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(BQ) Part 2 book “Breastfeeding management for the clinician” has contents: Physical, medical, and environmental problems and issues; maternal pathology - breast and nipple issues, physical, medical, emotional, and environmental challenges to the breastfeeding mother,… and other contents.
Chapter Beyond the Initial 48–72 Hours: Infant Challenges INTRODUCTION A number of breastfeeding problems and issues must be addressed immediately and throughout the initial hospital stay, whereas other issues may have their origins in the early days but become apparent after discharge Some are conditions that require an ongoing need for specialized lactation support postdischarge This chapter discusses situations that require close follow-up and intense support, including hyperbilirubinemia (jaundice), dehydration, weight gain/loss issues, and breastfeeding late preterm and preterm infants NEONATAL JAUNDICE Neonatal jaundice is a common condition and generally self-limiting in the newborn It is estimated that 60–70% of term infants will become visibly jaundiced—that is, they will have serum bilirubin levels exceeding 5–7 mg/dL (85–119 mmol/L)—in the first week of life (MacMahon, Stevenson, & Oski, 1998; Maisels & McDonagh, 2008) Neonatal hyperbilirubinemia increases during the hours after birth and usually peaks at 96–120 hours after discharge from the hospital Approximately 5% reach levels > 17 mg/dL (290.7 mmol/L; Harris, Bernbaum, Polin, Zimmerman, & Polin 2001), and around 2% of these newborns reach a total serum bilirubin level of > 20 mg/dL (342 mmol/L; Newman et al., 1999) Estimated rates of high-risk bilirubin levels (> 25 mg/dL [427 mmol/L]) vary from 1:700 (Newman et al., 1999) to 1:1,000 (Bhutani, Johnson, & Sivieri, 1999a) Jaundice is a frequent reason for readmission to the hospital during the first weeks of life (Hall, Simon, & Smith, 2000; Maisels & Kring, 1998) Most jaundice in healthy fullterm newborns is a benign condition that resolves over the first week or However, extremely high levels of bilirubin (> 25–30 mg/dL [427.5–513 mmol/L]) can be toxic to the brain, producing a condition known as kernicterus Kernicterus involves bilirubin toxicity to the basal ganglia and various brainstem nuclei when extreme amounts of bilirubin cross the blood–brain barrier, then infiltrate and destroy nerve cells Bilirubin Metabolism Bilirubin is an orange or yellow pigment, 80–90% of which is derived from the breakdown of hemoglobin from aged or hemolyzed red blood cells Heme is a constituent of hemoglobin that is released in association with the breakdown of aging red blood cells Most heme in the newborn originates from fetal • 397 • 398 • Chapter 6 Beyond the Initial 48–72 Hours: Infant Challenges erythrocytes, is initially converted to biliverdin through the action of the enzyme heme oxygenase, and then is reduced further to bilirubin that is transported in the circulation tightly bound to albumin In the liver, bilirubin is conjugated by another enzyme, uridine diphosphoglucuronosyl transferase (UDPGT); released into the bile duct; and delivered to the intestinal tract for elimination through the stool (also termed direct bilirubin) However, some unconjugated (indirect) bilirubin remains unbound to albumin and circulates as free bilirubin Unbound, unconjugated bilirubin passes easily through lipid-containing membranes, like the blood–brain barrier, where in high amounts it is neurotoxic and can transiently or permanently affect neurons (Volpe, 2001) The production, conjugation, and excretion of bilirubin are affected by conditions unique to the newborn that cause an imbalance in this metabolic process, predisposing the newborn to hyperbilirubinemia As the newborn moves from the low oxygen environment of the uterus to the relatively high oxygen environment of room air, excess fetal red blood cells are no longer needed Infants produce more bilirubin than they can eliminate, a situation exacerbated by prematurity, bruising or hematoma formation, infection, maternal glucose intolerance, weight loss, oxytocin exposure during labor, genetic modifiers of bilirubin metabolism, and all types of hemolysis Alterations in and to this process include the following: yy yy yy yy Production: High bilirubin production (twice that of an adult) occurs because fetal erythrocytes are overabundant, have a short lifespan, and their breakdown rapidly creates an excess of heme for the newborn liver to process Conjugation: Conjugation undergoes delays because the activity of UDPGT is limited and hepatic uptake of bilirubin is decreased Excretion: The small intestine of the newborn delays bilirubin excretion through the activity of the enzyme beta-glucuronidase, which converts conjugated bilirubin back to its unconjugated state, allowing bilirubin to be reabsorbed back into circulation (enterohepatic circulation) (Steffensrud, 2004) The newborn bowel slowly becomes colonized with the bacteria needed to degrade bilirubin into urobilinogen that cannot be reabsorbed The longer direct (conjugated) bilirubin remains in the intestine, the greater the likelihood of its conversion back to indirect bilirubin (unconjugated), which is sent back to the liver for reprocessing (Blackburn, 1995) At birth, the intestines can contain as much as 200 g of meconium, including up to 175 mg of bilirubin, half of which is in the indirect form, an amount that is to times the daily rate of bilirubin production at term (Bartoletti, Stevenson, Ostrander, & Johnson, 1979) Genetic predisposition: There are racial variations in bilirubin metabolism among the normal population (Beutler, Gelbart, & Demina, 1998) Mutation of a gene for the enzyme required for bilirubin conjugation contributes to the increased predisposition of some Asian infants (~20%) for severe neonatal hyperbilirubinemia (Akaba et al., 1998) UDPGT 1A1 was shown to be associated with hyperbilirubinemia in Asian infants but not Caucasian infants (Long, Zhang, Fang, Luo, & Liu, 2011) In a population of Asian infants, Chang, Lin, Liu, Yeh, and Ni (2009) found that male breastfed infants with a variant nucleotide 211 of the UGT 1A1 gene had a high risk for developing prolonged hyperbilirubinemia Sato and colleagues (2013) studied 401 exclusively breastfed Japanese infants and classified them into groups based on maximal weight Neonatal Jaundice • 399 loss following birth and presence of polymorphic mutations of UGT 1A1 (genotypes G71R and TA 7) They demonstrated that the effect of G71R mutation on neonatal hyperbilirubinemia was significant in infants, with 5% or greater maximal weight loss, and its influence increases in parallel with the degree of maximal weight loss This study indicates that optimal breastfeeding, breastfeeding management, and milk intake may overcome the genetic predisposition factor G71R for the development of hyperbilirubinemia in exclusively breastfed Asian infants Prolonged jaundice, often termed breastmilk jaundice, has also been shown to occur in a significant number of infants of Asian descent with a particular genotype (UGT 1A1*6) (Maruo et al., 2014) Other polymorphisms become risk factors in Asian infants who experience 10% or greater body weight loss during the neonatal period Inadequate breastmilk intake may increase the bilirubin burden in infants with polymorphisms in the genes that are involved in the transport or metabolism of bilirubin (Sato et al., 2015) Multiple genetic modifiers of bilirubin metabolism may interact in the presence of breastfeeding in an infant of Asian descent (Yang et al., 2015), making it important to monitor breastfeeding not only in the hospital but also following discharge to assure adequate milk intake yy yy Microbiological content of breastmilk: The microbiological content of breastmilk has been associated with the development of jaundice in breastfed infants Breastmilk with high levels of B ifidobacterium species may be protective against neonatal jaundice, whereas low concentrations of these microorganisms may facilitate the development of jaundice (Tuzun, Kumral, Duman, & Ozkan, 2013) Weight loss: Birth weight loss during the first days following birth may be a clinical indicator of a predisposition to significant jaundice at 72 hours One study found that weight loss of 4.48% on day 1, 7.6% weight loss on day 2, and 8.15% weight loss on day were useful cutoff values in predicting significant jaundice at 72 hours (Yang et al., 2013) These values may aid clinicians in determining the need for more intensive breastfeeding support during the hospital stay Classifications of Newborn Jaundice Clinicians see jaundice in an infant when bilirubin pigment is deposited in subcutaneous tissue, producing the characteristic yellowing of the skin and sclera The type of jaundice typically seen in full-term neonates is termed physiological jaundice, where bilirubin levels rise steadily during the first 3–4 days of life, peak around the 5th day, and decline thereafter In preterm infants bilirubin levels may peak on day or and resolve over a more extended period of time Total serum bilirubin levels are influenced by a number of factors such as race, gestational age, type of feeding, and drugs or medications given to the mother or infant The newborn’s age in hours is commonly used as the criteria to decide if a particular bilirubin level is acceptable or if further monitoring is necessary (Bhutani et al., 1999a) Other contributing factors to physiological jaundice include a previous sibling with jaundice, lack of effective breastfeeding, excessive weight or water loss after birth, infection, mother with diabetes, and bruising/hematoma (Dixit & Gartner, 2000) The incidence of hyperbilirubinemia can be higher in populations living at high altitudes (Leibson et al., 1989) Jaundice that is not physiological or that is not related to breastfeeding or breastmilk is classified as pathological Infants with risk factors should be monitored closely during the first days to weeks of 400 • Chapter 6 Beyond the Initial 48–72 Hours: Infant Challenges life (Porter & Dennis, 2002) Characteristics of pathological jaundice include the following (Dennery, Seidman, & Stevenson, 2001; Melton & Akinbi, 1999): yy yy yy yy Appearance of jaundice within the first 24 hours after birth Fast rising bilirubin levels (> mg/dL/day [85 μmol/L]) Total serum bilirubin level higher than 17 mg/dL (290.7 μmol/L) in a full-term newborn Bilirubin levels greater than mg/dL (136 μmol/L) in the first 24 hours may be hemolytic in origin (Maisels, 2001) Pathological causes may include: yy yy yy yy yy yy