Breast Feeding

Introduction

• Breastfeeding is the preferred feeding method for all infants, including those born prematurely, for a minimum of 4 but preferably 6 months.
• Following a preterm delivery, mothers should be encouraged to begin expressing milk within 24 hours.
• Although the sucking reflex starts at the 17th week of gestation, preterm newborns who are born before 34 week's gestation lack a well-coordinated suck and swallow reflex → they are fed via feeding tube (orogastric or nasogastric tube) every 2– 3 hours.
• Breast milk is a source of both nutrition and immunologic support—containing immunoglobulins, immune-modulating factors, hormones, growth factors, enzymes, and cholesterol.

Review of Breast Milk Physiology

• The newborn sucking on the nipple stimulates the release of prolactin and oxytocin by the mother’s pituitary gland → the production (prolactin) and "let-down” (oxytocin) of breast milk.
• Adequate breast drainage maintains prolactin levels.
• Oxytocin release and the “milk-ejection reflex”or the ‘’let-down reflex’’ occur in response to infant suckling and increase with rest, warmth, a quiet environment, and the sight and sound of the infant.
• Factors affecting the production of milk: medications, maternal fatigue, inadequate fluid intake, stress, pain, and fatigue.
• In the first few days of breastfeeding, the baby mainly receives low-volume, antibody-rich colostrum.
• The mouth and tongue movements needed by the infant for breastfeeding are very different from those needed for bottle feeding, so early introduction of the bottle can sometimes affect a newborn’s ability to breastfeed.

Different Types of Human Breast Milk

Remember: Colostrum has more calories and protein, while mature milk has less calories and more carbohydrates and fat

Benefits of Breastmilk

1. Benefits for Infant
   1. Decrease the incidence of the following: septicemia, acute and recurrent otitis media, diarrhea, necrotizing enterocolitis, and urinary tract infections
   2. Protect against the development of childhood asthma, obesity, Type 1 diabetes, celiac disease, Crohn disease, and cognitive delay.
   3. Available at the right temperature, and concentration.
2. Benefits for Mother
   1. Reduce the risk of breast and ovarian cancer, hip fractures, and osteoporosis.
   2. Weight loss and faster return to preconception uterine size.
   3. Natural contraception method
   4. Maintain strong psychological bond between mother and infant
   5. Cheap cost

Contraindications of Breastfeeding

Medication precautions during breastfeeding

• Medications that are not allowed in high doses (Vitamin C, Vitamin D, sedatives, first generation antihistamines)
• Medication that is not allowed in pregnancy, but is okay in breastfeeding→ warfarin.

Breastfeeding and Nutritional Deficiencies

• By 1 month of age, the nutritional requirements of a rapidly growing preterm infant exceed the amounts in breast milk for protein and certain vitamins (B2, B6, C, D, E, K, and folate), minerals (zinc and copper), Ca2+, Na+, phosphorus, and Mg2+.

1. Vitamin D Supplementation
   • Breast milk is low in vitamin D that is necessary for the prevention of early onset osteopenia and rickets disease.
   • The breastfeeding baby must be supplemented with Vitamin D (400IU/day).
   • It’s advised to start Vitamin D supplementation as early as possible after birth.
2. Iron Supplementation
   • Tht iron storage of newborn term babies can cover their requirements for up to 4-6 months ( preterm babies run out sooner).
   • Typically in the first 6 months of life, babies consume as low as 0.27 mg of iron daily.
   • Despite Breast milk lower iron level, it has higher bioavailability→ better absorption
   • Exclusively cow milk feeding is a risk for iron deficiency anemia
   • The daily needs of iron in an infant above 6 months is 11 mg (10-15 mg).
3. Vitamin K
   • Breast milk is low in vitamin K that is necessary for the prevention of hemorrhagic disease in newborns.
   • The baby's gut flora are immature, thus they are unable to make vitamin K until their gut microbiome is well established.
   • Thus, 1 mg of Vitamin K is administered intramuscularly at birth for all newborn babies.

Breastfeeding Complications for the Mother