{"id":398,"date":"2020-08-13T20:24:23","date_gmt":"2020-08-13T20:24:23","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=398"},"modified":"2020-08-13T20:24:23","modified_gmt":"2020-08-13T20:24:23","slug":"lactation","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/advanced-training\/lactation\/","title":{"rendered":"Lactation"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/GpDRox_3yVQ\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n<p>Duration 8:36<\/p>\n<input type='hidden' bg_collapse_expand='69e9b57f01d879039698097' value='69e9b57f01d879039698097'><input type='hidden' id='bg-show-more-text-69e9b57f01d879039698097' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b57f01d879039698097' value='Hide Transcript'><button id='bg-showmore-action-69e9b57f01d879039698097' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#fcfcfc;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b57f01d879039698097' ><\/p>\n<p>00:00<br \/>\nhello and welcome to this aapko basic<br \/>\n00:02<br \/>\nscience objective video on lactation the<br \/>\n00:04<br \/>\nobjectives for this aapko basic science<br \/>\n00:06<br \/>\nvideo are recognize normal anatomic and<br \/>\n00:09<br \/>\nphysiologic changes to breast tissue in<br \/>\n00:11<br \/>\npregnancy and lactation explain<br \/>\n00:12<br \/>\npathophysiology of milk synthesis milk<br \/>\n00:15<br \/>\nregulation and milk ejection and to<br \/>\n00:17<br \/>\nunderstand the composition of human milk<br \/>\n00:19<br \/>\nthis is Nina and Lisa they&#8217;re happily<br \/>\n00:22<br \/>\nenjoying getting ready for their new<br \/>\n00:24<br \/>\nbaby as Nina is learning about how to<br \/>\n00:26<br \/>\nbreastfeed her new baby let&#8217;s see what<br \/>\n00:27<br \/>\nher body is already started to do in<br \/>\n00:29<br \/>\norder to prepare for the big day breast<br \/>\n00:32<br \/>\narchitecture is a dynamic process that<br \/>\n00:34<br \/>\nhas been evolving since puberty each<br \/>\n00:36<br \/>\nbreast is composed of fifteen to twenty<br \/>\n00:38<br \/>\nfive lobes each lobe contains multiple<br \/>\n00:41<br \/>\nlobules which are each made up of<br \/>\n00:42<br \/>\nalveoli the alveoli have secretory<br \/>\n00:45<br \/>\nepithelium and are responsible for milk<br \/>\n00:47<br \/>\nproduction the alveoli formed ducks that<br \/>\n00:50<br \/>\ncoalesce into a single duct from each<br \/>\n00:51<br \/>\nlobe these lactiferous ducts open into<br \/>\n00:54<br \/>\nthe nipple and their pinpoint openings<br \/>\n00:56<br \/>\ncan be seen in lactation from birth<br \/>\n00:58<br \/>\nthrough puberty breast development<br \/>\n00:59<br \/>\noccurs in the volume and differentiation<br \/>\n01:01<br \/>\nof the structures of the mammary glands<br \/>\n01:03<br \/>\nfinal maturation past the state only<br \/>\n01:06<br \/>\ntakes place with pregnancy in pregnancy<br \/>\n01:09<br \/>\nprogesterone differentiation continues<br \/>\n01:12<br \/>\nto the point where the breast is mostly<br \/>\n01:13<br \/>\nglandular secretory units called a sin I<br \/>\n01:16<br \/>\nfully differentiate these changes begin<br \/>\n01:18<br \/>\nin pregnancy and continue until<br \/>\n01:20<br \/>\nlactation is complete after a beautiful<br \/>\n01:23<br \/>\ndelivery Nina and baby Z have already<br \/>\n01:25<br \/>\nstarted the process of breastfeeding<br \/>\n01:26<br \/>\nwhile they&#8217;re getting settled what&#8217;s<br \/>\n01:29<br \/>\nconsidered the three basic concepts of<br \/>\n01:30<br \/>\nmilk synthesis milk regulation and milk<br \/>\n01:33<br \/>\ncomposition exocytosis is the first<br \/>\n01:36<br \/>\nmechanism for milk synthesis it involves<br \/>\n01:38<br \/>\nthe golgi complex forming vesicles that<br \/>\n01:40<br \/>\ntransport protein and lactose to the<br \/>\n01:42<br \/>\nalveolar lumen water and electrolytes<br \/>\n01:44<br \/>\nfollow the lactose into the vesicle and<br \/>\n01:46<br \/>\nare also secreted into the lumen the<br \/>\n01:49<br \/>\nsecond mechanism is reversed pinocytosis<br \/>\n01:50<br \/>\nand is the main pathway for lipids and<br \/>\n01:53<br \/>\nphospholipids to be added to the breast<br \/>\n01:55<br \/>\nmilk this process occurs in the mammary<br \/>\n01:57<br \/>\nglands lipids formed in the smooth ER<br \/>\n02:00<br \/>\ncombined to form large droplets that get<br \/>\n02:02<br \/>\npushed out into the lumen the third<br \/>\n02:05<br \/>\nmechanism involves trance i ptosis<br \/>\n02:07<br \/>\nthis mechanism allows immunoglobulins<br \/>\n02:09<br \/>\nalbumin and hormones to bind to the<br \/>\n02:11<br \/>\nbasement membrane of alveolar cells and<br \/>\n02:13<br \/>\nget transported to the apical membrane<br \/>\n02:15<br \/>\nwhere they are released apical transport<br \/>\n02:18<br \/>\nthe fourth mechanism allows small<br \/>\n02:20<br \/>\nmolecules such as sodium potassium and<br \/>\n02:22<br \/>\nwater to move into the lumen the exact<br \/>\n02:25<br \/>\nmechanism is not well understood finally<br \/>\n02:28<br \/>\nin the fifth mechanism para cellular<br \/>\n02:30<br \/>\nmovement allows components such as<br \/>\n02:31<br \/>\nimmune cells to move between alveolar<br \/>\n02:33<br \/>\ncells across the type Junction these<br \/>\n02:36<br \/>\ntight junctions are more leaky during<br \/>\n02:38<br \/>\nspecific times such as pregnancy and<br \/>\n02:40<br \/>\nmediate postpartum period and during<br \/>\n02:42<br \/>\nmammary involution now let&#8217;s pause think<br \/>\n02:45<br \/>\nand apply think fast<br \/>\n02:47<br \/>\nwhat were the five