yy yy yy yy yy Sepsis Rubella Toxoplasmosis Hemolytic disease (Rh isoimmunization, ABO blood group incompatibility) Erythrocyte disorders (glucose-6-phosphate-dehydrogenase deficiency) Glucose-6-phosphatedehydrogenase deficiency occurs in 11–13% of African Americans (Kaplan & Hammerman, 2000) and is more common among mothers from Mediterranean countries and Southeast Asia. Screening for this disorder is not routinely performed and is associated with an increased incidence of hyperbilirubinemia and the need for phototherapy (Kaplan, Herschel, Hammerman, Hoyer, & Stevenson, 2004) It has also been associated with cases of kernicterus in the United States (Johnson & Brown, 1999; Penn, Enzmann, Hahn, & Stevenson, 1994; Washington, Ector, & Abboud, 1995) Extravasation of blood (cephalohematoma or subgaleal hemorrhage, such as from vacuum extraction, bruising) Inborn errors of metabolism Hypothyroidism Polycythemia (such as from delayed cord clamping, twin–twin transfusion) Intestinal defect or obstruction Macrosomic infant of a diabetic mother Whereas total serum bilirubin levels of 15–20 mg/dL (255–340 |μmol/L) are not that unusual in some healthy, full-term normal infants, extreme hyperbilirubinemia, although rare, is of concern Strong predictors of total serum bilirubin levels of at least 25 mg/dL are gestational age, bruising, family history, and a rapid rise in total serum bilirubin levels (Kuzniewicz, Escobar, Wi, Liljestrand, McCulloch, & Ne 2008) There is a set of common clinical risk factors for severe hyperbilirubinemia—the more risk factors present, the greater the risk for severe hyperbilirubinemia (Box 6-1) Newman and colleagues (1999) studied the incidence of extremes in bilirubin levels in a sample of 50,000 term and near-term infants and found the following: yy yy yy Levels greater than 20 mg/dL (340 μmol/L) in 2% of the sample (1 in 50 infants) Levels of 25 mg/dL (425 μmol/L) or greater in 0.15% (1 in 650 infants) Levels of 30 mg/dL (510 μmol/L) or greater in 0.01% (1 in 10,000 infants) Neonatal Jaundice • 401 Box 6-1 Clinical Risk Factors for Severe Hyperbilirubinemia yy Jaundice in the first 24 hours of life yy Visible jaundice before discharge (48 hours) Dermal icterus is not visibly noticed as yellowing of the skin when total serum bilirubin levels are less than mg/dL (68 μmol/L; Kramer, 1969) It progresses in a cephalocaudal pattern (Knudsen & Ebbesen, 1997) and is noticed in the face when the serum bilirubin reaches mg/dL, progresses to the upper chest at 10 mg/dL, becomes visible on the abdomen at 12 mg/dL, and finally appears on the palms and soles when bilirubin levels are greater than 15 mg/dL Although these observations not replace transcutaneous measurements or laboratory blood analysis, they give the clinician an idea of how closely an infant should be monitored yy Previous jaundiced sibling yy Gestational age of 35–38 weeks Late preterm infants are between 2.4 and 5.7 times more likely to develop significant hyperbilirubinemia (Newman, Xiong, Gonzales, & Escobar, 2000; Sarici et al., 2004), with their serum bilirubin levels peaking later, at 5–7 days, necessitating a longer period of follow-up Readmission for hyperbilirubinemia is much more likely in these infants when they are discharged less than 48 hours after birth (Hall et al., 2000) yy Exclusive breastfeeding Clinically, such cases usually involve infants who are not efficiently transferring milk yy East Asian ethnicity yy Bruising or cephalohematoma yy Maternal age greater than 25 years yy Male infant Data from American Academy of Pediatrics, Subcommittee on Neonatal Hyperbilirubinemia (2001) Neonatal jaundice and kernicterus Pediatrics, 108, 763–765 Bilirubin levels in some infants can infrequently rise high enough to cause neurological consequences if not monitored closely or if interventions are not implemented to lower bilirubin levels The term bilirubin encephalopathy is often used to describe the clinical manifestations of bilirubin toxicity, and the American Academy of Pediatrics (AAP, 2004) recommends that the term acute bilirubin encephalopathy be used to describe the acute manifestations of toxicity seen in the first weeks after birth and the term kernicterus be used as a pathological description of the yellow staining of the brainstem nuclei and basal ganglia (Cashore, 1998) The AAP (2004) recommends that the term kernicterus be reserved for the chronic and permanent clinical sequelae of bilirubin toxicity No exact bilirubin level or duration of hyperbilirubinemia exposure has been defined to locate the exact point at which neurotoxicity could occur Furthermore, evidence to date cannot explicitly account for why some infants with extremes of bilirubin levels develop kernicterus and others not, or why early signs of bilirubin encephalopathy appear reversible in some infants and are permanent in others (Hanko, Lindemann, & Hansen, 2001) Bilirubin entry into the brain is facilitated by numerous conditions, including displacement of bilirubin from its albumin binding, reduced albumin-binding capacity, and increased permeability of the blood–brain barrier Bilirubin is oxidized in the brain by an enzyme 402 • Chapter 6 Beyond the Initial 48–72 Hours: Infant Challenges whose activity increases with greater postnatal age (Hansen, 2000) The brain may be able to protect itself to an extent through bilirubin oxidation (Hansen, Allen, & Tommarello, 1999) that may be subject to genetic variability (Hansen, 2001) This protective effect may vary among infants, possibly accounting for the differing outcomes in infants with high bilirubin levels Bilirubin encephalopathy proceeds along a continuum (Table 6-1), where early signs and symptoms may be subtle, nonspecific, transient, and potentially reversible to an advanced and chronic stage of permanent neurological injury (Volpe, 2001) In a controlled study of 140 5-year-old children with a neonatal total serum bilirubin level of > 25 mg/dL, Newman and colleagues (Newman, Liljestrand, & Escobar, 2003; Newman et al., 2006) found no associations between bilirubin exposure and neurological abnormalities, IQ, behavioral problems, or frequency of parental concerns These outcomes were repeated in a study by Vandborg, Hansen, Greisen, Jepsen, and Ebbesen (2012), who found no evidence of developmental delay in children between and years of age who had a gestational age > 35 weeks and had experienced at least one measure of total serum bilirubin level > 25 mg/dL during the first weeks of life Although extreme levels of bilirubin have the potential to be neurotoxic, bilirubin actually has a physiological role in the body as an antioxidant (McDonagh, 1990) Bilirubin “protection” may be seen in infants with illnesses associated with free-radical production such as circulatory failure, neonatal asphyxia, aspiration, and sepsis, where the rate of bilirubin rise appears less in these infants, because bilirubin is consumed to cope with oxidative stress (Sedlak & Snyder, 2004) Neonatal blood plasma is better Table 6-1 Continuum of Bilirubin Encephalopathy Early (First 3–4 Days After Birth) After First Week Chronic (Kernicterus) Lethargy Increasing lethargy Athetoid cerebral palsy Decreased alertness Increased irritability High-frequency hearing loss Poor feeding Minimal feeding Developmental delays Weak suck Fever Motor delays Excessive sleepiness Shrill cry Paralysis of upward gaze High-pitched cry Opisthotonus* Dental dysplasia Hypertonia Seizures Apnea Retrocollis† Oculogyric crisis‡ Hypotonia Stupor, coma Rigidity Mild mental retardation *Opisthotonus is a spasm in which the heels and head are bent backward and the body is bowed forward † Retrocollis is torticollis with spasms affecting the posterior neck muscles ‡ Oculogyric crisis is a spasm causing upward fixation of the eyeballs lasting several minutes or hours Modified from Connelly, A M., & Volpe, J J (1990) Clinical features of bilirubin encephalopathy Clinical Perinatology, 17, 371–379; Dennery, P A., Seidman, D S., & Stevenson, D K (2001) Neonatal hyperbilirubinemia New England Journal of Medicine, 344, 581–590; Maisels, M J., & Newman, T B (1995) Kernicterus in otherwise healthy, breastfed term newborns Pediatrics, 96(4pt1), 730–733; Volpe, J J (2001) Bilirubin and brain injury In J J Volpe (Ed.), Neonatal neurology Philadelphia, PA: Saunders Neonatal Jaundice • 403 protected against oxidative stress due in part to the elevated levels of bilirubin (Wiedemann, Kontush, Finckh, Hellwege, & Kohlschutter, 2003) Shekeeb, Kumar, Sharma, Narang, and Prasad (2008) showed that bilirubin acts as a physiological antioxidant until it reaches a concentration of 20 mg/dL in full-term normal neonates Beyond that concentration, it is conjectured that bilirubin no longer acts as an antioxidant and cannot be considered physiological For bilirubin to disrupt brain function, it must gain entry into the brain Normally, the blood–brain barrier functions to block the passage of bilirubin into the brain, but this action is less mature in newborn infants Bilirubin, once it has entered the brain, has a short half-life and is cleared from the brain by the action of an enzyme However, this enzyme’s activity is lower in the neonate and is subject to inter-individual differences and genetic variability, suggesting that vulnerability to bilirubin toxicity may in part have a genetic basis (Hansen, 2002) A number of factors can disrupt the blood–brain barrier, which is normally closed to albumin and bilirubin as long as it is bound to albumin (Hansen, 1994) These include hyperosmolality, hypercarbia, hypoxia, hyperoxemia, asphyxia, acidosis, prematurity, hypoalbuminemia, and bilirubin-displacing drugs Breastfeeding and Jaundice Stevenson, Dennery, and Hintz (2001) consider breastfeeding as the “normal driving influence on the transitional pattern of hyperbilirubinemia with formula feeding representing an iatrogenic perturbation of the normal influences of human milk on the enterohepatic circulation of bilirubin.” Neonatal jaundice is connected to breastfeeding in three groups seen in clinical practice: The exclusively breastfed, healthy term infant during the 1st week after birth Newborns who not receive adequate amounts of breastmilk and have high concentrations of indirect bilirubin during the first postnatal week (referred to as nonfeeding jaundice, starvation jaundice, lack of breastfeeding jaundice) Breastfed infants who experience a situation of prolonged unconjugated hyperbilirubinemia (called breastmilk jaundice) Breastfeeding has long been associated with higher bilirubin levels and a more prolonged duration