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Breast Milk: Facts

  1. Human breast milk is the preferred food for full – time babies.
  2. Breast milk is premixed at the right temperature and concentration.
  3. Breast milk has immunologic factors such as IgA, Lactoglobulin and maternal macrophages, which protect the infant from infections.
  4. Breast-fed babies have a lower incidence of upper respiratory tract infections and otitis media then their formula-fed counterparts.
  5. Breast milk also decreases the incidence of allergic diseases.

Maternal advantages to breast feeding includes a more rapid return to pre pregnancy weight and faster uterine regression.

Breast feeding also promotes maternal – infant bonding.


Supplementation of other nutrients is rarely needed in breast-fed infant.

Vitamin K
is present in low amount in breast milk and all new born infant should receive vitamin K at birth to prevent hemorrhagic diseases of the new born. Fluoride is recommended after 6 months of age. Vitamin D should be given if mother’s intake is inadequate or if there is limited sun exposure.

Iron
-fortified foods are introduced at 4-6 month of age.

Contraindications
of breast feeding
  1. Active or untreated tuberculosis, syphilis, HIV, galactosemia, and varicella.
  2. Herpes is a contraindication if there are active lesions present on the breast.
  3. Drugs are contraindicated in breast feeding,
    1. antineoplastics,
    2. Radiopharmaceuticals,
    3. Ergot alkaloids,
    4. iodides,
    5. atropine,
    6. lithium,
    7. chloramphenicol
    8. cyclosporine
    9. nicotine
    10. alcohol.
  4. Relative contraindications
    1. sedatives,
    2. tranquilizers,
    3. metronidazole,
    4. tetracycline,
    5. sulfonamides
    6. steroids.
  5. Mastitis is not a contraindication to nursing and frequent nursing on the affected side is recommended to prevent engorgement.

FORMULA FEEDING

 

Formula feeding is used as a substitute for or to supplement breast milk. Most commercial formulas are cow milk – based with modifications to approximate breast milk. They contain 20 calories / ounce. Specialty formulas ( soy, lactose-free, premature, elemental) are modified to meet specific needs.

 

Whole Cow Milk

 

Whole cow milk is good for baby cows and any human over 1 year of age. It has a higher renal solute load, which can be damaging to the kidney.

 

The Varying composition of breast milk

  1. Colostrum – Is the milk secreted during the first three days after delivery. It is yellow and thick and contain more antibodies and white blood cells. It is also rich in protein, Vitamin and mineral. It should never be discarded.
  2. Transitional milk – Is the milk secreted during the following two weeks. The immunoglobin and protein content decreases wile the fat and sugar content increase.
  3. Mature milk – Follows transitional milk. It is thinner and watery but contain all the nutrients essential for optimal growth of the baby.
  4. Preterm milk – The milk of a mother delivery prematurely contains more calories, higher, concentration fat, protein and sodium. The concentration of lactose calcium and phosphorus are lower compared to milk produced by mother of term infants.
  5. Fore milk – Is the milk secreted at the start of a feed. It is watery and is rich in protein its satisfies the baby’s thrist.
  6. Hind milk – Comes later towards the end of feeding is richer infant content and provide more energy and satisfies the baby’s hunger.

Table

 

Component

Human Milk

Cow Milk

Water / solids

Same

Same

Calories

67 / 100 ml

67 / 100 ml

Protein

1-1.5% (whey/casein 78:25)

3.3% (whey/casein 22:78)

Carbohydrate

6.5-7% lactose

4.5% lactose

Fat

3.5% (diet dependent0

3-4% (pooled)

Minerals

Iron better absorbed

Low iron and copper

Vitamins

Diet dependent, low in K

Low in C,D

Bacterial content

Uncontaminated

Harmless Bacteria

Digestibility

Faster emptying

Same after 45 days

 

Guideline to provide fluids and nutrients to LBW babies.

 

Age

Categories of neonates

Birth wt

<1200 gm

1200 – 1800

>1800

Gestation

< 30 wk

30 – 34 wk

> 34 wk

At birth

IVF try gavage if sick

Gavage

BF if unsatisfactory try katori-spoon faced

1-3 day

Gavage

Katori-spouse

BF

2-4 wk

Ketorispoon

BF

BF

4-6 wk

BF

BF

BF

 

Maternal Drugs Affecting Neonate

 

Table

 

Drug

Effect

Anesthetics

Respiratory, CNS depression

Barbiturates

Respiratory, CNS depression

Magnesium sulphate

Respiratory depression

Phenobarbital

Vitamin K deficiency

Sulfonamides

Displaces bilirubin from albumin

 

Teratogenic Drugs

 

Table

 

Drug

Effect

Alcohol

Fetal alcohol syndrome

Isotretinoin

Facial, ear anomalies, congenital heart diseases

Phenytoin

Hypoplastic nails, typical facies, IUGR

Stilbestrol

Vaginal adenocarcinoma

Tetracyline

Enamel hypoplasia





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