cellular mechanisms<br \/>\n02:50<br \/>\nassociated with the transport of breast<br \/>\n02:51<br \/>\nmilk components into the alveolar lumen<br \/>\n02:54<br \/>\nof the breast lobules the answer is<br \/>\n02:57<br \/>\nexocytosis pinocytosis trans cytosis<br \/>\n03:01<br \/>\napical transport and para cellular<br \/>\n03:03<br \/>\nmovement milk synthesis is regulated<br \/>\n03:06<br \/>\nthrough a combination of processes the<br \/>\n03:09<br \/>\nmost important regulatory factor is<br \/>\n03:10<br \/>\nemptying the breast either through<br \/>\n03:12<br \/>\ninfant suckling or mechanical breast<br \/>\n03:14<br \/>\npump we will not discuss the clinical<br \/>\n03:17<br \/>\ncomponents of milk production here<br \/>\n03:19<br \/>\ninstead let&#8217;s focus on the cellular<br \/>\n03:21<br \/>\nlevel and how milk production is<br \/>\n03:23<br \/>\nregulated to create and maintain a<br \/>\n03:25<br \/>\nbreast milk supply the breasts must be<br \/>\n03:28<br \/>\nemptied on a regular basis the frequency<br \/>\n03:31<br \/>\nwith which the breast needs to be<br \/>\n03:33<br \/>\nemptied and the time needed will vary<br \/>\n03:34<br \/>\nwith each dyad if breast milk is not<br \/>\n03:38<br \/>\nemptied eventually there will be a<br \/>\n03:39<br \/>\nreduction in involution of the memory<br \/>\n03:41<br \/>\nglands the increased milk in the breast<br \/>\n03:44<br \/>\ncauses increased intro memory pressure<br \/>\n03:46<br \/>\nwhich decreases stimulatory hormones and<br \/>\n03:49<br \/>\ndisrupts the tight junctions between<br \/>\n03:50<br \/>\ncells thereby decreasing milk synthesis<br \/>\n03:54<br \/>\nthe increased pressure also increases<br \/>\n03:57<br \/>\nfeedback inhibitor of lactation or fil a<br \/>\n04:00<br \/>\npolypeptide which accumulates in the<br \/>\n04:02<br \/>\nbreast milk causing a down regulation of<br \/>\n04:04<br \/>\ncell surface prolactin receptors<br \/>\n04:07<br \/>\nthrough a positive feedback loop breast<br \/>\n04:10<br \/>\nstimulation via suckling or mechanical<br \/>\n04:12<br \/>\nstimulation also leads to spikes and<br \/>\n04:14<br \/>\nprolactin release which aids in<br \/>\n04:15<br \/>\nregulation<br \/>\n04:16<br \/>\nthe level of the spike is not correlated<br \/>\n04:18<br \/>\nto the amount of milk produced finally<br \/>\n04:21<br \/>\nit is important to remember that milk<br \/>\n04:23<br \/>\nejection is controlled by a different<br \/>\n04:25<br \/>\npathway and requires oxytocin to trigger<br \/>\n04:27<br \/>\nthe myoepithelial cells to contract<br \/>\n04:29<br \/>\nenforce milk out of the electa first<br \/>\n04:32<br \/>\nducts<br \/>\n04:32<br \/>\nnow let&#8217;s pause think and apply a<br \/>\n04:36<br \/>\npostpartum patient complains of<br \/>\n04:38<br \/>\nsignificant cramping associated with<br \/>\n04:40<br \/>\nbreastfeeding episodes she thinks<br \/>\n04:42<br \/>\nsomething is wrong how do you counsel<br \/>\n04:44<br \/>\nher here&#8217;s the answer you tell her that<br \/>\n04:49<br \/>\nthis is normal and explained that<br \/>\n04:50<br \/>\nsuckling triggers oxytocin release from<br \/>\n04:53<br \/>\nthe anterior pituitary the oxytocin has<br \/>\n04:56<br \/>\na dual mechanism it triggers<br \/>\n04:58<br \/>\nmyoepithelial cells in the breast to<br \/>\n05:00<br \/>\ncontract and force milk from the<br \/>\n05:01<br \/>\nelectives ducts and it stimulates the<br \/>\n05:04<br \/>\nsmooth muscle in the uterus to contract<br \/>\n05:05<br \/>\nallowing the uterus to involute it is<br \/>\n05:09<br \/>\nimportant to note that the composition<br \/>\n05:10<br \/>\nat volume of breast build changes to<br \/>\n05:12<br \/>\nmeet the demands of the baby<br \/>\n05:14<br \/>\nthe first secretions after delivery are<br \/>\n05:16<br \/>\ncalled colostrum this is a thick yellow<br \/>\n05:18<br \/>\nsecretion that is seen by post part of<br \/>\n05:21<br \/>\nday 2 it contains many immunological<br \/>\n05:23<br \/>\ncomponents and has more minerals and<br \/>\n05:26<br \/>\namino acids than mature milk there&#8217;s<br \/>\n05:28<br \/>\nalso more protein unless fats and sugars<br \/>\n05:30<br \/>\nmature milk usually does not appear<br \/>\n05:33<br \/>\nuntil at least 3 to 7 days after<br \/>\n05:34<br \/>\ndelivery mature milk secretion can be<br \/>\n05:38<br \/>\ndelayed by c-section in Prime members<br \/>\n05:40<br \/>\nwomen placental retention diabetes or<br \/>\n05:44<br \/>\nstressful partition the composition of<br \/>\n05:47<br \/>\nmature milk changes daily with the age<br \/>\n05:49<br \/>\nof the infant and between feeds to meet<br \/>\n05:51<br \/>\nthe ever-changing needs of the infant on<br \/>\n05:53<br \/>\naverage a woman makes about 600<br \/>\n05:56<br \/>\nmilliliters per day but this can be<br \/>\n05:57<br \/>\nhighly variable based on the infant&#8217;s<br \/>\n05:59<br \/>\nneeds and with multiple gestation &#8216;z<br \/>\n06:01<br \/>\nmilk is composed of fats proteins<br \/>\n06:04<br \/>\ncarbohydrates bioactive factors minerals<br \/>\n06:08<br \/>\nvitamins and hormones vitamin K is<br \/>\n06:10<br \/>\nvirtually absent from breast milk hence<br \/>\n06:12<br \/>\nthe need for injection at birth also<br \/>\n06:14<br \/>\niron and vitamin D is very low and thus<br \/>\n06:18<br \/>\nand is often recommended for moms to<br \/>\n06:19<br \/>\nsupplement babies with both<br \/>\n06:21<br \/>\nit is important to note that there are<br \/>\n06:23<br \/>\nmany changes that continue to happen to<br \/>\n06:25<br \/>\nthe press after lactation the mammary<br \/>\n06:27<br \/>\nglands will involute due to a pop tonic<br \/>\n06:29<br \/>\ncell death mediated by the lack of lacta<br \/>\n06:31<br \/>\ngenic hormones and local autocrine<br \/>\n06:33<br \/>\nsignals in menopause there&#8217;s further<br \/>\n06:36<br \/>\natrophy of the glandular elements and<br \/>\n06:38<br \/>\nloss of the lobules adipose tissue<br \/>\n06:40<br \/>\ndisplaces the fibers connective tissue<br \/>\n06:42<br \/>\nthe breast as well now let&#8217;s pause think<br \/>\n06:45<br \/>\nand apply a patient is ready for<br \/>\n06:49<br \/>\ndischarge after an uncomplicated vaginal<br \/>\n06:51<br \/>\ndelivery you discuss birth control<br \/>\n06:53<br \/>\noptions and she states she will be<br \/>\n06:55<br \/>\nbreastfeeding so should not need any<br \/>\n06:57<br \/>\nother methods how would you counsel her<br \/>\n06:59<br \/>\nin a lactating woman elevated prolactin<br \/>\n07:02<br \/>\nlevels provide a negative feedback on<br \/>\n07:04<br \/>\nthe hypothalamus suppressing ovulation<br \/>\n07:07<br \/>\nin order for this to be effective a<br \/>\n07:09<br \/>\nmother must be exclusively breastfeeding<br \/>\n07:11<br \/>\notherwise any drop in prolactin levels<br \/>\n07:14<br \/>\nwill release negative feedback and<br \/>\n07:16<br \/>\nresume ovulation it is important to<br \/>\n07:19<br \/>\nremind patients that they will ovulate<br \/>\n07:21<br \/>\nbefore their first menstrual cycle<br \/>\n07:22<br \/>\nindicating return of fertility Mina Lisa<br \/>\n07:27<br \/>\nand baby Z are growing together as a<br \/>\n07:28<br \/>\nfamily the ability of Mina to<br \/>\n07:31<br \/>\nexclusively breastfeed will depend on a<br \/>\n07:32<br \/>\nhost of factors from biological<br \/>\n07:34<br \/>\nconsiderations and milk production and<br \/>\n07:36<br \/>\nregulation to social and environmental<br \/>\n07:38<br \/>\ncues from babies II and the support of<br \/>\n07:40<br \/>\nthe community around the family for more<br \/>\n07:43<br \/>\ninformation on the clinical aspects of<br \/>\n07:45<br \/>\nbreastfeeding please see aapko clinical<br \/>\n07:47<br \/>\nvideo 14 on lactation that concludes the<br \/>\n07:51<br \/>\napp Co basic science video on lactation<br \/>\n07:53<br \/>\nyou should be able to recognize the<br \/>\n07:55<br \/>\nnormal anatomy and physiological changes<br \/>\n07:57<br \/>\nto the breast tissue in pregnancy and<br \/>\n07:59<br \/>\nlactation understand the composition of<br \/>\n08:01<br \/>\nhuman milk and explained the<br \/>\n08:03<br \/>\npathophysiology of milk synthesis<br \/>\n08:05<br \/>\nregulation and ejection<\/p>\n<p><\/div>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/Rn3SMg2cYLc\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration 12:26<\/p>\n<input type='hidden' bg_collapse_expand='69e9b57f026250085688782' value='69e9b57f026250085688782'><input type='hidden' id='bg-show-more-text-69e9b57f026250085688782' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b57f026250085688782' value='Hide Transcript'><button id='bg-showmore-action-69e9b57f026250085688782' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#fcfcfc;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b57f026250085688782' ><\/p>\n<p>00:06<br \/>\nhello everybody this is Chris Morosky<br \/>\n00:08<br \/>\nand this is a short video on the<br \/>\n00:10<br \/>\nbenefits of breastfeeding the content of<br \/>\n00:13<br \/>\nthis video was taken exclusively from an<br \/>\n00:15<br \/>\narticle written by Alison Stubbe from<br \/>\n00:17<br \/>\nthe University of North Carolina at<br \/>\n00:19<br \/>\nChapel Hill<br \/>\n00:19<br \/>\nthe title of our article is the risks of<br \/>\n00:22<br \/>\nnot breastfeeding for mothers and<br \/>\n00:23<br \/>\ninfants it was published in reviews and<br \/>\n00:25<br \/>\nobstetrics and gynaecology in 2009 for<br \/>\n00:28<br \/>\nthose who enjoy reading articles and<br \/>\n00:30<br \/>\nprefer that over video and PowerPoint<br \/>\n00:32<br \/>\nslides<br \/>\n00:32<br \/>\nI do recommend checking out this article<br \/>\n00:34<br \/>\nit is very well-written detailed and has<br \/>\n00:37<br \/>\na lot more information than is found in<br \/>\n00:38<br \/>\nthe video the goals and objectives of<br \/>\n00:41<br \/>\nthis video are to review the national<br \/>\n00:43<br \/>\nguideline recommendations for postpartum<br \/>\n00:45<br \/>\nbreastfeeding to correlate the transfer<br \/>\n00:47<br \/>\nof specific components of breast milk<br \/>\n00:48<br \/>\nfrom the mother to the infant with<br \/>\n00:50<br \/>\nimproved health outcomes for the infant<br \/>\n00:52<br \/>\nto describe the improved health outcome<br \/>\n00:55<br \/>\nseen in mothers who breastfeed their<br \/>\n00:56<br \/>\ninfants and to understand the importance<br \/>\n00:59<br \/>\nof physician support of breastfeeding<br \/>\n01:00<br \/>\nand its impact on women&#8217;s decisions to<br \/>\n01:03<br \/>\nchoose breastfeeding for their infants<br \/>\n01:06<br \/>\nfirst moving on to the national<br \/>\n01:07<br \/>\nguidelines the American College of<br \/>\n01:10<br \/>\nObstetricians and Gynaecologists<br \/>\n01:11<br \/>\nrecommends that women exclusively<br \/>\n01:13<br \/>\nbreastfeed their infants 6 months<br \/>\n01:15<br \/>\nfollowing delivery the American Academy<br \/>\n01:18<br \/>\nof Pediatrics and American Academy of<br \/>\n01:21<br \/>\nFamily Physicians take this one step<br \/>\n01:22<br \/>\nfurther<br \/>\n01:23<br \/>\nthey also recommend six months of<br \/>\n01:25<br \/>\nexclusive breastfeeding