NDT Lactation Stage

• Lactation


  The production and secretion of breast milk from the mammary glands for the purpose of nourishing an infant

  
• Lactation


  • Estrogen and Progesterone stimulate breast development during pregnancy
  • Prolactin (released by anterior pituitary) stimulates lactogenesis (milk production)
  • Oxytocin (released by posterior pituitary) causes milk ejection into the ducts (let-down)
• Average daily milk production for the first 6 months is 750 mL
• Average daily milk production for the second 6 months is 600 mL
• Average energy content of human milk is 75 kcal per 100 mL
• Average protein content of human milk is 1.3 gms per dL (first month) and 1.15 gms per dL (in the next months)
• Milk Composition


  • Lactoferrin inhibits growth of iron-dependent bacteria in GIT
  • Secretory IgA works to prevent against bacterial and viral infections
  • Lysozyme protects infants against E.coli and Salmonella; for healthy gut flora
  • Bifidus Factor supports the growth of lactobacillus
• Milk Phases


  • Colostrum (0 to 5 days after birth)
  • Transitional Milk (5 to 14 days after birth)
  • Mature Milk (2 weeks onwards)
• Colostrum


  The liquid gold, produced in 0 to 5 days after birth, high in protein and fats, fat soluble vitamins, minerals, antibodies, immune cells, and growth factors, daily volume ranges is 2 to 29 mL per feed (providing 580 to 799 kcal per liter)
• Transitional Milk


  Produced in 5 to 14 days after birth, bluish white and with thinner consistency, high in fat, lactose, water-soluble vitamins, and increased calories

  
• Mature Milk


  Produced 2 weeks onwards, white, watery, & less concentrated, composed of 90% water for hydration and 10% macronutrients (CHO, CHON, Fat), each ounce contains 20 kcal

  
• Producing 100 mL of breast milk demands for 85 kcal expenditure
• Lactation inhibits ovarian activity


  By suppressing the release of the Luteinizing Hormone and interfering with the secretion of Gonadotropin-Releasing Hormone, causing a delay in ovulation hence acts as preconceptive
• Benefits of Lactation


  • Sufficient nutrient content & Economical
  • Lower incidence of infections and diseases
  • Provide antibodies
  • Promotes good jaw development
  • Psychological benefits
  • Weight benefits & Uterine Involution
  • Less risk for Breast Cancer
• Nutritional Needs during Lactation


  • Protein (EAAs play an important role in milk protein synthesis)
  • Calcium (Contributes to bone development & recovery)
  • Iron (Prevents anemia that may cause low milk supply)
  • Iodine (Prevents impaired neurological development)
  • Energy (Meets milk supply demand)
  • Cobalamin (Provides brain support and anemia prevention)
  • Vitamin C (Supports immune system and increase milk supply)
  • Vitamin D (Prevent calcium deficiency)
  • Fluids (Helps build and maintain good milk supply)

  
• Differences between Human Milk and Cow's Milk

  • Human Milk has 20% whey and 80% casein, more cysteine & taurine, lower methionine, phenylalanine & tyrosine, lower Ca, P, & Fl content, 50% Iron bioavailability

  Cow's Milk has 60% whey and 40% casein, lower cysteine & taurine, more methionine, phenylalanine & tyrosine, more Ca, P, & Fl content, 1% Iron bioavailability

  Human Milk has higher solute load (SPPC), more unsaturated fatty acids (linoleic), richer source of Vitamin E, contains 10-20 mg/dL cholesterol

  Cow's Milk has lower solute load (SPPC), more saturated fatty acids, less rich source of Vitamin E, contains 10-15 mg/dL cholesterol
• Most Common Lactation Problems


  • Breast Engorgement
  • Plugged Ducts
  • Mastitis
  • Sore Nipples
  • Low Milk Supply
  • Hyperlactation
  • Breast Abscess
  • Latch Problems
• Breastfeeding Contraindications


  • Infants with Galactosemia
  • Mothers infected with Human Immunodeficiency Virus (HIV), untreated Brucellosis, or suspected or confirmed Ebola virus disease
  • Mothers using substances such as opioids, cocaine, and PCP (phencyclidine)
• Reading Assignment: Breastfeeding Contraindications

  
• Infancy


  The first year of life (0 to 12 months) and is the period of most rapid growth after birth
• Infant Terminologies


  • Full Term (born between 37 to 42 weeks)
  • Preterm (born before 37 weeks)
  • Low Birth Weight (weighs 2.5 kg or less at birth)
  • Very Low Birth Weight (weighs <1500g at birth)
  • Extremely Low Birth Weight (weighs <1000g at birth)
  • Post-term (born at 42 weeks or more)
• During the first few days after birth, a baby loses weight (<10%)
• Birth weight doubles by the age 4 to 6 months and triples by one year
• Birth length increases by 9-10 inches by the end of first year
• Fontanels close by 2 years old
• Fat accumulates rapidly until 9 months of age
• At birth, brain is 25% of adult brain size and becomes 75% at 12-24 months
• Stomach capacity of infant at birth is 10 to 20 mL, it is 200 mL by 1 year
• By 6 months of age, biting and chewing are added to reflexes
• By 9 months of age, there is already a good closure of mouth
• Trust vs Mistrust


  Psychosocial stage of development in infancy
• Nutritional Needs in Infancy


  • Protein (For the baby's extensive tissue building)
  • Energy (Needed to meet infant's higher demand for BMR)
  • Carbohydrates (Galactose needed for brain cell formation)
  • Fat (Needed for the infant's developing nervous system)
  • Vitamins & Minerals (Ensure optimum body functioning)
  • Water (For hydration)
  • Vitamins A, Iron, & Zinc
• Nutritional Problems in Infancy

  • Regurgitation of milk
  • Hiccoughs
  • Constipation
  • Burns to mouth
  • Nursing-bottle Syndrome
  • Iron Deficiency Anemia
  • Allergies
  • Colic
  • Diarrhea
  • Galactosemia
  • Phenylketonuria
  • Maple Syrup Urine Disease (MSUD)
• Daily volume ranges of colostrum

  2 t 29 mL per feed (580-799 kcal per liter)