerals

Overview of Lactation :

Overview of Lactation Milk production Female breast composed of 15 to 20 segments (lobes) embedded in fat and connective tissues; well supplied with blood vessels, lymphatic vessels, and nerves Within each lobe are alveoli, the milk-producing cells, surrounded by myoepithelial cells that contract to send milk forward into the ductules

PowerPoint Presentation:

Fig. 26-1. Detailed structural features of human mammary gland.

Overview of Lactation—cont’d :

Overview of Lactation—cont’d Milk production Ductules enlarge into lactiferous ducts and sinuses, where milk collects behind nipple Each nipple has 15 to 20 pores through which milk is transferred to the suckling infant After birth precipitate decrease in estrogen and progesterone levels triggers release of prolactin from anterior pituitary gland

Overview of Lactation—cont’d :

Overview of Lactation—cont’d Milk production Prolactin levels highest during first 10 days after birth Gradually decline but remain above baseline levels for duration of lactation Prolactin produced in response to infant suckling and emptying of breasts Lactating breasts never completely empty Milk constantly produced as infant feeds

Overview of Lactation—cont’d :

Overview of Lactation—cont’d Milk production Oxytocin: other hormone essential to lactation As nipple is stimulated by suckling infant, posterior pituitary prompted by hypothalamus produces oxytocin Responsible for milk-ejection reflex or let-down reflex Nipple-erection reflex is integral to lactation

PowerPoint Presentation:

Fig. 26-3. Maternal breastfeeding reflexes. A, Milk production. B, Let-down.

Overview of Lactation—cont’d :

Overview of Lactation—cont’d Unique properties of human milk Human milk contains antimicrobial factors Antibodies that provide some protection against broad spectrum of bacterial, viral, and protozoal infections Secretory immunoglobulin A is the major antibody in human milk

Overview of Lactation—cont’d :

Overview of Lactation—cont’d Unique properties of human milk Colostrum, a clear, yellowish fluid More concentrated than mature milk Extremely rich in immune globulins Higher concentration of protein and minerals Less fat than mature milk

Overview of Lactation—cont’d :

Overview of Lactation—cont’d Unique properties of human milk Composition changes during each feeding Fat content of breast milk increases Initially foremilk is released that: Is part skim milk: about 60% of volume Is part whole milk: about 35% of volume Provides primarily lactose, protein, and water-soluble vitamins

Overview of Lactation—cont’d :

Overview of Lactation—cont’d Unique properties of human milk Composition changes during each feeding Hindmilk, or cream (about 5%), usually let down 10 to 20 minutes into feeding Contains denser calories from fat for ensuring optimal growth and contentment Changing composition of human milk during each feeding requires breastfeeding long enough to supply balanced feeding

Breastfeeding: Mother and Infant :

Breastfeeding: Mother and Infant Assessment Infant Mother

Breastfeeding: Mother and Infant—cont’d :

Breastfeeding: Mother and Infant—cont’d Implementation Positioning Latch-on Milk ejection or let-down Frequency of feedings Duration of feedings Supplements, bottles, and pacifiers

PowerPoint Presentation:

Fig. 26-6. Correct attachment (latch-on) of infant at breast.

Breastfeeding: Mother and Infant—cont’d :

Breastfeeding: Mother and Infant—cont’d Special considerations Sleepy baby Fussy baby Slow weight gain Jaundice Preterm infants Breastfeeding twins

Breastfeeding: Mother and Infant—cont’d :

Breastfeeding: Mother and Infant—cont’d Expressing and storing breast milk Hand expression Pumping Types of pumps Storage of breast milk Being away from the infant Weaning Milk banking

PowerPoint Presentation:

Fig. 26-10. A, Hospital-grade electric breast pump. B, Manual breast pumps.

Breastfeeding: Mother and Infant—cont’d :

Breastfeeding: Mother and Infant—cont’d Care of mother Diet Weight loss Exercise Rest Breast care Breast self-examination

Breastfeeding: Mother and Infant—cont’d :

Breastfeeding: Mother and Infant—cont’d Care of mother Effect of menstruation Sexual sensations Breastfeeding and contraception Breastfeeding during pregnancy Mother with diabetes Breastfeeding and drugs Environmental contaminants

Breastfeeding: Mother and Infant—cont’d :

Breastfeeding: Mother and Infant—cont’d Special considerations Engorgement Sore nipples Monilial infections Plugged milk ducts Mastitis Hepatitis B and C

Breastfeeding: Mother and Infant—cont’d:

Breastfeeding: Mother and Infant—cont’d Role of the nurse in promoting successful lactation Baby-Friendly Hospital Initiative developed by the World Health Organization Instrumental in initiating breastfeeding Breastfeeding support and education Follow-up by the nurse after discharge

Formula-Feeding :

Formula-Feeding Rationale for formula-feeding Personal preference Influence of other significant family members Lack of familiarity with breastfeeding Breast surgery Infant formula may supplement breastfeeding if mother’s milk supply is inadequate

Formula-Feeding—cont’d :

Formula-Feeding—cont’d Parent education Readiness for feeding Feeding patterns Feeding techniques Bottles and nipples

Formula-Feeding—cont’d :

Formula-Feeding—cont’d Parent education Infant formulas Commercial formulas Cow’s milk–based formulas Soy-based formulas Casein- or whey-hydrolysate formulas Amino acid formulas

Formula-Feeding—cont’d :

Formula-Feeding—cont’d Parent education Formula preparation Vitamin and mineral supplementation Weaning

Key Points :

Key Points Human milk is the recommended form of nutrition for infants Provides immunologic protection against many infections and diseases Breast milk changes in composition: With each stage of lactation During each feeding As the infant grows

Key Points—cont’d :

Key Points—cont’d During prenatal period parents should be informed of benefits of breastfeeding for infants, mothers, families, and society Infants should be breastfed as soon as possible after birth and at least 8 to 12 times per day thereafter Objective, measurable indicators that infant is breastfeeding effectively

Key Points—cont’d :

Key Points—cont’d Breast milk production is based on a “supply-meets­demand” principle More the infant nurses, the greater the milk supply Commercial infant formulas provide satisfactory nutrition for most infants All infants should be held for feedings

Key Points—cont’d :

Key Points—cont’d Parents should be instructed about types of commercial infant formulas, proper preparation for feeding, and correct feeding technique Unmodified (whole) cow’s milk is not appropriate for feeding during first year of life