but they also<br \/>\n01:27<br \/>\nrecommend continued breastfeeding while<br \/>\n01:28<br \/>\nintroducing complementary foods until<br \/>\n01:31<br \/>\ntwelve months or longer following<br \/>\n01:33<br \/>\ndelivering the question is how are we<br \/>\n01:36<br \/>\ndoing and the answer really is that we<br \/>\n01:38<br \/>\nare falling far short of these guideline<br \/>\n01:40<br \/>\nrecommendations only approximately 75%<br \/>\n01:43<br \/>\nof all infants are ever breastfed one<br \/>\n01:45<br \/>\nsince delivery only 31.5%<br \/>\n01:48<br \/>\nare exclusively breastfed at three<br \/>\n01:50<br \/>\nmonths and only 12% are exclusively<br \/>\n01:53<br \/>\nbreastfed at six months what we can see<br \/>\n01:56<br \/>\nis that the variations in breastfeeding<br \/>\n01:57<br \/>\nrates are closely tied to physician and<br \/>\n02:00<br \/>\nhospital messaging practices and support<br \/>\n02:02<br \/>\nrelated to breastfeeding what are some<br \/>\n02:06<br \/>\nof the improved health outcomes for<br \/>\n02:08<br \/>\ninfants we&#8217;ll review these in the next<br \/>\n02:10<br \/>\nfew slides<br \/>\n02:12<br \/>\nincreased protection from infectious<br \/>\n02:14<br \/>\ndisease seen with breastfeeding plasma<br \/>\n02:17<br \/>\ncells from the mothers bronchial tree in<br \/>\n02:19<br \/>\nintestines migrate to the mammary<br \/>\n02:21<br \/>\nepithelial and produce iga antibodies<br \/>\n02:24<br \/>\nspecific to the antigens and the mother<br \/>\n02:26<br \/>\ninfant diods<br \/>\n02:27<br \/>\nimmediate surroundings is actually<br \/>\n02:29<br \/>\npretty cool this provides specific<br \/>\n02:32<br \/>\nprotection against pathogens in the<br \/>\n02:34<br \/>\nmother&#8217;s environment also<br \/>\n02:36<br \/>\noligosaccharides in breast milk prevent<br \/>\n02:38<br \/>\nattachment of common respiratory<br \/>\n02:39<br \/>\norganisms including Hamas Phylis<br \/>\n02:42<br \/>\ninfluenza and streptococcus pneumoniae<br \/>\n02:44<br \/>\nto the respiratory epithelium<br \/>\n02:47<br \/>\nglycoproteins and breast milk prevent<br \/>\n02:49<br \/>\nbinding of intestinal pathogens<br \/>\n02:51<br \/>\nincluding Vibrio cholera ecoli and<br \/>\n02:54<br \/>\nrotavirus glycosaminoglycans and breast<br \/>\n02:57<br \/>\nmilk prevent binding of HIV gp120 to the<br \/>\n03:01<br \/>\ncd4 receptor thus decreasing<br \/>\n03:03<br \/>\ntransmission of HIV and human milk<br \/>\n03:07<br \/>\nlipids contribute innate immunity with<br \/>\n03:09<br \/>\nactivity against Giardia lamblia<br \/>\n03:11<br \/>\nPamela&#8217;s influenza Group A streptococcus<br \/>\n03:15<br \/>\nstaff at the dermis respiratory<br \/>\n03:17<br \/>\nsyncytial virus and herpes simplex virus<br \/>\n03:20<br \/>\ntype one looking at some of the<br \/>\n03:25<br \/>\ninfections and some of the research<br \/>\n03:27<br \/>\nclinically that documents this immunity<br \/>\n03:30<br \/>\nfirst otitis media approximately 44<br \/>\n03:34<br \/>\npercent of infants will have one episode<br \/>\n03:35<br \/>\nof otitis media in their first year of<br \/>\n03:37<br \/>\nlife the risk of otitis media among<br \/>\n03:40<br \/>\nformula-fed infants is doubled compared<br \/>\n03:43<br \/>\nto infants who are exclusively breastfed<br \/>\n03:45<br \/>\nhuman milk oligosaccharides in<br \/>\n03:48<br \/>\nantibodies to common respiratory<br \/>\n03:49<br \/>\npathogens in the infant&#8217;s environment<br \/>\n03:52<br \/>\nare thought to provide protection from<br \/>\n03:53<br \/>\ninfection next lower respiratory tract<br \/>\n03:58<br \/>\ninfection in a meta-analysis of seven<br \/>\n04:01<br \/>\ncohort studies of healthy term infants<br \/>\n04:03<br \/>\nBachrach at all in 2003 showed that<br \/>\n04:06<br \/>\ninfants who were not breastfed faced a<br \/>\n04:08<br \/>\n3.6 fold increased risk of<br \/>\n04:10<br \/>\nhospitalization for lower respiratory<br \/>\n04:12<br \/>\ntract infection in the first year of<br \/>\n04:14<br \/>\nlife compared to infants who are<br \/>\n04:15<br \/>\nexclusively breastfed for more than four<br \/>\n04:17<br \/>\nmonths the majority of respiratory<br \/>\n04:20<br \/>\nhospitalizations were from RSV have you<br \/>\n04:23<br \/>\ndone your pediatric rotation during the<br \/>\n04:25<br \/>\nwinter time you can<br \/>\n04:26<br \/>\nsee plenty of RSV interestingly lipids<br \/>\n04:29<br \/>\nin human milk appeared to have antiviral<br \/>\n04:31<br \/>\nactivity against RSV gastrointestinal<br \/>\n04:35<br \/>\ninfections and a meta-analysis of 14<br \/>\n04:38<br \/>\ntolbert studies Chen and Holly in 2001<br \/>\n04:41<br \/>\nshowed that infants who were formula fed<br \/>\n04:43<br \/>\nor fed a mixture of formula and breast<br \/>\n04:45<br \/>\nmilk were two point eight times more<br \/>\n04:47<br \/>\nlikely to develop GI infection than<br \/>\n04:51<br \/>\nthose who are exclusively breastfed in a<br \/>\n04:54<br \/>\nstudy of over 17,000 infants Kramer at<br \/>\n04:57<br \/>\nall in 2001 showed that infants in the<br \/>\n04:59<br \/>\ncontrol group which had a 6.4 percent<br \/>\n05:02<br \/>\nexclusive breastfeeding rated three<br \/>\n05:04<br \/>\nmonths so is low these infants were 1.7<br \/>\n05:07<br \/>\ntimes more likely to develop GI illness<br \/>\n05:10<br \/>\nthan those in the intervention group and<br \/>\n05:13<br \/>\nthe intervention group had a 43.3%<br \/>\n05:17<br \/>\nexclusive breastfeeding rate at three<br \/>\n05:19<br \/>\nmonths so again showing the impact of<br \/>\n05:21<br \/>\nexclusive breastfeeding