of jaundice compared with formula feeding (Dahms et al., 1973; Osborn, Reiff, & Bolus, 1984; Schneider, 1986) Breastfeeding practices at the time of these studies, however, may have contributed to this impression Infants in the early studies may have experienced restricted milk intake due to: yy yy yy yy Hospital policies that ordered nothing by mouth for the first 24 hours Limited access to breastfeeding from restrictive schedules that allowed feedings only every 4 hours and usually not at night Short access times to the breast from advice that limited feedings to only a couple of minutes per side Supplementation with sterile water or sugar water that provided few to no calories Fasting (lack of calories) can enhance the enterohepatic circulation of bilirubin as can the continued presence of a reservoir of bilirubin contained in unpassed meconium Bertini, Dani, Tronchin, and Rubaltelli (2001) demonstrated that the development of early jaundice was not associated with breastfeeding per se, but rather with increased weight loss after birth subsequent to fasting or insufficient milk intake A subpopulation of breastfed infants in their study experienced a high bilirubin level peak that 404 • Chapter 6 Beyond the Initial 48–72 Hours: Infant Challenges was associated with mixed feeding (supplemented infants) and a higher weight loss They also found a strong association between significant hyperbilirubinemia and vacuum extraction Thus, what is sometimes termed early-onset breastfeeding jaundice is most likely a manifestation of inadequate breastfeeding that causes the exaggerated pattern of hyperbilirubinemia in the first days of life (Gartner, 2001; Neifert, 1998) Infrequent, inefficient breastfeeding reduces caloric intake, increases weight loss, delays meconium passage, and can drive bilirubin to levels where clinical intervention becomes necessary Hyperbilirubinemia that peaks between and 14 days has been termed late-onset or breastmilk jaundice and can develop in up to one-third of healthy breastfed infants (AAP, 1994) Total serum bilirubin levels may range from 12 to 20 mg/dL (205.2–342 mmol/L) and are considered nonpathological Hyperbilirubinemia can persist for up to months (Gartner, 2001) It appears that it is normal for 20–30% of predominantly breastfed infants to be jaundiced at 3–4 weeks and for 30–40% of these infants to have bilirubin levels greater than mg/dL (Maisels et al., 2014) The underlying cause of breastmilk jaundice is not clearly understood and may be multifactorial It has been suggested that substances in breastmilk such as beta-glucuronidases and nonesterified fatty acids might inhibit normal bilirubin metabolism (Brodersen & Herman, 1963; Gartner & Herschel, 2001; Melton & Akinbi, 1999; Poland, 1981) Maruo, Nishizawa, Sato, Sawa, and Shimada (2000) suggested that a defect or mutation in the bilirubin UDPGT gene may cause an infant with such a mutation to be susceptible to jaundice that components in the mother’s milk may trigger Ota and colleagues (2011) describe pregnanediol as a contributor to breastmilk jaundice in carriers of the G71R polymorphic mutation The milk of mothers whose infants experienced prolonged jaundice was found to have a decreased antioxidant capacity (Uras et al., 2010) Managing Hyperbilirubinemia Numerous methods are used to prevent or manage hyperbilirubinemia: yy yy One of the most successful methods for preventing hyperbilirubinemia has been the administration of high-titer anti-D immunoglobulin G, or RhoGAM, to reduce the incidence and severity of Rh isoimmunization disease (Rh incompatibility) Phototherapy is the most common therapy for high bilirubin levels Its use is designed to prevent bilirubin toxicity, but it does not treat the underlying cause of the hyperbilirubinemia Phototherapy uses light energy to change the shape and structure of bilirubin, which converts it to molecules that the body can excrete Phototherapy works on bilirubin that is present in the skin and superficial subcutaneous tissue Phototherapy has a number of side effects (Blackburn & Loper, 1992), some of which can affect breastfeeding (separation, lethargy, poor feeding, increased fluid requirement, poor state control) Conventional phototherapy lights can produce a change in the infant’s thermal environment with increased heat contributing to insensible water loss The new generation of light-emitting diode (LED) phototherapy devices should reduce this problem because they produce less heat (Dijk & Hulzebos, 2012) Phototherapy has been shown to induce DNA damage in lymphocytes, with the DNA damage increasing significantly with longer durations of phototherapy (Tatli, Minnet, Kocyigit, & Karadag, 2008) A fiberoptic blanket or band may be used—in lower urgency situations—allowing parents to hold, care for, Neonatal Jaundice • 405 yy yy and breastfeed the infant This also allows treatment to occur in the home rather than the infant being readmitted into the hospital A rebound of to mg/dL (17 to 34 |μmol/L) can occur after phototherapy is discontinued and usually a follow-up bilirubin level is recommended 24 hours after discharge Exchange transfusion is used in more extreme situations, usually for infants with hemolytic disease Pharmacological agents have been tried over the years, with most being discarded as ineffective A number of chemoprevention and treatment therapies have included heme oxygenase inhibitors such as metal meso- and protoporphyrins Tin-mesoporphyrin (SnMP), blocks the action of heme oxygenase in converting hemoglobin to bilirubin Its action is designed to shut off production of bilirubin at its source rather than remove it after it has been formed It reduces blood bilirubin levels for 7–10 days after administration (Kappas, 2004) Its safety, indications for use, efficacy, and side effects of whole-scale inhibition of bilirubin production remain to be determined (Blackmon, Fanaroff, & Raju, 2004; Hansen, 2003) L-aspartic acid, a beta-glucuronidase inhibitor (and component in hydrolyzed infant formula), has been given experimentally to breastfed newborns Gourley, Zhanhai, Kreamer, and Kosorok (2005) reported on a small number of infants whose fecal bilirubin excretion increased and jaundice decreased when given 5-mL doses of L-aspartic acid times a day for days after birth Changes in the Approach to and Prevalence of Hyperbilirubinemia and Kernicterus The root cause for the development of kernicterus has been identified as a systems failure in neonatal care, especially during the 1st week after birth A convergence of a number of changes and factors began contributing to an increasing number of infants being readmitted to the hospital for hyperbilirubinemia and an increase in reports of the development of acute bilirubin encephalopathy and kernicterus (Ross, 2003), including the following: yy yy yy A more relaxed approach to jaundice because studies did not reveal adverse developmental outcomes in infants who had experienced mild to moderate jaundice (Newman & Maisels, 1992; Watchko & Oski, 1983) More liberal treatment guidelines that postponed phototherapy in infants older than 72 hours of age until the total serum bilirubin level reached 20 mg/dL and for infants between 49 and 72 hours old until it reached 18 mg/dL (AAP, 1994) The practice of discharging healthy term newborns within 48 hours of birth, before many infants appear clinically jaundiced and after which bilirubin levels are most likely to rise (Braveman, Egerter, Pearl, Marchi, & Miller, 1995; Braveman, Kessel, Egerter, & Richmond, 1997; Britton, Britton, & Beebe, 1994; Liu, Clemens, Shay, Davis, & Novack, 1997): Early hospital discharge is associated with increased hospital readmissions for jaundice (Brown et al., 1999; Grupp-Phelan, Taylor, Liu, & Davis, 1999) Short hospital stays, minimal staffing, and lack of provider expertise in breastfeeding management provide limited time and often little guidance for mothers and infants to become proficient at breastfeeding 406 • Chapter 6 Beyond the Initial 48–72 Hours: Infant Challenges Minimum criteria for discharge within 48 hours of birth includes an infant who has completed at least two successful feedings, with documentation that the infant is capable of coordinating sucking, swallowing, and breathing The breastfeeding mother and infant should be assessed by trained staff regarding positioning, latch-on, and adequacy of swallowing (AAP, 2004), criteria that are not routinely performed in many hospital settings The shift in locus of care surrounding hyperbilirubinemia from the hospital to the community has created a need for early postdischarge observation (Palmer et al., 2003) A pattern of newborn follow-up care that consists of a 1- to 2-week postdischarge visit, occurring long after the period of high risk and the time for effective intervention has passed (Eaton, 2001); lack of adherence to an evidence-based follow-up schedule that recommends healthcare provider examinations and observations at age 72 hours if discharged before age 24 hours, a visit at 96 hours of age if discharged between 24 and 47.9 hours of age, and a visit at 120 hours of age if discharged between 48 and 72 hours of age (AAP, Subcommittee on Hyperbilirubinemia, 2004) An increase in reports of kernicterus (Johnson & Bhutani, 2003; Johnson & Brown, 1999): Severe hyperbilirubinemia and kernicterus were the subjects of a report (Carter & Dixon, 2001) Kernicterus was the subject of a sentinel event alert by the Joint Commission (2001) and a second alert of revised guidelines (2004) Hyperbilirubinemia and kernicterus were discussed in a commentary by the AAP’s subcommittee on hyperbilirubinemia (Eaton, 2001), emphasizing that many of the infants experiencing these conditions did not have obvious hemolytic disease and were healthy breastfeeding newborns (frequently not receiving adequate nutrition and hydration, most likely due to inefficient feeding skills), a significant portion of whom were less than 38 weeks’ gestational age (near term) In July 2003 the National Institute of Child Health and Human Development convened a group of experts to review the existing knowledge base regarding neonatal hyperbilirubinemia and the barriers to preventing kernicterus (Palmer, Keren, Maisels, & Yeargin-Allsopp, 2004) A 5-year consortium funded by the Agency for Healthcare Research and Quality explored the barriers to implementing the 1994 AAP jaundice guideline in healthcare systems Some of the major problems included discharge before breastfeeding was established, cumbersome reimbursement policies for blood tests, clinicians who would not see infants