3/22/2011 Research Validation of How Breastfeeding Works - PDF document

3/22/2011 Research Validation of How Breastfeeding Works 22.03.2011 1 Training Agenda Synthesis and Secretion of Breastmilk Changes in Volume and Composition of Breastmilk Breastfeeding Patterns of babies How Babies Regulate Milk Production 2 22.03.2011 In Utero Fetus receives continuous nutrition 22.03.2011 3 1

3/22/2011 After birth … Exclusive breastfeeding is the optimum way to nourish babies from birth to 6 months old, and it is recommended that breastfeeding and it is recommended that breastfeeding continues into the second year of life and beyond. World Health Organization 2001 Advantages of Breastfeeding: Baby Mother Gold Standard Recover from infant food childbirth Facilitates Facilitates Body weight loss growth and development Cholesterol Protects against clearance illness Suppression of maternal fertility. Diabetics How is breastmilk made? Alveoli ‐ group of lactocytes Blood supply Myoepithelial cells Lactocyte Milk Duct 2

3/22/2011 How is breastmilk made? Alveoli ‐ group of lactocytes How is human milk manufactured? Lactocyte – milk making cell Blood Supply Rough Endoplasmic Reticulum Nucleus Golgi Process/Dispatch Proteins Tight/Gap Junctions Hold Cells Together Milk 3

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3/22/2011 New Breast Cells 5

3/22/2011 Maternal Diet: Volume and Composition NO….diet is not a factor Maternal Diet: Volume and Composition Energy Content = determined by concentrations of lactose, fat and protein 630 Kcal/day is energy required to produce average daily milk production. On average, breastfeeding mothers lose 2 kg more body weight over 6 months of lactation compared with mothers who do not breastfeed. Maternal Volume and Composition Well balanced diet is important Diet does affect concentrations of some vitamins and minerals in breast milk. AAP Guidelines for Vitamin D supplementation 6

3/22/2011 Secretory Differentiation Lactogenesis I Ability to secrete milk components during pregnancy Secretory Activation Lactogenesis II Prolactin Insulin Adrenal Cortisol Occurs about 60 hours postpartum Oxytocin release causes MER (milk ejection reflex) Secretory Activation Volume Changes Babies volume of feeds change from day to day 0 – 5 mL within 60 minutes of birth 7 – 123 mL in first 24 hour Generally, in 3 ‐ 8 breastfeeds (Arthur, 1989; Saint, 1984) 395 – 868 mL from 2 ‐ 6 days Generally, in 5 ‐ 10 breastfeeds (Arthur, 1989; Saint 1984; Casey, 1986; Glassier, 1990) 750 – 800 mL by 1 month of age (Hartmann, 1995; Kent, 2006; Cox 1996;) Milk production on day 6 is significantly associated with milk production at week 6. (Neville, 1991) 7

3/22/2011 Secretory Activation Composition Changes Increase in lipid content, casein, lactose, potassium, citrate, calcium, phosphate Decrease in total protein, sodium and chloride D i t t l t i di d hl id (Thrift, 1999, Harzer, 1986; Neville, 1991; Kunz, 1992) Changes in lactose, citrate, protein and sodium are biochemical markers that Secretory Activation has taken place. (Arthur, 1989; Cregan, 2002) Established Lactation Milk Volume and Composition Baby’s growth rate is related to the total amount of milk consumed rather than the concentration of fat, protein or lactose. (Kent, 1999; Butte, 1984) Range of Milk Production (71 Western Australian Mothers) 20 18 16 Mothers 14 12 Number of 10 8 6 4 2 0 24 ‐ h Milk Production (mL) 8

3/22/2011 Infra-red Image of Lactating Breast 32.0 30.0 28.0 26.0 24.0 22.0 20.0 Storage Capacity Computerized Breast Measurement 9

3/22/2011 Established Lactation Storage Capacity Storage capacity is the maximum amount of milk that can be stored in the breast and is available to the infant be stored in the breast and is available to the infant under normal patterns of breastfeeding. Established Lactation Storage Capacity Relates to the amount of milk available to the baby ranges from 81 to 606 mL (Daly, 1993) Storage Capacity and Available Milk 2000 Right breast Storage Capacity 1800 t Volume (mL) Available 1600 1600 Breast Milk 1400 1150 Left breast 1050 950 Time of Day 6:30 16:30 20:30 12:30 10

