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Managing Lactation Problems in the Neonate. Kristi Palmer, M.D. Neonatology UAMS/Arkansas Children’s Hospital. Synagis. Monoclonal Antibody Given to all < 32 wk preemies Hospitalization rates for RSV fell by 47% Last winter 1200 children dosed in AR Cost $7,082 per patient

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managing lactation problems in the neonate

Managing Lactation Problems in the Neonate

Kristi Palmer, M.D.

Neonatology

UAMS/Arkansas Children’s Hospital

synagis
Synagis
  • Monoclonal Antibody
  • Given to all < 32 wk preemies
  • Hospitalization rates for RSV fell by 47%
  • Last winter 1200 children dosed in AR
  • Cost $7,082 per patient
  • Total bill = $8,498,400
breastmilk
Breastmilk
  • Hospitalizations for pneumonia or bronchiolitis less than 50% that of formula-fed babies
  • Improves immune development
  • Decreased risk for diabetes, Crohn’s, ulcerative colitic, lymphoma, allergies, obesity
  • Higher I.Q.
  • 60% lower incidence of NEC
  • Family saves $1000/year
managing lactation problems in the neonate1

Managing Lactation Problems in the Neonate

Kristi Palmer, M.D.

Neonatology

UAMS/Arkansas Children’s Hospital

benefits for mother
Benefits for mother
  • Lower risk of postpartum bleeding
  • Faster weight loss after delivery
  • Fewer missed days of work
  • Decreased risk of ovarian and breast cancer
  • Lower risk of osteoporosis
objectives
Objectives
  • Common myths
  • Common lactation problems and basic management
  • Resources for physicians/nurses
myths
Myths
  • A postpartum patient should not breastfeed because she is taking pain medicine or “strong” antibiotics.
  • The baby is sick, so mom cannot breastfeed.
  • The baby is premature and too small to nurse.
contraindications to breastfeeding
Contraindications to Breastfeeding
  • Galactosemia
  • Mother using illicit drugs
  • Mother with active untreated TB
  • HIV (in developed countries)
  • Herpetic lesions on breast
  • Maternal Varicella
what can the obstetrician pediatrician do
What can the obstetrician/pediatrician do?
  • Encourage the patient to consider breastfeeding
  • Inform her of the real health benefits for herself and baby
  • Provide written information
what can we do on l d or postpartum
What can we do on L & D or postpartum?
  • Encourage Breastfeeding as the norm
  • Feed within the first hour
  • Keep baby with mother
  • Assess feedings regularly
  • Knowledgeable nurses
  • Lactation Consultant Services
  • Limit Supplementing
  • Encourage pumping if baby is not breastfeeding
sleepy baby problems latching
Sleepy Baby/Problems Latching
  • Wake the baby
  • Correct Positioning
  • Baby’s mouth opened widely
assessment prior to discharge
Assessment Prior to Discharge
  • Trained Observer
  • Assess Latch/Positioning/Adequacy of feed
  • Documentation every shift
  • Educate parents
    • Positioning
    • Feeding cues
    • Feeding 8-12 times/day on demand
    • Diary of feeds/output
    • Pumping
    • When to call physician
signs of adequate intake
Signs of adequate intake
  • Audible Swallowing
  • Minimal Weight Loss
    • < 3% at 24 hours
    • < 7% during first week
  • Normal Output for age
    • 1 wet/1 stool by 24 hours
    • 6-8 wets/4 stools at 7 days
follow up
Follow-Up
  • AAP recommendation – Office visit within one to two days after discharge (by 2-4 days of age)
  • For < 38 weeks, weekly weight check until 40 weeks
  • Feeding frequency, duration, supplements, output, weight
premature or ill baby
Premature or Ill Baby
  • Don’t forget to help mother start pumping
  • Save all milk
  • Label with date/time/medications
  • Store in refrigerator

or freezer

engorgement
Engorgement
  • Red Flag – Assess the baby
  • Prevention

Nurse or pump frequently, limit supplements

  • Treatment

Cold compresses between feedings

Warm compresses prior to Pumping/Feeding

Pain Medication

low milk supply growth failure
Low Milk Supply/Growth Failure
  • Maternal issues
  • Infrequent/timed nursing
  • Infant issues
    • Difficult delivery/sedation
    • Jaundice
    • Infection
mastitis
Mastitis
  • Mother has flu-like symptoms:
    • Fever, chills, aches
    • Breast may be painful/warm/red
  • Risk factors:
    • Engorgement
    • skin breakdown
    • tight clothing
    • poor feeding
mastitis1
Mastitis
  • Nurse or pump frequently
  • Warm compresses
  • Acetaminophen/ibuprofen for fever/pain
  • Antibiotics - 10 day course
    • Clindamycin
    • Cephalexin
    • Augmentin
maternal medications
Maternal Medications

Mother should interrupt breastfeeding if receiving:

Radioactive isotopes

Antimetabolites

Cancer chemotherapy agents

American Academy of Pediatrics, Committee on drugs. The transfer of drugs and other chemicals into human milk. Pediatrics. 1994;93:137-150.

medications principles to consider
Medications: Principles to Consider
  • Lipid Solubility
  • Maternal Plasma Levels
  • Molecular weight (< 500)
  • Protein Binding
  • T1/2
  • Infant Dose
  • Oral Absorption
thomas hale medications and mothers milk
Thomas Hale: Medications and Mothers’ Milk

Information by Drug

  • Pregnancy Risk
  • Lactation Risk Category: L1 to L5
    • L1 Safest
    • L2 Safer
    • L3 Moderately Safe
    • L4 Possibly Hazardous
    • L5 Contraindicated
  • AAP recommendations
  • Alternatives
thomas hale clinical therapy in breastfeeding patients
Thomas Hale: Clinical Therapy in Breastfeeding Patients

Drug therapy listed by maternal disease

  • Mastitis
  • Postpartum Depression
  • Contraception
  • Hypertension
  • Diabetes
who can i call
Who can I call?
  • Hospital Lactation Specialist/Consultant
  • Area Health Department
  • WIC Breastfeeding Services
  • Arkansas Children’s Hospital Lactation Consultant
wic breastfeeding services
WIC Breastfeeding Services
  • Information Hotline for parents and health professionals
  • www.healthyarkansas.com/breastfeeding
  • Provide pumps for mothers
  • Peer counselors in some counties
  • Educational opportunities
resources for the health professional
Resources for the Health Professional
  • AAP: Breastfeeding and the Use of Human Milk Pediatrics Vol. 100, No. 6, Dec. 1997
  • AAP: The Transfer of Drugs and Other Chemicals Into Human Milk

Pediatrics Vol. 108, No. 3, Sept. 2001.

  • Academy of Breastfeeding Medicine (protocols): www.bfmed.org
  • The Breastfeeding Answer Book

La Leche League International

www healthyarkansas com breastfeeding information sheets for parents
www.healthyarkansas.com/breastfeedingInformation Sheets for Parents
  • Planning ahead during pregnancy
  • Difficult Latch-On
  • Sore Nipples
  • Engorgement
  • Mastitis
  • Yeast Infection
  • Storing Breastmilk
what about formal training
What about formal training?
  • Contact WIC Breastfeeding Services

501-661-2905

  • Arkansas Children’s Hospital/ADH
    • Training for the health professional
    • Conference Scheduled Sept. 28-30

501-364-1576