until 2 weeks postdischarge, and insurance carriers rejecting claims for the early visit (Ip, Glicken, Kulig, & O’Brien, 2003) yy yy More recent reports show that the diagnosis of kernicterus has decreased to an estimated incidence of approximately 1.5 per 100,000 term newborn births and per 100,000 births of preterm infants (Burke et al., 2009) Preterm infants with jaundice require close monitoring and a consistent breastfeeding plan of care with access to lactation consultant services Clinical Approaches to Breastfeeding Support: Practice Suggestions Because all infants have an initial rise in bilirubin levels as they transition to extrauterine life, the goal of breastfeeding management strategies revolves around optimizing the skill sets mothers and newborns 724 • Index formula (Continued) phenylalanine-free, 534 risk for diabetes, 663 fortification of human milk described, 55–57, 59 preterm infants, 432–433 free nipple graft technique, 113 freezing human milk, safety, 64 frenotomy, 497, 498, 499, 503, 504, 506 Frenotomy Decision Rule for Breastfeeding Infants, 499 frenuloplasty, 504 frenulum, 181–182, 182f Froben, 682 fungal colonization of the nipple nipple soreness, 589–591 treatment, 592–600 fussy infants breastfeeding management, 371–375, 373f, 375f care plan for latching problems, 355, 357f collaborative plan of care, 355, 356b, 357f decision trees/clinical algorithms, 359–364, 360f–364f hospital assessment, charting for, 355, 356b, 357f problem of hypoglycemia, 364–367, 366f, 367b problems with glucose-level measurements, 368–371, 369b, 371t FUT2 gene, 39 G gabapentin, 641 Gabitril, 641 gag reflex, 168 galactoceles, 615 galactocerebrosides, 38 galactolipids, 38 galactosemia described, 538–539, 538f Duarte galactosemia, 539 screening for, 533 galactosylceramide, 38 gastric acidity inhibitors, 528 gastric bypass surgery, maternal, 49 gastroesophageal reflux (GER) breastfeeding, clinical implications for, 194–195 breastfeeding management, 527 described, 526–527 gastroesophageal reflux disease (GERD) breastfeeding, clinical implications for, 195 breastfeeding management, 527 gastrointestinal disorders, 521–533 See also gastroesophageal reflux (GER); gastroesophageal reflux disease (GERD) colic, 522–526 colitis/proctocolitis, 529–530 pyloric stenosis, 531–533 tracheoesophageal fistula and esophageal atresia, 521–522 gastrointestinal (GI) tract, 125 associate with suckling, 126t colonization of, 13, 14 GDM See gestational diabetes mellitus GDNF See glial cell line-derived neurotrophic factor Gender-Role Attitudes toward Breastfeeding Scale (GRABS), 211 genetics bilirubin metabolism, 397–398 cleft lips and palate, 506–507 inborn errors of metabolism, and supplementation, 267, 267b metabolic disorders, 533–539, 538f gentian violet, 592 GER See gastroesophageal reflux GERD See gastroesophageal reflux disease German Commission E Monographs, 649 gestational age birth weight and multiple births, 486t developmental maturity and feeding behaviors, 325–326 latch, 325–326 gestational diabetes mellitus (GDM) described, 663 lactogenesis II, 131 GI tract See gastrointestinal tract glatiramer, 677 glial cell line-derived neurotrophic factor (GDNF), 36 glossopharyngeal nerve (CN IX) birth trauma, and feeding problems, 328 soft palate paralysis, 192–193 glucocorticoids, rheumatoid arthritis, 682 gluconeogenesis, 263 Glucophage, 669 glucose level fasting, in diabetic mothers, 664 infants, and separation from mother, 243 measurement of, in newborns, 368, 369b screening techniques and equipment, 369–371, 369b glycogenolysis, 263 glycolysis, 263 goat’s rue, 648 gold, injectable, 682 gold, oral, 682 Goldenhar syndrome, 183 GRABS See Gender-Role Attitudes toward Breastfeeding Scale Graves disease, 672 See also hyperthyroidism growth hormone breast development and function, 119t insufficient milk supply, 646 Gua-sha therapy, 605 H H & H Lactation Scale, 205, 210 Haberman (SpecialNeeds) Feeder adequate intake, by preterm infants, 448 cleft lips and palates, 506–515 Haemophilus influenza, 39, 50 HAMLET See human alphalactalbumin made lethal to tumor cells hand positions during breastfeeding See also Dancer hand (U-hold) position C-hold, 309–310, 309f scissors or V-hold, 309 Index • 725 hand techniques for breast engorgement, 604 hands, arthritic, 683 hard palate breastfeeding, clinical implications for, 189–191, 192f latch problems, 320 Hashimoto thyroiditis, 671 Hazelbaker FingerFeeder, 274 HealthStyles survey, 4, Healthy People 2020 breastfeeding objectives, 1, 2–3 hearing impairment, maternal, 641 heart rate, of crying neonates, 246, 246f heart-shaped tongue, 187, 187f heat therapy for breast engorgement, 603 heat treatment of human milk, 58–60, 62b Helicobacter pylori, 531 hemifacial microsomia, 183 hemoglobin abnormalities, screening for, 533 hemorrhagic disease of newborn, 46 heparin, subcutaneous, 680 herbal preparations induced lactation, 653b insufficient milk supply, 648–649 herpes infection of the nipple, 586 herpes simplex type I, 586 hindmilk cleft lips, 513 cleft of the soft palate, submucous cleft/bifid uvula, 513 cystic fibrosis, 537 HIV/AIDS antisecretory factor, 610 breastfeeding, contraindication to, 430 HMF See human breastmilk fortifier HMOs See human milk oligosaccharides Hoffman’s technique, 577, 578 holder pasteurization, 58–59 homeopathic treatment for mastitis, 612 homocysteinuria, 533 hormones gastrointestinal hormones of infants, 125, 126t polycystic ovary syndrome, 669t sleepy infants, 349 hormones of lactation clinical implications, 125–128 hormonal regulation of breast development and function, 119t oxytocin, 122–128, 126t prolactin, 118–122, 119t, 120f hospital discharge, 492 hospital experience, 489 hospital-acquired methicillin-resistant S aureus, 612 hot castor-oil packs, 612 human alpha-lactalbumin made lethal to tumor cells (HAMLET), 35 human breastmilk fortifier (HMF), 56 human milk, 143 composition, 11 definition of, Human Milk Banking Association of North America, 60, 489 human milk banks in North America, 91–93 human milk oligosaccharides (HMOs), 40–41 human T-cell lymphotropic virus types I and II, 430 Humira, 682 hydrocephalus, 548 hydrogel wound dressings, 594 hydrolyzed formula, 666 hydroxychloroquine rheumatoid arthritis, 682 systemic lupus erythematosus, 680 hyoid bone, infant, 166 hyperbilirubinemia See also neonatal jaundice supplementation, 261–263 weight loss after birth, 262 hyperlactation breastfeeding management, 651–652 signs and symptoms, 650–651, 650b hypernatremic dehydration breastfeeding support, 416 clinical signs of, 414 described, 411–412 infant issues, 414 maternal issues, 412 neonates, 258–259, 258b, 259b, 261 risk factors for, 412 treatment, 415 hyperreactio luteinalis breastfeeding management, 671 described, 671 hyperthyroidism breastfeeding management, 673–674 described, 672 hypoglycemia breastfeeding management, 371–375 described, 364–365 glucose-level measurement, 368–369, 369b infants, with diabetic mothers, 666 maternal, in diabetic mothers, 667 operational thresholds, 370, 371t physiological adaptation after birth, 365–367 problem of, 364 screening and management algorithm, 366, 366f statistical definition, 264, 264t supplementation, 263–265, 264t hypoplastic breasts, 109 hypoplastic left heart syndrome, 456b hypotension, 239 hypothalamus, 118–119 hypothyroidism breastfeeding management, 673–674 congenital, screening for, 533 described, 671 polycystic ovary syndrome, 671–672 hypotonia epidural analgesia/anesthesia, 238 first hours of life, and feeding problems, 330–331 hypozincemia, 48 I IBCLC See international board certified lactation consultant IBFAT See Infant Breastfeeding Assessment Tool ibuprofen, 682 IDDM See insulin-dependent diabetes mellitus IDDM, or type I See insulindependent diabetes mellitus I:G See insulin-to-glucose ratio IgA See immunoglobulin A IgG See immunoglobulin G 726 • Index IIFAS See Iowa Infant Feeding Attitudes Scale immune system colostrum, 12 GI tract colonization, 18 immunomodulators in human milk, 54 mammary glands, evolution of, 10, 10f immunoglobulin A (IgA), 18–19 concentrations of, in human milk, 36 secretory immunoglobulin A (sIgA), 12, 609 immunoglobulin G (IgG), 12, 21, 36 impending failure to thrive, 419 impetigo vulgaris, 584 imprinting artificial nipples and pacifiers, 322–325 self-destructive behavior, 233 Imuran, 680 inborn errors of metabolism cystic fibrosis, 536–537 galactosemia, 538–539, 538f phenylketonuria, 533–534 screening for, 533 supplementation, 267, 267b incisions for breast implants, 110–111, 110f Inderal, 672 individualized fortification of human milk, 432 Indocin See indomethacin indomethacin congenital heart disease, 539 rheumatoid arthritis, 682 infant anatomy and physiology influence on breastfeeding, 159–212 assessment tools Beginning Breastfeeding Survey, 206–207, 211 Breastfeeding Assessment Score, 204, 204t, 211–212 Breastfeeding Assessment Tool, 198 Breastfeeding Attrition Prediction Tool, 205, 211 Breastfeeding Self-Efficacy Scale, 205, 210–211 Bristol Breastfeeding Assessment Tool, 207, 208t H & H Lactation Scale, 205, 210 Infant Breastfeeding Assessment Tool, 196–197, 197t, 207–210 Latch Assessment Documentation Tool, 197–198, 198t LATCH Scoring System, 203–204, 203t Latch-On Assessment Tool, 201–203, 201b–202b Maternal Breastfeeding Evaluation Scale, 205, 210 Mother–Baby Assessment Tool, 199–200, 200t, 207–209 Mother–Infant Breastfeeding Progress Tool, 206, 207t Neonatal Oral–Motor Assessment Scale, 205–206 Newborn Individualized Developmental Care and Assessment Program, 206 Potential Early Breastfeeding Problem Tool, 205, 210 Preterm Infant Breastfeeding Behavior Scale, 206 Systematic Assessment of the Infant at Breast, 198–199, 198b–199b validity and reliability, 207–212 Via Christi Breastfeeding Assessment Tool, 200–201, 201t breathing, 179–180 chapter summary, 212 clinical implications cheeks, 182–184 esophagus, 194–195 hard palate, 189–191, 192f jaw, 182 lips, 180–182, 182f nasal cavity, pharynx, larynx, and trachea, 193–194 soft palate, 192–193, 193f tongue, 184–189, 185f–189f esophagus, 166, 194–195 hyoid bone, 166 larynx, 166, 193–194 muscles, 167 nasal cavity, 166, 193–194 neural control, 167, 168t oral cavity, 159–165, 160b–161b, 160f, 165f pharynx, 166, 193–194 reflexes, 167–168 sucking mechanisms, 169–176, 170f–172f, 174t swallowing, 176–178, 177f trachea, 166 infant anomalies, abnormalities, diseases, and disorders, 495–516 ankyloglossia See ankyloglossia cleft lips and palates, 506–515 congenital heart disease, 539–542, 540b gastrointestinal, 521–533 metabolic disorders, 533–539 neurological, 543–549 syndromes and