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One-Day Primary Care Breastfeeding Medicine Course Lecture Notes

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One-Day Primary Care Breastfeeding Medicine Course Lecture Notes One-Day Primary Care Breastfeeding Medicine Course Lecture Notes Table of Contents 1) The Biologic Components of Breastmilk Infant, and Maternal Risks of Not Breastfeeding 2) Prenatal Education and Support, Anatomy and Physiology of Breastfeeding 3) Positioning and Latch 4) Breastfeeding in the Immediate Postpartum Period 5) Breastfeeding Support and Management of Common Problems in the First Week Postpartum 6) Sore Nipples and Sore Breasts 7) Low Milk Production 8) Medications and Breastfeeding 9) Symptoms, Evaluation, and Management of Excessive Lactation 10) Pump Technology and Human Milk Storage 11) Weaning, Re-lactation, Induced Lactation, and Tandem Nursing 1/4/2021 The Biologic Components of Breastmilk • Conflict of Interest to disclose- None • Nursing credits and continuing education recognition Infant and Maternal Risks of Not points (CERPs) for IBCLE are awarded commensurate Breastfeeding with participation and complete/submission of the evaluation form. • For CMEs, please keep track of the hours you have attended, and completion of an evaluation is required 1 What is The Institute for the Advancement of Breastfeeding and Lactation Education (IABLE)? • Non-profit 501c3 membership organization of breastfeeding medicine and lactation educators • Mission – Create breastfeeding-knowledgeable health care institutions and community support systems • Provide a safety net for families, reduce risks, increase rates • Focus on the provision of evidence-based resources and educational courses – Breastfeeding medicine for physicians and other providers A bi-weekly blog highlighting recent important – Lactation education for allied health professionals policies, research, consensus statements – Educational tools for families- handouts, videos Lacted.org/questions/ www.lacted.org © IABLE 3 © IABLE 4 The Little Green Book of Breastfeeding Management For Physicians and other Providers 7th Edition 2020 Pocket-sized Free © IABLE 5 © IABLE 6 1 1/4/2021 © IABLE 7 © IABLE 8 IABLE Online Courseware for Physician/Provider Learning © IABLE 9 © IABLE 10 Need Help with Triage and Patient Education? Second Sunday Breastfeeding Medicine Train Your Team!! Case Discussion Series Outpatient Breastfeeding Champion Course CME and Free CMECMECERPs Awarded © IABLE 11 © IABLE 12 2 1/4/2021 The Art and Science of Breastfeeding Conference Online January 23rd, 2021 We will try to use inclusive language where possible Best Bargain on Science Ever! $45 for 6 CERPs Research tends and 6 CMEs!! to include Jan 23rd 2021 binary individuals © IABLE 13 © IABLE 14 Objectives Medical Student Survey March 2015 • WHO and UNICEF have core competencies for • Recite 3 components of breastmilk that knowledge and skills during medical school provide immunologic protection from illness. • Out of 137 students surveyed: • Identify 6 infant risks of not breastfeeding. – 64% had no formal education on breastfeeding • Identify 4 maternal risks of not breastfeeding. – On a scale of 1-10, 10 being most confident: • 80% students rated themselves ‘5’ or less for ability to counsel on contraindications to breastfeeding • 68% rated themselves ‘5’ or less on ability to counsel on benefits of breastfeeding • 91% rated ‘5’ or less on comfort with assessing latch © IABLE 15 Educ Health 2017;30:163-8 Peptides (combinations of amino acids) Water VitaminSterols: A acetate Amino Acids: Fats:Antimicrobial Triglycerides factors: HMGF I (Human growth factor) Carbohydrates: PyridoxineSqualene hydrochloride (the building blocks of proteins) LongLeukocytes-chain polyunsaturated (white blood cells) fatty acids HMGF II Lactose ThiamineLanosterol mononitrate Alanine DocosahexaenoicPhagocytes acid (DHA) HMGF III Hormones: Corn maltodextrin Folic acidDimethylsterol Arginine ArachidonicBasophils acid (AHA) Cholecystokinin (CCK) Cortisol ONE HMO PhylloquinoneMethosterol FORMULATriiodothyronineAspartate (T3) LinoleicNeutrophils acid β-endorphins Protein: Biotin Lathosterol Clycine AlphaEoisinophils-linolenic acid (ALA) Parathyroid hormone (PTH) Thyroxine (T4) Partially hydrolyzed reducedEnzymes: VitaminDesmosterol D3 Cystine EicosapentaenoicMacrophages acid (EPA) Parathyroid hormone-related peptide (PTHrP) Thyroid stimulating hormone (TSH) (also known as thyrotropin) minerals whey proteinAmylase VitaminTriacylglycerol B12 Glutamate ConjugatedLymphocytes linoleic acid (Rumenic acid) β-defensin-1 Thyroid releasing hormone (TRH) concentrate (from cow’sArysulfatase milk) Enzyme:Cholesterol Histidine FreeB lymphocytes Fatty Acids (also known as B cells) Calcitonin Prolactin Fats: Catalase Trypsin7-dehydrocholesterol Isoleucine MonounsaturatedT lymphocytes (also fatty known acids as C cells) Gastrin