3/22/2011 Established Lactation Appetite Babies do not drain the breast at each feed ~ 1or more times/day. On average, take only 67% of the available milk Indicates babies feed according to appetite; they do not stop feeding because the breast is empty. Breast is not drained after each feed 1.0 0.8 e of Fullness 0.6 Degree 0.4 0.2 0.0 6:00 12:00 18:00 0:00 6:00 12:00 Time of Day Storage Capacity: 192 mL Average Feed: 80 mL Established Lactation Milk storage is a function of the mother’s breast anatomy and mother s breast anatomy and the baby’s appetite. 11

3/22/2011 Established Lactation Lung Capacity Tidal volume is the amount of air taken in during normal breathing. Vital capacity is the largest amount of air that can be e exhaled after taking a deep breath. a ed a e a g a deep b ea Expiratory reserve is the air that is left in the lungs after exhaling in normal breathing. Established Lactation Lung Capacity In the average adult, the amount of air that can be exhaled from a deep breath is about 4.5 L (8.4 pints.) A well trained athlete has a greater lung capacity. The A well-trained athlete has a greater lung capacity. The average amount of air she could exhale from a deep breath is 6.5 L (12 pints.) Established Lactation Breastmilk Storage Capacity Similarly, breastfeeding storage capacity can: Increase if the breast us consistently well-drained. D Decrease if the demand on the breast decreases. if th d d th b t d 12

3/22/2011 Established Lactation Appetite cr cream eam skim milk skim milk Established Lactation Appetite If fat content before a feed is <4%, breast is reasonably full with a significant amount of milk available to the baby. If fat content after a feed is >10%, breast If f t t t ft f d i 10% b t is reasonably well ‐ drained indicating baby has taken most of the available milk. 13

3/22/2011 Maintaining Lactation Demand and Supply 350 900 Basal 800 Peak 300 700 250 600 200 500 Milk Plasma Production Production P Prolactin l ti (mL/d) (µg/L) 400 150 300 100 200 50 100 0 0 Month of Lactation 1 2 4 6 Maintaining Lactation Demand and Supply 14

3/22/2011 The more the breast is drained, the faster the milk is made 2000 Breast Volume 1800 (mL) 1600 1400 6:30 16:30 2:30 12:30 Time of Day Maintaining Lactation Demand and Lactation Do Do they ey bot both pr produ oduce t ce the e same qu me quan antity of of milk? milk? Difference Between Breasts 500 24 ‐ h Milk Production (mL) P < 0.0001 400 9 mL) 300 (range 161 ‐ 769 200 100 0 More Less Productive Productive Kent, 2006 15

3/22/2011 Maintaining Lactation Breastfeeding Patterns “Feed on Demand” Maintaining Lactation Breastfeeding Patterns A breastfeed is defined as … a feed from one breast. During a breastfeed, a baby may: feed from one breast (unpaired breastfeed) OR feed from both breasts (two paired breastfeeds) within 30 min OR have a cluster of breastfeeds Maintaining Lactation Left Unpaired Feeds Paired Feeds Right (13% of babies ) (30% of babies) 140 140 120 120 100 100 ed (mL) 80 80 Fee 60 60 60 60 40 40 20 20 0 0 6:00 12:00 18:00 0:00 6:00 12:00 18:00 0:00 6:00 12:00 18:00 Time of Day Time of Day 24h Production 24h Production Left Breast 253 g Left Breast 353 g Right Breast 397 g Right Breast 534 g Total 787 q Total 750 q 16

3/22/2011 Maintaining Lactation Breastfeeding Patterns 11 breastfeeds/day ( on average ) but ranged from 6 – 18 feeds. They took these breastfeeds as 8 meals (on average) ( ) but ranged from 4 – 13 meals (Kent, 2006.) Maintaining Lactation Breastfeeding Patterns Babies who are exclusively breastfed on demand show a wide range of breastfeeding behavior. (Kent, 2006) Maintaining Lactation Breastfeeding Patterns Normal Breastfeeding Behavior Average Range Number of Feeds Number of Feeds 11 6 18 11 6-18 Average Feed (mL) 76 30-135 Storage Capacity (mL) 179 74-382 % Avail Milk Removed 67 43-92 Fat Content (g/L) 41 22-62 24-h Production (mL) 798 478-1298 17

3/22/2011 Maintaining Lactation Breastfeeding Patterns Most babies feed at night, often the time of the biggest breastfeed from a full breast. Babies who do not feed at night usually had their largest breastfeed in the morning-when breasts were usually full. Maintaining Lactation Feeding Frequency 12 10 Feeds 8 6 6 Meals Meals 4 2 Night Feeds 0 0 2 4 6 Month of Lactation Maintaining Lactation Breastfeeding Patterns The baby gets enough fat if it has many small feeds or few large feeds 18