congenital anomalies, 516–518 upper airway issues, 518–521 Infant Breastfeeding Assessment Tool (IBFAT), 196–197, 197t, 207–210 Infant Feeding Practices Study I, 226 Infant Feeding Practices Study II, 227 infant formula, 9, 17 digestion of, 16 feeding preterm infants with, 18 LCPUFA supplementation of, 29 infants appetite, and lactogenesis III, 134, 137 temperament, and postpartum depression, 659 inflammation breasts, 117 postpartum depression, 661 infliximab, 682 Institute of Medicine, 30 insulin, 21 breast development and function, 119t diabetic mothers, 664 resistance diabetes, 664 polycystic ovary syndrome, 668–670, 668b–670b suckling, 126t Index • 727 insulin-dependent diabetes mellitus (IDDM/type I) See also diabetes described, 662 lactogenesis II, 130–131 mastitis, 608 insulin-to-glucose ratio (I:G), 130 intelligence quotient (IQ), 26, 27b, 31–33, 88, 402, 420, 429, 534, 640, 672 interferon beta-1A, 678 interferon beta-1B, 678 interferon, in colostrum, 12 international board certified lactation consultant (IBCLC), 3, 308 intracranial hemorrhage, and vacuum extraction, 240 intraductal papilloma, 617 intrapartum fever, 237–238 intrauterine growth retardation, 680 inverted nipples, 107t, 117 described, 575 everting, 577 inverted-appearing nipple, 107t iodine-131 breastfeeding, contraindication to, 267 hyperthyroidism, 672 iodine, and maternal smoking, 48 Iowa Infant Feeding Attitudes Scale (IIFAS), 211 iron Candida albicans, 590 human milk fortification, 55 human milk, in, 47–48 supplementation, 47–48 IV fluids received by mothers edematous areolae, 118 epidural analgesia/anesthesia, 234 weight loss in infants, 254–256 J jaundice See neonatal jaundice jaws breastfeeding, clinical implications for, 182 latch problems, 320, 321f support of, with Down syndrome, 545 Joint Commission, and Perinatal Care core measure set, 251 K kangaroo care, 442, 445 Keppra, 641 kernicterus approach to and prevalence of, 405–406 defined, 405–406 signs of, 402t ketorolac, 682 Kineret, 682 Klonopin See clonazepam Kotlow classifications of infant maxillary frenum attachment, 181, 182f of tongue-tie, 188, 188f L labor medications See also epidural analgesia/anesthesia regional analgesia/anesthesia, 233–235 systemic agents, 231–233, 232t Lact-Aid Nursing Trainer cleft lip and cleft palate, 510 cleft lips, 513 cleft palate, 509–510 supplementation, 274 lactating breast, side view of, 100f lactation evolution of, 10, 10f induced interventions for, 653b reasons for, 652–653 lactation consultants breastfeeding success, influence on, 306 in-hospital, criteria for referral to, 358t in-hospital, for preterm infants, 427 lactation management experts, 359b lactation process, 135 “lactiferous sinus,” 104 Lactobacillus brevis, 524 Lactobacillus reuteri, 524 Lactococcus acidophilus, 524 Lactococcus lactis, 524 lactoferrin Candida albicans, 590 functions of, 35–36 lactogenesis I, defined, 96 lactogenesis II clinical implications, 135 defined, 96 delayed, factors related to, 129–134 delayed, with diabetic mothers, 667 described, 128–136 medications, 135–136 prolactin secretion, 125–126 suckling and suckling frequency, 134–136 lactogenesis III autocrine (local) control, 136–138 prolactin secretion, 125–126 supplementation, 252 volume of milk production over time, 138–139 lactose functions of, 38–39 intolerance, 524 iron absorption, 47 lactose-free formula, 539 Lamictal See lamotrigine lamotrigine epilepsy, maternal, 641 postpartum depression, 660 lanolin, for nipple fissure, 593–594, 596t laryngomalacia breastfeeding management, 519–520 described, 518–519 larynx breastfeeding, clinical implications for, 193–194 infant anatomy, and breastfeeding, 166, 193–194 L-aspartic acid, 405 latch congenital heart disease, 542 Down syndrome, 545 first 24–48 hours artificial nipples and pacifiers, 322–325 birth trauma, medications, conditions, and events, 326–338, 329b, 333t deep latch, 318–319 gestational age, 325–326 importance of, 318–319, 319f 728 • Index latch (Continued) problems, 319–321, 320f, 321f state and feeding readiness, 321–322, 322t nipple soreness, 582 Latch Assessment Documentation Tool, 197–198, 198t LATCH Scoring System, 203–204, 203t Latch-on Assessment Tool, 201–203, 201b–202b late preterm infants differentiating from term infants, 450–451, 452t feeding skills, 450 in-hospital feeding plans, 451, 452t positioning for breastfeeding, 451 postdischarge feeding plan, 454–455, 454b pumping for supplementation, 453–455 late-onset (breastmilk) jaundice, 404 laughter, maternal colic, 526 melatonin, 54–55 LCPUFAs See long-chain polyunsaturated fatty acids lecithin, 606 left lateral sleeping position for infants, 528 legislation breastfeeding, protecting, expressing milk in the workplace, maternal employment, 686, 689 lemon balm, 524 letdown reflex action of, 101 oxytocin nasal spray, 127 leukocytes, 53 levetiracetam, 641 Levothroid, 672 levothyroxine, 672 Levoxyl, 672 Lexapro, 660 light-emitting diode (LED) phototherapy, for nipple trauma, 595 limb deficiencies, abnormalities/ absence, 639–640 lipids clinical implications, 31–34 content and composition, factors influencing, 27, 28t human milk component, 25–34, 26b–27b, 28t lips See also cleft lip and cleft palate breastfeeding, clinical implications for, 180–182, 182f infant anatomy, and breastfeeding, 159, 161b latch problems, 320 Lip-ties, 182 Listening to Mothers Survey, 223 Listening to Mothers Survey II, 224b lithium therapy, 660 Lithobid, 660 local (autocrine) control of milk synthesis, 136–138 long-chain polyunsaturated fatty acids (LCPUFAs), 26–27, 29–33 lorazepam, 660 Luminal (phenobarbital), 640, 641 lymphatic breast drainage therapy, 604 lysozyme enzymes in human milk, 36 mammary glands, evolution of, 10, 10f M M cells, 19 magnesium, in human milk, 46 magnesium sulfate (MgSO4), 490 mammary candidosis described, 589 diagnosis of, 589 risk factors for, 589 mammary glandular tissue, 100 mammary hypoplasia, 98 mammary pit, 95 mandible, infant, 160b–161b, 162–163 maple syrup urine disease, 533 Massachusetts Breastfeeding Coalition, 6, 6f massage, for neonatal jaundice, 408 mastalgia, 618 mastitis bacterial pathogens, 611–612 breastfeeding management, 612–613 causative organisms, 608 depth of latch, 319 diabetic mothers, 667 diagnosing, 607 incidence of, 607 precipitating factors, 608 recurrent mastitis, 610–611 signs and symptoms, 607 subclinical mastitis, 609–610 maternal anatomy and physiology influence on lactation, 95–143 breast anomalies, 116–117 breast augmentation, 110–113, 110f breast development accessory nipples and breast tissue, 95–96, 97f pregnancy, 96–99, 98f prenatal development, 95, 96t puberty, 96 breast reduction, 113–116 chapter summary, 143 functional anatomy of the breast areola, 98, 104–106 clinical implications, 109 nipple ducts, 101–104, 102f, 103f nipple types and classification, 106–108, 107t, 108f nipple–areolar complex, 105–106 overview of, 100–109 hormones of lactation clinical implications, 125–128 gastrointestinal hormones, 125 oxytocin, 122–128, 126t prolactin, 118–122, 119t, 120f lactogenesis II, 128–136 lactogenesis III, 136–139 newborn stomach, 139–143, 139t–140t nipple anomalies, 117–118 nipple preparation, 109 volume of milk production over time, 138–139 Maternal Breastfeeding Evaluation Scale (MBFES), 205, 210 maternal elimination diet atopic disease, 20 colitis/proctocolitis, 530 maternal emotional challenges, 657–660 maternal employment, 684–690, 688b, 689f–690f breastfeeding management, 686–690, 688b, 689f –690f legislation, 686, 689 maternity leave, 684–685 worksite conflicts, 685 Index • 729 maternal pathology: breast and nipple issues, 575–618 breast abscess, 613–615 chapter summary, 618 engorgement, 600–605 galactoceles and other breast masses, 615–616 mastalgia, 618 mastitis, 606–613 nipple discharge, 616–617 plugged ducts, 605–606 sore nipples bacterial infection, 584–585, 585t, 589–590 eczema and psoriasis, 585–586 fungal colonization, 589–591 glands of Montgomery, 588–589 nipple bleb, 588 maternal request for supplementation, 265–266 maternal stress, with preterm infants, 429–430 maternal visual/hearing impairment, 641–642 maternal–infant bond, and oxytocin, 122–123 maternity care practices and breastfeeding epidural drugs, 235–242 labor medications regional analgesia/anesthesia, 233–235 systemic agents, 231–233, 232t prenatal maternal medications, 230 Maternity Practices in Infant Nutrition and Care (mPINC) survey, 23 Maternity Practices in Infant Nutrition and Care (mPINC) survey (CDC), 228 maxilla infant anatomy, and breastfeeding, 160b–161b, 162–163 maxillary lip-tie, 504–505 MBA See Mother–Baby Assessment Tool MBFES See Maternal Breastfeeding Evaluation Scale Mead-Johnson Cleft Lip/Palate Nurse, 509 Medela Soft Feeder, 274 medically challenged mothers, 637–640 medications lactogenesis II, 135–136 maternity care practices and breastfeeding, 229–230 Medihoney, 598 medium-chain Acyl-CoA dehydrogenase deficiency, 533 Medrol, 678 melatonin circadian rhythm in human milk, 54 colic, 526 meperidine See Demerol metabolic status, and lactogenesis II, 129–130 metabolism, inborn errors of cystic fibrosis, 536–537 galactosemia, 538–539, 538f phenylketonuria, 534–536 screening for, 533 supplementation, 267, 267b metformin, 669 methadone, maternal, 331–334, 333t methicillin, 611 methicillin-resistant Staphylococcus aureus (MRSA) breast abscess, 614 Medihoney, 598 methimazole, 672 methotrexate, 682 methylprednisolone, 678 metoclopramide induced lactation, 652 insufficient milk supply, 645 MFGM See milk fat globule membrane miconazole, 592 microbiome, 13–16, 250, 428, 528, 537, 613 micrognathia, breastfeeding, clinical implications for, 183 micrognathia, Pierre Robin sequence, 516, 517 microminerals in human milk categories of, 46–47 clinical implications, 48–50, 49t micronutrients, 42 microwaving human milk, 58 milk ejection reflex action of, 101 oxytocin, 126–127 milk fat globule membrane (MFGM), 36, 60 milk production volume over time, 138–139 milk secretion, 95 milk supply, insufficient, 642–649 milk thistle, 648 minerals ions in human milk, 46 microminerals in human milk, 46–50, 49t modified C-hold position for hands, 310 Montgomery tubercles/glands anatomy and physiology of, 106 obstruction of, 588–589 mood, depressive, and anxiety disorders breastfeeding management, 662 holistic care, 658 nonpharmacological interventions, 661–662 pharmacological interventions, 660–661 postpartum depression, 659–660 More Milk Plus, 648 morphine administration, 123 Mortierelle alpina, 29 Mother–Baby Assessment (MBA) Tool, 199–200, 200t, 207–209 Mother–Infant Breastfeeding Progress Tool, 206, 207t Mother’s Lactaflow, 