on decreasing GI<br \/>\n05:23<br \/>\nillness in terms of necrotizing<br \/>\n05:27<br \/>\nenterocolitis among preterm infants not<br \/>\n05:31<br \/>\nbeing breastfed is associated with a 2.4<br \/>\n05:34<br \/>\nfold risk of necrotizing enterocolitis<br \/>\n05:36<br \/>\nwith an absolute risk difference of 5<br \/>\n05:38<br \/>\npercent the case fatality rate of neck<br \/>\n05:42<br \/>\nis 15% so this absolute risk difference<br \/>\n05:45<br \/>\nof five percent is clinically<br \/>\n05:46<br \/>\nsignificant and I can tell you with all<br \/>\n05:48<br \/>\nthe neonatologist that I work with<br \/>\n05:50<br \/>\nnowadays focusing on mothers milk and<br \/>\n05:53<br \/>\nbreast milk decreasing necrotizing<br \/>\n05:55<br \/>\nenterocolitis is very very important in<br \/>\n05:57<br \/>\nthis premature population there is also<br \/>\n06:02<br \/>\nimproved immunity for babies with<br \/>\n06:05<br \/>\nprolonged and exclusive breastfeeding<br \/>\n06:08<br \/>\nformula-fed infants have a higher ph of<br \/>\n06:10<br \/>\ntheir stools and a greater colonization<br \/>\n06:13<br \/>\nwith e-coli Clostridium difficile and<br \/>\n06:15<br \/>\nBacteroides fragilis bioactive factors<br \/>\n06:19<br \/>\nin human milk appear to facilitate a<br \/>\n06:20<br \/>\nmore favorable gut colonization in<br \/>\n06:22<br \/>\nbreastfed infants oligosaccharides<br \/>\n06:25<br \/>\ncytokines and immunoglobulins regulate<br \/>\n06:28<br \/>\ngut colonization and development of gut<br \/>\n06:30<br \/>\nassociated lymphoid tissue and govern<br \/>\n06:33<br \/>\ndifferentiation of T cells that play a<br \/>\n06:35<br \/>\nrole in host defense and tolerance and<br \/>\n06:37<br \/>\nit&#8217;s these differences in the<br \/>\n06:39<br \/>\nimmune system differentiation which may<br \/>\n06:42<br \/>\nunderlie the higher incidence of<br \/>\n06:43<br \/>\nallergic disease and formula-fed<br \/>\n06:46<br \/>\nchildren and looking at asthma and a<br \/>\n06:49<br \/>\nmeta-analysis by if at all in 2007<br \/>\n06:52<br \/>\nformula-fed children with a family<br \/>\n06:54<br \/>\nhistory of asthma or a2p had a one point<br \/>\n06:57<br \/>\nseven risk of developing asthma compared<br \/>\n07:00<br \/>\nwith those who were breastfed for three<br \/>\n07:01<br \/>\nmonths or more and another separate<br \/>\n07:04<br \/>\nstudy exclusive breastfeeding for less<br \/>\n07:06<br \/>\nthan three months compared to exclusive<br \/>\n07:08<br \/>\nbreastfeeding for three months or more<br \/>\n07:10<br \/>\nwas associated with a one point nine<br \/>\n07:13<br \/>\nfold risk of developing asthma among<br \/>\n07:16<br \/>\nthose with a family history of asthma or<br \/>\n07:17<br \/>\na Sabine and in terms of atopic<br \/>\n07:21<br \/>\ndermatitis infants with the family<br \/>\n07:23<br \/>\nhistory of a2p who are exclusively<br \/>\n07:25<br \/>\nbreastfed for less than three months<br \/>\n07:27<br \/>\nhave a one point seven fold increased<br \/>\n07:29<br \/>\nrisk of atopic dermatitis compared with<br \/>\n07:31<br \/>\ninfants who are exclusively breastfed<br \/>\n07:33<br \/>\nand infants who were delivered in<br \/>\n07:35<br \/>\nhospitals with decreased breastfeeding<br \/>\n07:38<br \/>\nwere one point nine times as likely to<br \/>\n07:40<br \/>\ndevelop atopic dermatitis compared to<br \/>\n07:43<br \/>\nthose who delivered in hospitals with<br \/>\n07:44<br \/>\nincreased breastfeeding rates again<br \/>\n07:47<br \/>\nprolonged breastfeeding appears to be<br \/>\n07:49<br \/>\nassociated with decreased rates of<br \/>\n07:51<br \/>\natopic dermatitis and finally looking at<br \/>\n07:55<br \/>\nobesity and metabolic disease in terms<br \/>\n07:57<br \/>\nof breastfeeding and two separate<br \/>\n07:59<br \/>\nmeta-analysis formula-fed infants were<br \/>\n08:01<br \/>\n1.1 to 1.3 times more likely to become<br \/>\n08:04<br \/>\nobese compared to children who had ever<br \/>\n08:07<br \/>\nbeen breastfed and being formula-fed in<br \/>\n08:09<br \/>\ninfancy is associated with a 1.6 fold<br \/>\n08:12<br \/>\nrisk of type 2 diabetes compared with<br \/>\n08:14<br \/>\nbeing breastfed the proposed mechanisms<br \/>\n08:17<br \/>\nare that human milk contains edible<br \/>\n08:19<br \/>\nkinds which may play a role in<br \/>\n08:21<br \/>\nregulating energy intake in long-term<br \/>\n08:23<br \/>\nobesity rescue also long-chain<br \/>\n08:26<br \/>\npolyunsaturated fatty acids found in<br \/>\n08:29<br \/>\nbreast milk may improve blood pressure<br \/>\n08:31<br \/>\nand insulin resistance later in life<br \/>\n08:33<br \/>\ncertainly there are also differences in<br \/>\n08:35<br \/>\ncomposition of breast milk versus<br \/>\n08:37<br \/>\nformula associated lifestyle factors and<br \/>\n08:40<br \/>\nself-regulation of intake by the infant<br \/>\n08:42<br \/>\nwhich may play a role in changing<br \/>\n08:44<br \/>\nmetabolic disease associated and around<br \/>\n08:47<br \/>\nbreastfeeding a quick transition to<br \/>\n08:51<br \/>\nimproved health outcomes<br \/>\n08:53<br \/>\nfor mothers who exclusively breastfeed<br \/>\n08:56<br \/>\nor breastfeed for longer durations of<br \/>\n08:58<br \/>\ntime there is a known and decreased risk<br \/>\n09:01<br \/>\nof certain malignancies for women who<br \/>\n09:04<br \/>\nbreastfeed lactation suppresses<br \/>\n09:06<br \/>\novulation and leads to a left ational<br \/>\n09:08<br \/>\namenorrhea decreased ovulatory cycles<br \/>\n09:11<br \/>\nare associated with a decreased risk of<br \/>\n09:13<br \/>\novarian cancer