Oxytocin Palm olein HistaminaseAmino Stigma acids:-and campesterol Leucine OleicsIgA acid Motilin Insulin Soybean oil Lipase Taurine7-ketocholesterol CorticosteroneLycine PalmitoleicIgA2 , IgG ,acid IgD , IgM , IgE BombesinGrowth Factors:(AKA neuromedin B) Coconut oil Lysozyme L-CarnitineSitosterol ThrombopoietinMethionine HeptadecenoicComplement C1acid NeurotensinCytokines High oleic safflowerPAF -oilacetylhydrolaseNucleotides:β-lathosterol GonadotropinPhenylalanine-releasing hormoneSaturatedComplement (GnRH) fatty C2 acids Somatostatininterleukin-1β (IL-1β) M. alpina oil (Fungal DHA)PhosphataseCytidine Vitamin 5-MP D metabolites GRH Proline StearicComplement C3 IL-2 C.cohnii oil (Algal ARA)Xanthine oxidaseDisodiumSteroid uridine hormones 5-MP Leptin (aidsSerine in regulation of foodPalmiticComplement intake) acid C4 IL-4 Minerals AntiproteasesAdenosineVitamins: 5-MP Ghrelin (aidsTaurine in regulation of foodLauricComplement intake)acid C5 IL-6 Minerals Potassium citrate a-1-antitrypsinDisodium Vitamin guanosine A 5-MP AdiponectinTheronine MyristicComplementacid C6 IL-8 Calcium Potassium phosphatea-1-antichymotrypsinSoy LecithinBeta carotene Feedback Tryptophaninhibitor of lactationPhospholipids Complement(FIL) C7 IL-10 Sodium Calcium chloride Vitamin B6 EicosanoidsTyrosine PhosphatidylcholineComplement C8 Granulocyte-colony stimulating factor (G-CSF) Potassium Tricalcium phosphate Vitamin B8 (Inositol) ProstaglandinsValine (enzymatically PhosphatidylethanolaminederivedComplement from fattyC9 acids) Macrophage-colony stimulating factor (M-CSF) Iron Sodium citrate Vitamin B12 PG-E1 Carnitine PhosphatidylinositolGlycoproteins: Mucins Platelet derived growth factors (PDGF) ZincNucleotides: Magnesium chloride Vitamin C PG-E2 LysophosphatidylcholineLactadherin Vascular endothelial growth factor (VEGF) Chloride(the structural units of RNA and DNA) Formula is Lacking Ferrous sulphate HumanVitamin DMilk PG-F2 LysophosphatidylethanolamineAlpha-lactoglobulin Hepatocyte growth factor -α (HGF-α) Phosphorus5’-Adenosine monophosphate (5”-AMP) Zinc sulphate Water Vitamin E Leukotrienes PlasmalogensAlpha-2 macroglobulin HGF-β Magnesium3’:5’-Cyclic adenosine monophosphate (3’:5’-cyclic AMP) Many Components Sodium chloride a-Tocopherol Thromboxanes SphingolipidsLewis antigens Tumor necrosis factor-α Lactose Copper5’-Cytidine monophosphate (5’-CMP) Copper sulphate Vitamin K Prostacyclins SphingomyelinRibonuclease Interferon-γ Oligosaccharides ManganeseCytidine diphosphate choline (CDP choline) Potassium iodide Whey proteinThiamine GangliosidesHaemagglutinin inhibitors Essential for Optimal Epithelial growth factor (EGF) IodineGuanosine diphosphate (UDP) Manganese sulphate Alpha-lactalbuminRiboflavin GM1Bifidus Factor Transforming growth factor-α (TGF-α) SeleniumGuanosine diphosphate - mannose Sodium selenate HAMLET (HumanNiacin Alpha - GM2Lactoferrin TGF β1 Choline3’- Uridine monophosphate (3’-UMP) Infant Immunity Vitamins: lactalbumin)Folic acid GM3Lactoperoxidase TGFSodium-β2 ascorbate Pantothenic acid Sulpher5’-Uridine monophosphate (5’-UMP) GlucosylceramideB12 binding protein Insulin-like growth factor-I (IGF-CaseinI) ChromiumUridine diphosphate (UDP) And Maturation Inositol Serum albuminBiotin GlycosphingolipidsFibronectin (also known as somatomedin C) CobaltUridine diphosphate hexose (UDPH) Choline bitartrate Non-protein nitrogens: GalactosylceramideOligosaccharides Insulin-like growth factor- II FluorineUridine diphosphate-N-acetyl-hexosamine (UDPAH) Alpha-Tocopheryl acetate Creatine Lactosylceramide(more than 150 different kinds!) Nerve growth factor (NGF) NickelUridine diphosphoglucuronic acid (UDPGA) Niacinamide Creatinine Globotriaosylceramide (GB3) 18 © IABLE 17 Erythropoietin MolybdenumSeveral more novel nucleotides of the UDP type © IABLE 18 Calcium pantothenate Urea Globoside (GB4) Riboflavin Uric acid 3 1/4/2021 HMO = Human Milk Oligosaccharides (>130) Postulated effects: Entero-Mammary Circulation of Antibodies Predominantly sIgA Lars Bode Glycobiology 2012;22:1147-1162 © IABLE 19 © The Author 2012. Published by Oxford University Press. All rights reserved. For permissions, © IABLE 20 please e-mail: [email protected] Many Bioactive Factors Have Duel Roles The Evidence- An Overview Lactoferrin • AHRQ (2007): Comprehensive review/analysis Iron of published literature, Ip et al • AAP (2012): Summarizes & updates AHRQ • WHO (2013): Systematic Reviews, Horta & Victora • Chowdhury et al (2015): Sys Review and meta-analysis maternal outcomes • Lancet BF Series Group (2016): Binds Iron, Kills Bacteria Systematic/Meta-analysis, Victora et al © IABLE 22 http://chemistry.umeche.maine.edu/CHY431/Conformation3.html © IABLE 21 Risks of Less Breastfeeding for Children • Increased mortality – NEC – SIDS • Increased Infection – GI – Respiratory – Otitis • Metabolic – Obesity – Type 1 and 2 DM • Cognition (IQ) A pregnant
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