648 Mother’s Milk herbal blend tea, 648 motilin, 354 Motrin, 682 mouth opening latch, 318–319, 319f latch problems, 319, 320f late preterm infants, 451 mouth-orienting reflex, 168 mPINC See Maternity Practices in Infant Nutrition and Care mPINC survey See Maternity Practices in Infant Nutrition and Care survey MRSA See methicillin-resistant Staphylococcus aureus MS See multiple sclerosis mucins, 35, 53 multidrug-resistant gram-negative organisms, 598 multiple sclerosis, 676–679 breastfeeding management, 678–679, 679f–680f described, 676–678 treatment, 677 730 • Index multivariate analysis, 124 mupirocin APNO (Newman’s all-purpose nipple ointment), 592 bacterial infection of the nipple, 592, 593 recurrent mastitis, 611 muscles for breastfeeding artificial nipples, 322–325 infant anatomy, and breastfeeding, 167 myelomeningocele, 548 Myidone, 640 Myochrysine, 682 myoepithelial cells, 101 myofascial release, 328 N nalbuphine, 232 narcotics during labor, and effect on infant, 233 NAS See neonatal abstinence syndrome nasal cavity breastfeeding, clinical implications for, 193–194 infant anatomy, and breastfeeding, 166 nasogastric feeding tubes, adequate intake, by preterm infants, 448 National Alliance for Breastfeeding Advocacy, 32 National Conference of State Legislatures, National Health and Nutrition Examination Survey (NHANES), 653 NEC See necrotizing enterocolitis necrotizing enterocolitis (NEC), 13, 18, 55–56 infant formula, 16 platelet-activating factor acetylhydrolase, 36–37 neonatal abstinence syndrome, 331 neonatal intensive care units (NICUs), 15, 23, 55, 57 GI tract colonization, 15 hospital lactation care and services, 434–437, 436b in-hospital, for preterm infants, 426 twins and higher-order multiples, 486–487 neonatal jaundice, 397 See also hyperbilirubinemia bilirubin metabolism, 397–399 breastfeeding, effects of, 410–411 breastfeeding support: practice suggestions, 406–410 classifications of, 397–411 continued breastfeeding and maternal behaviors, 410–411 hyperbilirubinemia and kernicterus, approach to and prevalence of, 405–406 managing hyperbilirubinemia, 404–405 NSAIDs, 680 overview, 397 slow weight gain, 416–426, 422t, 423t, 425b neonatal lupus, 681 Neonatal Oral–Motor Assessment Scale, 205–206 Neu5Ac sialic acid, 41 neural control, breastfeeding, clinical implications for, 167, 168t neural tube defects breastfeeding management, 548–549 types of, 548 neuregulin-4 (NRG4), 37 neurological disorders categories of, 543–544 cerebral palsy, 546–547 Down syndrome, 544–546 neural tube defects, 548–549 Rubinstein-Taybi syndrome, 547–548 neurological system, first hours of life, and feeding problems, 329–331 Neurontin, 641 newborn hydration model, 24, 24f Newborn Individualized Developmental Care and Assessment Program (NIDCAP), 206 newborns, beyond initial 48–72 hours, 397–455 chapter summary, 456 hypernatremic dehydration, 411–416 late preterm infants, 450–455, 452t, 454b neonatal jaundice, 397–411 preterm infants breastfeeding, advantages of, 426–427 breastfeeding, contraindications to, 430–431 breastfeeding support: practice suggestions, 437–445 full feedings at the breast, transitioning to, 446–449 hospital lactation care and services, 434–437, 436b incidence of preterm birth, 426, 429 infant stresses, 433–434 maternal stresses, 429–430 not breastfeeding, disadvantages of, 433–434 skin-to-skin contact, early and frequent, 445 sucking at the breast, implementing, 445–446 sufficient and appropriate milk, 431–433 slow weight gain, 416–426, 422t, 423t, 425b newborns, fever, and epidural analgesia, 239 newborns, first 24–48 hours, 305–375 breastfeeding, clinician influence on success of, 305–308 chapter summary, 375–376 decision trees for breastfeeding, 359–364, 360f–364f fussy infants, 349–354, 350f, 351b, 352b, 353f, 354b hypoglycemia, 364–371, 366f, 367b, 369b, 371t latch artificial nipples and pacifiers, 322–325 birth trauma, medications, conditions, and events, 326–338, 329b, 333t gestational age, 325–326 importance of, 318–319, 319f problems with, 319–321, 320f, 321f state and feeding readiness, 321–322, 322t Index • 731 latch, gestational age, 406 nipple shields, 338–342, 341f, 341t positioning of the infant, 311–317, 312f–315f, 316f positioning of the mother, 308–311, 308f–311f reluctant nursers, 342–349, 343b–345b, 346f, 348b, 349t sleepy infants, 342–349, 343b–345b, 346f, 348b, 349t, 350f newborn’s stomach, 139–143 anatomic stomach capacity in first 10 days, 141–142, 142t feeding clinical implications, 141–143 feeding size and frequency, factors related to, 141t milk production and intake volumes over time, 139t–140t physiological stomach capacity in first 10 days, 141–142, 142t Newman’s all-purpose nipple ointment (APNO), 592 NHANES See National Health and Nutrition Examination Survey niacin, in human milk, 41 NICUs See neonatal intensive care units NIDCAP See Newborn Individualized Developmental Care and Assessment Program nifedipine, 587 Niplette, 577 nipple bleb, 588 nipple confusion, described, 273 nipple discharge, 616–617 nipple duct system described, 101–104, 102f, 103f duct ectasia, 617 plugged ducts, 605–606 nipple fissure, 581 nipple piercing, 608 nipple rolling, 576, 578 nipple shields advantages and disadvantages, 338–349 cleft lip and palate, 510 congenital heart disease, 510 consent and follow-up, 342 latch, helping with, 338 preterm infants, 448 shield composition and dimensions, 340–342, 341f, 341t weaning from, 342 nipple–areolar complex, 117–118 olfactory cues, 105–106 proper placement, 581 nipples, 101 anomalies, 117–118 antenatal preparations, 576–578 artificial challenges to breastfeeding, 322–325 differences from human nipples, 271–273, 273b tongue, effect on, during breastfeed in, 185–186, 185f–186f breastfeeding management, 578–579 breastfeeding recommendations based on type, 576 classification by type, 106–108, 107t, 108f discharge from, 611, 616–617 inverted, grades of, 575–576 latch problems, 321 nipple duct system, 101–104, 102f, 103f nipple–areolar complex, 105–106 preparation of, 109 stimulation for induced lactation, 652 nitrogen, in human milk, 37 non-insulin-dependent diabetes mellitus (type II), 663 See also diabetes nonorganic failure to thrive, 419 nonpharmacological interventions, 661–662 nonprotractile nipples, 576 nonsecretors, 39 nonsteroidal anti-inflammatory drugs (NSAIDs) rheumatoid arthritis, 682 systemic lupus erythematosus, 680 nortriptyline, 660 NRG4 See neuregulin-4 NSAIDs See nonsteroidal anti-inflammatory drugs Nubain, 232 nucleotides, in human milk, 37 Nutramigen, 530 nystatin Candida albicans, 592–593 fungal infection of the nipple, 589 O obesity breastfeeding, effect on, 653–656 breastfeeding management, 657 GI tract colonization, 14 incidence of, 654 lactogenesis II, 131–132 mother, 653–656 occlusive dressings, for nipple wounds, 594 odor of the breast artificial nipples and pacifiers, 324–325 Montgomery tubercles, 104–105 oligosaccharides actions of, 39–40 antimicrobial agent, 52 olive oil, for nipple trauma, 595 opioid, 231, 233, 236, 327, 331–334 oral aversion, and feeding problems, 330 oral cavity of infants, and breastfeeding cheeks, 161 hard palate, 160f, 161b, 164–165, 165f lips and cheeks, 159, 161b mandible and maxilla, 160b–161b, 162–163 soft palate, 160f, 161b, 165 tongue, 160b, 160f, 163–164 oral contraceptive pills, and induced lactation, 652 oral stimulation, and Down syndrome, 545 oral water intoxication, 23 oral-tactile hypersensitivity, 330 Orencia, 682 orthodontic problems, and ankyloglossia, 498 otitis media, 508 overweight mothers and breastfeeding, 653–657 See also obesity oxacillin-resistant Staphylococcus aureus, 614 oxcarbazepine, 641 732 • Index oxytocin, endogenous biological nurturing position for the infant, 316–317 effects of other hormones influenced by suckling, 125–128 epidural analgesia/anesthesia, 237 hormone of lactation, 122–125 maternal–infant bond, 122–123 prolactin, 123 oxytocin infusion breastfeeding, effects on, 235 edema, 239 epidural analgesia/anesthesia, 236 labor medication, 233 oxytocin nasal spray induced lactation, 652 milk production, 127 oxytocin, sublingual or buccal preparations, 647 ozonated olive oil, and nipple trauma, 595 P pacifiers challenges to breastfeeding, 322–325 Down syndrome, 545 fungal colonization of the nipple, 590 hypernatremic dehydration, 412 multiples, 489–492 PAF-AH See platelet-activating factor acetylhydrolase Paget disease of the nipple, 586 palatal obturator, cleft palate, 191, 508–510 palmitic acid, 32 Pancrease, 530 pancreatic secretory trypsin inhibitor (PSTI), 12 Paneth cells, 37 pantothenate, 41 Paracetamol (acetaminophen), 682 paroxetine infant feeding problems, 336 postpartum depression, 660 prenatal maternal medications, 230 partial breastfeeding, 494 pasteurization of human milk, 58–59 pathological jaundice, causes of, 400 Patient Protection and Affordable Care Act of 2010 legal protection for breastfeeding, 6–7 maternal employment, 686 patient-controlled analgesia (PCA), 490 PCA See patient-controlled analgesia PCA (patient-controlled analgesia), 490 PCOS See polycystic ovary syndrome PEBPT See Potential Early Breastfeeding Problem Tool penicillamine, 682 penicillinase-resistant penicillins, 611 peppermint tea/gel hyperlactation, 651 sore nipples, 595–598 periareolar incision site, 111 Perinatal Care core measure set (joint commission), 251 peripartum factors, birthing practices, and early caretaking behaviors, 223–276 birth interventions and breastfeeding, 223–229, 224b, 226b crying, 246–248, 246f, 247f maternity care practices and breastfeeding, 229–245 labor medications, 231–242, 232t prenatal maternal medications, 229–230 separation, 242–245 separation, 242–245 supplementation, 248–276, 249b dehydration, 257–261, 258b, 258t, 259b, 260f gut flora, effect on, 266 hyperbilirubinemia, 261–263 hypoglycemia, 263–265, 264t indications for, 267–269, 267b–269b, 267b–269b maternal request, 265–266 trends in, 248–250, 249b types of supplements, 270, 270t weight loss, 254–257 supplementation breastfeeding, intensity and duration of trends in, 251–254 peripartum mood, depressive and anxiety disorders, 657–662 nonpharmacological interventions, 661–662 pharmacological interventions, 660–661 postpartum depression, 659–660 peristaltic action, in the sucking dynamic, 170 persistent occiput posterior position, 240 Pertofrane, 660 pharmacological interventions, 660–661 pharyngeal swallow, 176 pharynx breastfeeding, clinical implications for, 193–194 infant anatomy, and breastfeeding, 166, 193–194 phasic bite reflex, 168 phencyclidine, 430 phenobarbital, 640 phenylalanine-free formula, 534 phenylephrine, 239 phenylketonuria (PKU) breastfeeding management, 535–536 described, 534–535 maternal breastfeeding management, 676 fetal phenylalanine effect on the mother, 676 maternal PKU effects on the fetus, 676 screening for, 533, 676 phenytoin cleft lips and palate, 507 epilepsy, maternal, 640 phosphate, in human milk, 46 phototherapy, for hyperbilirubinemia, 404–405 physical, medical, and environmental airway problems, 518–521 anomalies, diseases, and disorders, 495–515 congenital heart disease, 539–543 gastrointestinal disorders, 521–533 metabolic disorders, 533–539 neurological disorders, 543–549 syndromes and congenital anomalies, 516–518 twins and higher order multiples, 485–495 physically challenged mothers limb deficiencies, abnormalities, or absence, 639–640 spinal cord injury or involvement, 637–638 Index • 733 physiological jaundice, defined, 399–400 Pierre Robin Sequence, 516 cleft lips and palate, 508 Pierre Robin syndrome breastfeeding, clinical implications for, 183 cleft lip or palate, 190 Pigeon Cleft Palate Nipple, 510 pillows for support multiple sclerosis, 679, 679f–680f positioning the mother, 308–309, 308f stroke, 639 “pinch test” on nipples, 117 piroxicam, 682 PKU See phenylketonuria plagiocephaly, 183, 493 plasma levels, of oxytocin, 123 plastic surgery, 97–98 platelet-activating factor acetylhydrolase (PAF-AH), 36–37, 54 plugged ducts, 605–606 polycystic ovary syndrome (PCOS), 668–670, 668b–670b breast glandular tissue, amount of, 109 breastfeeding management, 670 clinical and laboratory manifestations, 668–670, 668b–670b diabetic mothers, 668 diagnostic criteria, 668 hormonal aberrations, 669, 670b treatment, 670 polyethylene bags, 62 polyethylene film dressing, 594 polyunsaturated fatty acids (PUFAs), 26, 29 poor neonatal adaptation, described, 336–337 positioning of the mother hand positions, 309–311, 309f–311f semireclining, 315, 316f hand positions, 309–311, 309f–311f overview, 308–311, 308f–311f side-lying position, 315–316, 315f, 316f positioning the infant biological nurturing position, 316–317, 316f cleft lip, 512 cleft lip and palate, 515 cleft lips, 512–513 clutch (football) hold, 314, 314f, 447 congenital heart disease, 542 cradle hold, 312–313, 312f, 545 cross-cradle hold, 313–314, 313f, 447, 545 Down syndrome, 544–546 GER and GERD, 527–528 importance of, 311–312 late preterm infants, 453–454, 454b prone position, 315, 527 semiprone, 315–316, 316f side-lying position, 315, 315f straddle (sitting) position, 315, 512 posterior tongue-ties, 501–502 postpartum depression, 659–660 breastfeeding management, 662 holistic care, 658 nonpharmacological interventions, 661–662 obesity, 655, 656 pharmacological interventions, 660–661 postpartum depression, described, 659–660 postpartum thyroiditis, 673 potassium, in human milk, 46 Potential Early Breastfeeding Problem Tool (PEBPT), 205, 210 preeclampsia systemic lupus erythematosus, 680 twins and higher-order multiples, 490 prefeeding cues, 124–125 Pregestimil, 530 pregnancy, and breast development, 96–99, 98f pregnancy-induced hypertension, 490 prematurity lactogenesis II, 130 systemic lupus erythematosus, 680 prenatal breast development, 95, 96t prenatal preparation, 487–489, 488t Preterm Infant Breastfeeding Behavior Scale, 206 preterm infants breastfeeding, advantages of, 427–429, 428b breastfeeding, contraindications to, 430–431 breastfeeding support: practice suggestions, 437–445 colostrum, 12 full feedings at the breast, transitioning to, 446–449 hospital lactation care and services, 434–437, 436b incidence of preterm birth, 426, 429 infant stresses, 433–434 maternal stresses, 429–430 not breastfeeding, disadvantages of, 433–434 postdischarge feeding plan, 454, 454b skin-to-skin contact, early and frequent, 445 sucking at the breast, implementing, 445–446 sufficient and appropriate milk, 431–433 twins and higher-order multiples, 491–492 preventive care services, primidone, 640 proctocolitis described, 529 treatment, 530 progesterone breast development and function, 119t induced lactation, 652 polycystic ovary syndrome, 669, 669t, 670, 670b projectile vomiting, and pyloric stenosis, 531 prolactin gastrointestinal hormones, 125 hormone of lactation, 118–122, 119t, 120f recombinant human prolactin, 135–136, 647 prolonging breastfeeding, 494–495 prone position GER and GERD, 527 position for the infant, with mother supine, 315f propoxyphene, 682 propranolol, 672 propylthiouracil, 672 prostaglandins labor medication, 233 protective component in human milk, 52t, 54 protective components in human milk, 50, 51t 734 • Index protein clinical implications, 37–38 fortification of human milk, 55–57 human milk component, 34–38 protective components in human milk, 50, 51t protein-A immunoadsorption therapy, 682 proton pump inhibitors, 528 protoporphyrins, 405 provision of breastmilk, 494–495 Prozac See fluoxetine pseudoephedrine, 651 pseudoinverted nipples, 575 Pseudomonas aeruginosa breast abscess, 614 cystic fibrosis, 537 psoriasis, 585–586 PSTI See pancreatic secretory trypsin inhibitor psychomotor development lipids in human milk, 25, 26b–27b, 28t SSRIs during pregnancy, 230 Psychomotor Developmental Index and Behavioral Rating Scale, 230 psychotherapy, for postpartum depression, 661 puberty, and breast development, 96 PUFAs See polyunsaturated fatty acids pumping breastmilk See also breast pumps breast engorgement, 605 cleft lips and palate, 518 induced lactation, 652 late preterm infants, 453–455 maternal employment, 684–686 preterm infants, 444 preterm twins and higher-order multiples, 494 pyloric stenosis breastfeeding management, 533 causal factors, 531–532 incidence and signs of, 532 surgical intervention, 532–533 pyloromyotomy, 532 pyridoxine (vitamin B6), 41 Q quiet alert state, for feeding readiness, 321–322 R RA See rheumatoid arthritis Raynaud phenomenon of the nipple, 586–588 receding jaw, 320, 321f recombinant human prolactin insufficient milk supply, 647 lactogenesis II, 135–136 recombinant human prolactin (r-hPRL), lactogenesis II, 135–136 recurrent mastitis, 610–611 red patches, on breast, 117 reflexes, infant, 167–168 refrigeration of human milk, safety, 60 regional analgesia/anesthesia, 233–235 Reglan See metoclopramide relactation, 652–653, 653b described, 653 reluctant nursers described, 342, 343b–345b problems and management, 343, 343b–345b sleepy infant, 342–349, 343b–345b, 346f, 348b, 349t Remicade, 682 retinoids, and cleft lips and palate, 507 retracted nipples, 107t described, 117–118, 575 retrognathia, 320, 321f retroplaced tongues, 511 reverse pressure softening of the nipple, 579 rheumatoid arthritis, 681–682 breastfeeding management, 683 cervical spine, 683 described, 681 drug therapy, 682 prevalence of, 681 spinal column, 683 wrists, hands, and fingers, 683–684 Rheumatrex, 682 RhoGAM, 404 r-hPRL See recombinant human prolactin riboflavin (vitamin B2), 41 rice cereal, for GER and GERD, 528 rickets, 42–43 Ridaura, 682 rifampin, 614 Rituxan, 682 rituximab, 682 rooting reflex, 168 Ross Cleft Palate Assembly, 510 rotavirus, 53 rubella, 539 Rubinstein-Taybi syndrome breastfeeding management, 547–548 described, 547 Ruminococcus, 16 S sample feeding plan, for mothers with breast augmentation/ reduction, 115b scales (weight) cleft lips and palates, 510 slow weight gain, 422 scissors hold for hands, 311 screening maternal depression, 661 metabolic disorders, 533 phenylketonuria, 533, 676 secretors, 39 secretory immunoglobulin A (sIgA), 18–19 colostrum, 12 mastitis, 609 selective serotonin reuptake inhibitors (SSRIs) depressive disorders, 661 infant feeding problems, 336 prenatal maternal medications, 229–230 self-destructive behavior later in life, and maternal narcotics, 233 semiprone position for the infant, 315–316, 316f sensitization to food allergens neonatal period, 20 supplementation, 266–267 sensory-integration disturbance in the first hours of life, 329, 329b Index • 735 separation of mother and newborn, and effects on breastfeeding, 243, 245 serotonin, 526 serrapeptase, 605 sertraline infant feeding problems, 336, 337 postpartum depression, 660 severe hyperbilirubinemia, 401 risk factors for, 401 shatavari, 649 Sheehan syndrome, 125 shield composition and dimensions, nipple shields, 340–342, 341f, 341t short-term breastfeeding, 21 shut-down states, and feeding readiness, 322, 322t sialic acid, 40, 41 side-lying position, 542 infants, 315–316, 315f, 316f infants, with congenital heart disease, 542 mothers, 315–316, 315f, 316f mothers, after cesarean birth, 308–309, 308f sIgA See secretory immunoglobulin A silicone nipple shields described, 340, 341f preterm infants, 447 sitting (straddled) position See straddle (sitting) position skin temperatures of infants, 244–245 skin-to-skin contact first hours of life, and effect on breastfeeding, 327–328 hormone function, 127–128 infant skin temperatures, 244–245 odor from Montgomery tubercles, 104–105 preterm infants, 445 sleep, and separation of mother and baby, 244–245 sleep states feeding readiness, 321–322, 322t sleepy infants, 321–322, 322t, 346–348, 347–348, 348b, 349t sleepy infants interventions to help, 349 metabolic hormones, 349 reluctant nurser, 342–349, 343–345b, 346f, 348b, 349t sleep states, 321–322, 322t, 347, 348, 348b, 349t sufficient intake, signs of, 347–348, 348b, 349t swallowing, signs of, 348, 348b, 349t slings multiple sclerosis, 678 stroke, 639 smoking, maternal colostrum, 13 congenital heart disease, 539 infant feeding problems, 334–336 iodine content of breastmilk, 48 pyloric stenosis, 531 SnMP (tin-mesoporphyrin), 405 SNS See Supplemental Nursing System social attitudes toward breastfeeding, social support, and postpartum depression, 661 sodium, in human milk, 46 soft palate breastfeeding, clinical implications for, 192–193, 193f infant anatomy, and breastfeeding, 160f, 161b, 165 latch problems, 320 Solganal, 682 Solu-Medrol, 678 somatostatin, 126t sore bacterial infection, 584–585 eczema and psoriasis, 585–586 fungal colonization, 589–591 glands of Montgomery, 588 herpes infection, 586 incidence of, 579 nipple bleb, 588 proper nipple–areolar placement, 581 Raynaud phenomenon of the nipple, 586–588 skin changes over time, 581 sore nipples bacterial infection, 584–585, 585t, 589–590 eczema and psoriasis, 585–586 fungal colonization, 589–591 glands of Montgomery, 588–589 herpes infection, 586 nipple bleb, 588 overview, 579–581 proper nipple–areolar placement, 581 Raynaud phenomenon of the nipple, 586–588 treatments, 592–600 soy allergy, 37 spastic cerebral palsy, 546 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), 684 SpecialNeeds Feeder (Haberman Feeder) See Haberman (SpecialNeeds) Feeder speech problems, and ankyloglossia, 497–498 spina bifida aperta, 548 spina bifida cystica, 548 spinal accessory nerve (CN XI), 328 spinal column, arthritic, 683 spinal cord injury or involvement breastfeeding management, 638 complete or incomplete injury, 637–638 spoon feeding cleft lips and palates, 510 described, 274, 275 SSRIs See selective serotonin reuptake inhibitors St John’s wort, 659 Stadol, 232 Staphylococcus aureus atopic dermatitis on the nipple, with, 585 bacterial infection of nipples, 584–585 breast abscess, 613–614 mastitis, 608 obesity, 17 recurrent mastitis, 610–611 virgin coconut oil, 598 Staphylococcus epidermidis, 610 Starter Supplemental Nursing System, 274 state and feeding readiness, latch, 321–322, 322t 736 • Index states of arousal, and feeding readiness, 321–322, 322t Stein-Leventhal syndrome, 668 See also polycystic ovary syndrome stem cells, 37 steroids, 593, 600 stomach capacity, infant, 141–142, 642 stools color and consistency, as sign of sufficient intake, 348, 349t diaper diary, 353f storage containers for human milk, 62–65, 63t, 65t straddle (sitting) position cleft lip and palate, 512 cleft lips, 512 position for the infant, 315 Streptococcus pneumoniae, 39, 52 Streptococcus species bacterial infection of nipples, 584–585 mastitis, 608 stress lactogenesis II, 132–133 mastitis, 609 mothers of preterm infants, 429–430 oxytocin, 122–123 preterm infants, 433–434 stridor, 518–519 stroke, 639 subclinical mastitis described, 609–610 fungal colonization of the nipples, 589 prevention of, 610 subgaleal (subaponeurotic) hematoma, 241 subutex, 334 sucking complete suck cycle, described, 170, 170f congenital heart disease, 542 crying, 247f Down syndrome, 545 lactogenesis II and III, 134–136 sucking dynamic, described, 170–171, 171f, 172f sucking mechanisms, 169–176, 170f–172f, 174t sucking bursts breathing, 179 described, 175 sucking patterns cleft lip or palate, 190 parameters of, 197 sucking reflex, 167–168 suckling, initiating, with preterm infants, 206 sucrose solution, for colic, 525 suction, as nipple preparation, 577 Sudafed, 651 sudden infant death syndrome, 331 sufentanil, 235 sulfasalazine, 682 sulfate, in human milk, 46 sunflower oil, 610 Supple Cups, 578 Supplemental Nursing System (SNS) cleft lip, 513 cleft lip and cleft palate, 510 cleft palate, 514 supplementation, 274 supplementation See also formula breastfeeding, intensity and duration of, 251–254 dehydration, 257–261, 258b, 258t, 259b, 260f gut flora, effect on, 266 hyperbilirubinemia, 261–263 hypoglycemia, 263–265, 264t indications for, 267–269, 267b–269b infant indications for, 268b maternal indications for, 268b maternal request, 265–266 trends in, 248–250, 249b types of supplements, 270, 270t weight loss, 254–257 surrogate pregnancy, and induced lactation, 652 swaddling breastfeeding, effect on, 245 Down syndrome, 545 swallowing infant anatomy and physiology, 176–178, 177f listening for, with cleft lips, 513–514 neonatal jaundice, 406–407 phases of, 176 reflex, 167 signs of, in sleepy infants, 347–349, 348b, 349t sympathetic nervous system, and spinal cord injury, 638 synthetic oxytocin, 127 Synthroid, 672 Systematic Assessment of the Infant at Breast, 198–199, 198b–199b Systematic Assessment of the infant at breast areolar compression, 199b areolar grasp, 199b audible swallowing, 199b systemic lupus erythematosus, 679–681 breastfeeding management, 681 described, 679–681, 679f–680f signs and symptoms, 680 treatment, 680 T Tapazole, 672 targeted fortification of human milk described, 57 preterm infants, 432 tea bags/green tea, for nipple trauma, 599 “teacup” hold during breastfeeding, 579 technetium-99m pertechnetate, 672 TEF See tracheoesophageal fistula (TEF) Tegretol See carbamazepine Ten Steps to Successful Breastfeeding, 225–227, 226b tetralogy of Fallot, 540b TGF-beta2, 18 TGF-β See transforming growth factor beta theca lutein cysts, 671 theophylline, 527 thiamin (vitamin B1), 41 thickened feedings, for GER and GERD, 528 3∙-FL, 39 three-sided bassinets, 243 thymus, 64 thyroid hyperthyroidism, 672–673 hypothyroidism, 671–672 thyroid disorders, 671–673 breastfeeding management, 673–674 congenital hypothyroidism, 533 diabetic mothers, 671 Index • 737 hyperthyroidism, 672–673 hypothyroidism, 533, 671–672 postpartum thyroiditis, 673 types of, 671 thyroid hormones breast development and function, 119t lactogenesis II, 136 thyrotropin-releasing hormone, 647 thyroxine, 672 tiagabine, 641 tight labial frenum, 162 tin-mesoporphyrin (SnMP), 405 tissue atrophy, 111 TNF-alpha, 18 tobramycin, 675 Tobrex, 675 tongue breastfeeding, clinical implications for, 184–189, 185f–189f infant anatomy, and breastfeeding, 160b, 160f, 163–164 latch problems, 319–320, 320f peristaltic movements, 173 protrusion, with Down syndrome, 545 retroplaced, 511 vacuum-generating movements, 173 tongue-tie See ankyloglossia Topamax, 641 topiramate, 641 Toradol, 682 torticollis, 183 total anomalous pulmonary venous return, 540b trace elements in human milk, 46 trachea breastfeeding, clinical implications for, 193–194 infant anatomy, and breastfeeding, 166 tracheoesophageal fistula (TEF), 521–522 tracheomalacia, 520 breastfeeding management, 520 tracheostomy, 521 transcutaneous bilirubin measurement, 409–410 transforming growth factor beta (TGF-β), 18 transverse tongue reflex, 168 trauma diabetic mothers, 667 nipple–areolar placement, 581 preventing, 593–594 treatment, 592–600 types of, 575–579 tray supports for mothers with multiple sclerosis, 679, 680f Treasury and General Government Appropriations Act (1999), triacylglycerols, 32 triamcinolone, 682 trigeminal nerve (CN V), 351b triglycerides, 32 Trileptal, 641 trimethoprim-sulfamethoxazole breast abscess, 614 mastitis, 611 triplets See twins and higher order multiples truncus arteriosus, 540b tube-feeding devices cleft lip and palate, 510 described, 274, 274f tuberculosis, 430 tuberous breast anomaly, 98 tuberous breasts, classification of, 99f Turner syndrome, 190 twins and higher order multiples, 485–495 birth weight and multiple births, 486t breastfeeding, importance of, 485–486, 486t feeding rotations, 492 hospital discharge, 492 incidence of, 485 in-hospital experience, managing goals, 489 healthy full-term multiples, 489–490 preterm multiples, 490–492 partial breastfeeding and breastmilk feeding options, 494 prenatal preparation for breastfeeding, 487–489, 488t prolonging breastfeeding and the provision of breastmilk, 494–495 separate and simultaneous feedings, 493 2∙-FL, 39 Tylenol (acetaminophen), 682 type diabetes, 21 type diabetes, 21 U U-hold position See Dancer hand (U-hold) position ultradian rhythms, and sleepy infants, 347 ultrasound treatment, for breast engorgement, 604 Unithyroid, 672 Update on the Safety of Silicone Gel-Filled Breast Implants (FDA), 111 upright position cleft of the soft palate, submucous cleft, or bifid uvula, 513 congenital heart disease, 542 GER and GERD, 528 reluctant nursers, 346f urinary tract infections, 525 urine, diaper diary, 353f urine, volume in 24 hours by age, 257–258, 258t U.S Department of Health and Human Services (HHS), U.S Food and Drug Administration (FDA), 30, 56 Update on the Safety of Silicone Gel-Filled Breast Implants, 111 vacuum extraction devices, 241 V vaccines, response to, in breastfed infants, 50 vacuum extraction delivery devices, problems with, 240–241 epidural analgesia, 240–241 vacuum-generating movements for sucking, 173 cleft palate, 173 vaginal delivery, 14 vagus nerve (CN X) birth trauma, and feeding problems, 328 soft palate paralysis, 192–193 738 • Index Valium, 660 valproic acid epilepsy, maternal, 640 neural tube defects, 548 postpartum depression, 660 vancomycin, 614 vancomycin-resistant enterococci, 598 vasopressin, effects of, 124 VATER/VACTERL association, 521 vegetarian mothers, and vitamin B12 supplements, 49 velum (soft palate), 165 venlafaxine, 660 ventral position, with Down syndrome, 545 ventricular septal defect, 540b V-hold position for hands, 309 Via Christi Breastfeeding Assessment Tool, 200–201, 201t Vibrio cholerae, 52 virgin coconut oil, for nipple trauma, 598 visual impairment, maternal, 641 vitamin A colostrum, 11–12 human milk component, 42 vitamin B6 (pyridoxine), 41 vitamin B12 human milk component, 41, 42 infant deficiency, and hypotonia, 330–331 lactating mothers, supplement for, 49 vitamin B1 (thiamin), 41 vitamin B2 (riboflavin), 41 vitamin C (ascorbic acid), 41, 42 vitamin D, 42–45, 43b vitamin D2 (ergocalciferol), 42 vitamin D3 (cholecalciferol), 42 vitamin E colostrum, 12 human milk component, 45–46 vitamin K dose given at birth, 46 human milk component, 46 vitamins in human milk, 41–46, 43b Voltaren (diclofenac), 682 W water bilirubin levels, 261, 262 clinical implications, 22–25 proportion in human milk, 22 water intoxication, 256 water-soluble vitamins in human milk, 41 wax-injected ductal system, in cadaver dissection, 101f weaning from nipple shields, 342 weight at birth, 486t weight gain (infant), slow ankyloglossia, 498 associated factors, 415, 419 breastfeeding support: practice suggestions, 437–445 causes, 419–420 feeding plans, 426–427 frameworks for, 411 initial weight loss, 417 summary of interventions for, 482–483 weight charts, 420 weight gain, maternal, with multiples, 487–489, 488t weight loss (infant) after birth epidurals, 257 IV fluids received by mother, 254–256 normal ranges, 254 weight loss patterns, 25 welfare reform, and maternal employment, 684 Wellbutrin (bupropion), 660 wheelchairs, for mothers with multiple sclerosis, 678–680, 679f–680f whey proteins, function of, 35, 53 WIC See Special Supplemental Nutrition Program for Women, Infants, and Children “witch’s milk,” 95 World Health Organization evidence-based best practices for breastfeeding, 225, 226b supplementation, indications for, 267, 267b weight charts, 420 wound healing, and nipple trauma, 594 wrists, arthritic, 683–684 X xanthine oxidoreductase (XOR), 10 XOR See xanthine oxidoreductase Z Zarontin, 640 zinc, in human milk, 48 Zoloft See sertraline Zonegran, 641 zonisamide, 641 ... 1990) These procedures are not indicative of 24 -hour intakes and milk production, but may help the clinician to gather data regarding whether the 424 • Chapter 6 Beyond the Initial 48– 72 Hours:... to provide at least 50% of their infants’ intake for the first weeks, 48.8% for the 4th week, and 32. 8% of the infants’ intake for the entire hospitalization period Mothers in both groups stated... mothers to change their feeding goals to exclusive breastmilk feeding for their preterm infant Unfortunately, the mother’s breastmilk may be inadequate for the maintenance of lactation beyond the