by tation also causes<br \/>\n09:16<br \/>\nterminal differentiation of breast<br \/>\n09:17<br \/>\ntissue which following involution<br \/>\n09:20<br \/>\nremoves these cells from the long-term<br \/>\n09:22<br \/>\neffects of malignant transformation in a<br \/>\n09:25<br \/>\nlarge longitudinal follow-up study<br \/>\n09:27<br \/>\ncalled the Nurses Health Study &#8211; it was<br \/>\n09:31<br \/>\nfound that never breastfeeding was<br \/>\n09:32<br \/>\nassociated with a 2.4 fold increase in<br \/>\n09:34<br \/>\nthe incidence of premenopausal breast<br \/>\n09:36<br \/>\ncancer compared to having had ever<br \/>\n09:38<br \/>\nhaving breastfed also never<br \/>\n09:41<br \/>\nbreastfeeding was associated with a 1.5<br \/>\n09:43<br \/>\nfold increase in the incidence of<br \/>\n09:45<br \/>\novarian cancer compared to women who<br \/>\n09:47<br \/>\nbreastfed for greater than 18 months<br \/>\n09:50<br \/>\nthere was also a large impact of<br \/>\n09:52<br \/>\nlactation on maternal metabolism<br \/>\n09:54<br \/>\nbreastfeeding poses a 500 kilo calorie<br \/>\n09:57<br \/>\nper day metabolic burden on mothers this<br \/>\n09:59<br \/>\ncan contribute to an increased pregnancy<br \/>\n10:02<br \/>\nweight loss for mothers who breastfeed<br \/>\n10:05<br \/>\nbreastfeeding also is associated with<br \/>\n10:07<br \/>\nmore favorable glucose levels and the<br \/>\n10:09<br \/>\nmother live at metabolism and blood<br \/>\n10:11<br \/>\npressure in 1993 do-it-all showed that<br \/>\n10:14<br \/>\nwomen who breastfed for more than one<br \/>\n10:16<br \/>\nyear lost on average four point four<br \/>\n10:18<br \/>\npounds more than women who breastfed<br \/>\n10:20<br \/>\nless than three months and this<br \/>\n10:22<br \/>\ndifference persisted for two years<br \/>\n10:24<br \/>\npostpartum again returning to the nurse<br \/>\n10:26<br \/>\nhealth study &#8211; the risk of type 2<br \/>\n10:29<br \/>\ndiabetes 15 years since birth was 1.7<br \/>\n10:33<br \/>\nfold higher among Paris women who never<br \/>\n10:35<br \/>\nbreastfed compared to those who<br \/>\n10:37<br \/>\nbreastfed for a lifetime total of two<br \/>\n10:39<br \/>\nyears and more and the risk of<br \/>\n10:42<br \/>\nmyocardial infarction 15 years since<br \/>\n10:44<br \/>\nbirth was 1.3 fold higher among Paris<br \/>\n10:47<br \/>\nwomen who never breastfed compared to<br \/>\n10:49<br \/>\nthose who breastfed for a lifetime total<br \/>\n10:51<br \/>\nof two years or more and just to end on<br \/>\n10:55<br \/>\none small point about the role of the<br \/>\n10:57<br \/>\nphysician in promoting breastfeeding the<br \/>\n11:00<br \/>\nthings that physicians can do to promote<br \/>\n11:02<br \/>\nbreastfeeding include providing<br \/>\n11:04<br \/>\neducation and counseling during prenatal<br \/>\n11:06<br \/>\ncare<br \/>\n11:07<br \/>\navoid participating in Formula marketing<br \/>\n11:09<br \/>\ncampaigns and programs physicians can<br \/>\n11:12<br \/>\nalso encourage immediate skin-to-skin<br \/>\n11:14<br \/>\ncontact<br \/>\n11:15<br \/>\nfeeding on demand and rooming in with<br \/>\n11:17<br \/>\nthe infant following delivery and<br \/>\n11:19<br \/>\nfinally in a leadership role physicians<br \/>\n11:22<br \/>\ncan support a hospital culture that<br \/>\n11:24<br \/>\npromotes breastfeeding all of these<br \/>\n11:26<br \/>\nactions have been shown to greatly<br \/>\n11:28<br \/>\nincrease the likelihood that women will<br \/>\n11:30<br \/>\nchoose breastfeeding for their infants<br \/>\n11:31<br \/>\nand exclusively breastfeed their infants<br \/>\n11:34<br \/>\nfor longer durations of time which as<br \/>\n11:36<br \/>\nwe&#8217;ve shown improves health outcomes for<br \/>\n11:39<br \/>\nboth the moms and their peas and that<br \/>\n11:42<br \/>\nbrings us to the end of the video as you<br \/>\n11:44<br \/>\ncan see we did review the national<br \/>\n11:46<br \/>\nguideline recommendations for postpartum<br \/>\n11:48<br \/>\nbreastfeeding we also correlated the<br \/>\n11:50<br \/>\ntransfer of specific components of<br \/>\n11:52<br \/>\nbreast milk from the mother to the<br \/>\n11:53<br \/>\ninfant with improved health outcomes for<br \/>\n11:55<br \/>\nthe infant we described the improved<br \/>\n11:57<br \/>\nhealth outcome seen and mothers who<br \/>\n11:58<br \/>\nbreastfeed their infants and there was<br \/>\n12:01<br \/>\nan understanding of the importance of<br \/>\n12:03<br \/>\nphysician support of breastfeeding and<br \/>\n12:05<br \/>\nits impact on women&#8217;s decisions to<br \/>\n12:07<br \/>\nchoose breastfeeding for the infants<br \/>\n12:08<br \/>\nthank you for taking the time to watch<br \/>\n12:10<br \/>\nthis video I hope you found it<br \/>\n12:12<br \/>\neducational go luck with your studies<br \/>\n12:14<br \/>\nand we&#8217;ll see you soon in class<br \/>\n12:16<\/p>\n<p><\/div>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/PdpdNEQ1yhs\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration 13:44<\/p>\n<input type='hidden' bg_collapse_expand='69e9b57f0320e2029478170' value='69e9b57f0320e2029478170'><input type='hidden' id='bg-show-more-text-69e9b57f0320e2029478170' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b57f0320e2029478170' value='Hide Transcript'><button id='bg-showmore-action-69e9b57f0320e2029478170' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#faf5f5;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b57f0320e2029478170' ><\/p>\n<p>hello everyone this is Chris mirage key<br \/>\n00:08<br \/>\nand this is a short video on<br \/>\n00:10<br \/>\nbreastfeeding complications the goals<br \/>\n00:12<br \/>\nand objectives of this video are to<br \/>\n00:14<br \/>\nreview some of the common infectious and<br \/>\n00:16<br \/>\nnon-infectious complications of<br \/>\n00:17<br \/>\nbreastfeeding to discuss the risk<br \/>\n00:19<br \/>\nfactors for and management of these<br \/>\n00:21<br \/>\nconditions and to describe the impact<br \/>\n00:24<br \/>\nthat these complications can have on<br \/>\n00:25<br \/>\nboth the lactating mother and the<br \/>\n00:27<br \/>\nnursing infant there are obvious health<br \/>\n00:30<br \/>\nbenefits for both the mother and the<br \/>\n00:32<br \/>\nbaby for breastfeeding the American<br \/>\n00:33<br \/>\nAcademy of pediatricians recommend that<br \/>\n00:35<br \/>\nmoms breastfeeding for the first six<br \/>\n00:38<br \/>\nmonths of the baby&#8217;s life and continue<br \/>\n00:40<br \/>\nbreastfeeding while introducing<br \/>\n00:41<br \/>\ncomplementary foods up to one year of<br \/>\n00:44<br \/>\nlife or longer there are some common<br \/>\n00:47<br \/>\nminor complications of breastfeeding<br \/>\n00:49<br \/>\nunfortunately major complications are<br \/>\n00:51<br \/>\nmore rare we&#8217;re going to review some of<br \/>\n00:53<br \/>\nthese minor and major complications in<br \/>\n00:56<br \/>\nthis video breast engorgement usually<br \/>\n00:59<br \/>\nhappens about three to seven days<br \/>\n01:01<br \/>\nfollowing birth and this is more likely<br \/>\n01:04<br \/>\nin first-time mothers with the increase<br \/>\n01:07<br \/>\nin blood supply to the breasts the<br \/>\n01:09<br \/>\naccumulation of milk and the breasts and<br \/>\n01:11<br \/>\nswelling there is increased pain and<br \/>\n01:13<br \/>\ntissue damage the cause of breast<br \/>\n01:16<br \/>\nengorgement is not getting enough of the<br \/>\n01:18<br \/>\nbreast milk out this happens with the<br \/>\n01:22<br \/>\nlays and breastfeeding poor infant latch<br \/>\n01:25<br \/>\nand not feeding on infant cues but<br \/>\n01:29<br \/>\ntrying to stick to more of a schedule<br \/>\n01:31<br \/>\nbreast engorgement can be treated with<br \/>\n01:33<br \/>\nregular breastfeeding breast pumping or<br \/>\n01:35<br \/>\nhand expression and when we can also<br \/>\n01:38<br \/>\ngently massage the breast and use warm<br \/>\n01:40<br \/>\ncompresses prior to breastfeeding and<br \/>\n01:42<br \/>\nthen use cool compresses in Tylenol in<br \/>\n01:45<br \/>\nbetween the breast feedings low milk<br \/>\n01:47<br \/>\nsupply is a major cause of stopping<br \/>\n01:50<br \/>\nbreastfeeding women will commonly feel<br \/>\n01:52<br \/>\nlike they are not producing enough milk<br \/>\n01:53<br \/>\ndue to your irritability of the baby or<br \/>\n01:57<br \/>\nfeeling their breasts aren&#8217;t as<br \/>\n01:59<br \/>\nencouraged as I continue to breastfeed<br \/>\n02:01<br \/>\nand most of the time their milk supply<br \/>\n02:04<br \/>\nactually is normal low milk supply is<br \/>\n02:07<br \/>\ncaused by a decreased emptying of the<br \/>\n02:09<br \/>\nbreast milk when this happens there are<br \/>\n02:12<br \/>\nincreased amounts of<br \/>\n02:13<br \/>\nfeedback inhibitor of lactation this<br \/>\n02:16<br \/>\npeptide can build up in the breast and<br \/>\n02:17<br \/>\nthen this actually inhibits ciation the<br \/>\n02:20<br \/>\ncauses here are poor latch breast<br \/>\n02:22<br \/>\nengorgement use of formula and pacifiers<br \/>\n02:25<br \/>\nand then trying to stick to more a timed<br \/>\n02:28<br \/>\nfeeding schedule rather than feeding<br \/>\n02:31<br \/>\nwhen the baby requests to be fed there&#8217;s<br \/>\n02:35<br \/>\nalso changes in infant growth and<br \/>\n02:38<br \/>\nfeeding patterns babies will tend to<br \/>\n02:39<br \/>\ncluster feed and eat while they&#8217;re<br \/>\n02:41<br \/>\ngrowing rapidly<br \/>\n02:42<br \/>\nsometimes they grow a little more slowly<br \/>\n02:44<br \/>\nand they&#8217;ll eat differently mothers will<br \/>\n02:48<br \/>\nsometimes believe that this is a supply<br \/>\n02:50<br \/>\nproblem when really it&#8217;s just a change<br \/>\n02:51<br \/>\nin the baby&#8217;s growth and feeding the<br \/>\n02:54<br \/>\ntreatment is to increase skin-to-skin<br \/>\n02:55<br \/>\ntime with the mother to also increase<br \/>\n02:58<br \/>\nbreastfeeding with pumping right after<br \/>\n03:00<br \/>\nif you look to the right you can see<br \/>\n03:03<br \/>\nhere&#8217;s a nice schedule for a mother who<br \/>\n03:06<br \/>\nwants to try to increase her milk supply<br \/>\n03:08<br \/>\nwhich combines nursing and pumping<br \/>\n03:10<br \/>\nthroughout the day any type of increased<br \/>\n03:13<br \/>\nnipple stimulation nipple massage is<br \/>\n03:15<br \/>\nhelpful treating nipple pain is also<br \/>\n03:18<br \/>\nvery important there are some<br \/>\n03:20<br \/>\nmedications called Galacta gags the one<br \/>\n03:23<br \/>\nmost commonly known and studied which is<br \/>\n03:25<br \/>\nproven to be effective is domperidone it<br \/>\n03:27<br \/>\nis a selective dopamine d2 receptor<br \/>\n03:30<br \/>\nantagonists also metoclopramide can be<br \/>\n03:33<br \/>\nused but this is off-label there are<br \/>\n03:35<br \/>\nsome herbal therapies including<br \/>\n03:37<br \/>\nfenugreek and milk thistle sometimes<br \/>\n03:40<br \/>\ncalled blessed and oak thistle it&#8217;s not<br \/>\n03:42<br \/>\nentirely sure and studies how these<br \/>\n03:44<br \/>\nmedications work there may be simple<br \/>\n03:45<br \/>\nSIBO effects but you will commonly see<br \/>\n03:47<br \/>\nthese being prescribed and taken by<br \/>\n03:49<br \/>\nwomen to increase their low milk supply<br \/>\n03:51<br \/>\non the other end of things is oversupply<br \/>\n03:54<br \/>\nof milk now for a lot of mothers who<br \/>\n03:56<br \/>\nhave low milk supply this seems like a<br \/>\n03:58<br \/>\ngood problem to have<br \/>\n03:59<br \/>\nbut actually it&#8217;s not the reason it&#8217;s<br \/>\n04:02<br \/>\nnot is that there&#8217;s an increased risk<br \/>\n04:03<br \/>\nfor a gorge meant an increased risk for<br \/>\n04:05<br \/>\nblock ducks and mastitis also what ends<br \/>\n04:09<br \/>\nup happening in these situations is that<br \/>\n04:11<br \/>\nthere is a lot more for milk being<br \/>\n04:13<br \/>\nproduced rather than hind milk for milk<br \/>\n04:16<br \/>\nis more watery it&#8217;s higher in lactose<br \/>\n04:18<br \/>\nand it&#8217;s lower in fat as compared to<br \/>\n04:21<br \/>\nhind milk which is thicker and has<br \/>\n04:23<br \/>\nhigher fat so what ends up happening<br \/>\n04:24<br \/>\nwith these moms are making a lot more<br \/>\n04:26<br \/>\nquantity of milk<br \/>\n04:27<br \/>\nis that the babies getting more for milk<br \/>\n04:29<br \/>\nand therefore the baby is less satisfied<br \/>\n04:31<br \/>\nit&#8217;s more fussy it&#8217;s wanting to feed<br \/>\n04:33<br \/>\nmore often and surprisingly these babies<br \/>\n04:36<br \/>\nactually can have trouble gaining weight<br \/>\n04:38<br \/>\nbecause they&#8217;re not getting that higher<br \/>\n04:40<br \/>\nfat thicker hind milk the way to treat<br \/>\n04:43<br \/>\nthis is to breastfeed on only one breast<br \/>\n04:46<br \/>\nfor two-hour block period of time<br \/>\n04:49<br \/>\nwhenever the baby wants to feed so that<br \/>\n04:51<br \/>\nyou can get to the hind milk in that<br \/>\n04:52<br \/>\nbreast the other option is to pump some<br \/>\n04:56<br \/>\nof the four milk<br \/>\n04:57<br \/>\nprior to breast feeding the infant and<br \/>\n05:00<br \/>\nif you&#8217;re sticking with one breast<br \/>\n05:02<br \/>\nduring that two-hour block period the<br \/>\n05:04<br \/>\nother contralateral breast may become<br \/>\n05:06<br \/>\nmore engorged and hand expression and<br \/>\n05:08<br \/>\npumping of the contralateral breast can<br \/>\n05:10<br \/>\nhelp if the mom is having too much<br \/>\n05:12<br \/>\ndiscomfort while trying to stay without<br \/>\n05:14<br \/>\none breast for the baby during that<br \/>\n05:16<br \/>\ntwo-hour block period overactive milk<br \/>\n05:19<br \/>\nletdown is the overly forceful ejection<br \/>\n05:21<br \/>\nof breast milk this can cause difficulty<br \/>\n05:24<br \/>\nfor the baby feeding because too much<br \/>\n05:26<br \/>\nbreast milk is pushed into the mouth the<br \/>\n05:29<br \/>\nbabies can be fussy they can ingest a<br \/>\n05:31<br \/>\nlot of air and then it can be very<br \/>\n05:33<br \/>\ncolicky this is caused by a very strong<br \/>\n05:35<br \/>\nmilk letdown reflex and as well as<br \/>\n05:38<br \/>\nincreased sensitivity of the<br \/>\n05:40<br \/>\nmyoepithelial cells to oxytocin the<br \/>\n05:43<br \/>\ntreatment here is to use hand expression<br \/>\n05:45<br \/>\nor pumping prior to the infant latching<br \/>\n05:48<br \/>\nalso gentle compression on either side<br \/>\n05:51<br \/>\nof the nipple can decrease some of the<br \/>\n05:53<br \/>\nflow of the breast milk right after the<br \/>\n05:54<br \/>\nbaby is latched one of the things that&#8217;s<br \/>\n05:57<br \/>\nvery helpful is to avoid engorgement and<br \/>\n05:59<br \/>\nto have regular milk emptying and there<br \/>\n06:02<br \/>\nare certain positions to hold the baby<br \/>\n06:03<br \/>\nthat reduced gravity to the nipple these<br \/>\n06:06<br \/>\nwould include sidelines or the football<br \/>\n06:08<br \/>\nhold nipple pain is common it can happen<br \/>\n06:13<br \/>\nreally in the first few days after<br \/>\n06:16<br \/>\ninitiating breast feeding but this<br \/>\n06:18<br \/>\nreally should resolve by five to seven<br \/>\n06:19<br \/>\ndays<br \/>\n06:20<br \/>\nthe woman has nipple pain a week out<br \/>\n06:22<br \/>\nfrom delivery then really need to look<br \/>\n06:26<br \/>\ninto why this is happening the most<br \/>\n06:28<br \/>\ncommon cause is um poor latch of the<br \/>\n06:31<br \/>\nbaby latching directly onto the nipple<br \/>\n06:34<br \/>\nor even biting down on the nipple rather<br \/>\n06:36<br \/>\nthan the areola an improper release<br \/>\n06:39<br \/>\nwhere the baby sort of pulled off the<br \/>\n06:41<br \/>\nbreast<br \/>\n06:41<br \/>\nand the nipple is stretched and that<br \/>\n06:43<br \/>\nsort of snaps back this can all lead to<br \/>\n06:47<br \/>\ncracking bleeding cellulitis and<br \/>\n06:49<br \/>\nmastitis well and the treatment really<br \/>\n06:51<br \/>\nis to focus on first a good latch so to<br \/>\n06:54<br \/>\nmake sure that the baby has the whole<br \/>\n06:55<br \/>\nnipple on the back of their mouth and<br \/>\n06:56<br \/>\nthat sort of suckling of the gums is on<br \/>\n07:01<br \/>\nthe areola rather than the nipple also<br \/>\n07:04<br \/>\nmassaging a little bit of breast milk at<br \/>\n07:07<br \/>\nthe end of the feeding into the nipple<br \/>\n07:08<br \/>\ncan help and then lanolin cream which<br \/>\n07:11<br \/>\ncan be obtained over the counter can be<br \/>\n07:13<br \/>\nused to hydrate the nipple and keep it<br \/>\n07:15<br \/>\nprotected and this is done following<br \/>\n07:17<br \/>\nfeeding the cream isn&#8217;t wiped off before<br \/>\n07:19<br \/>\nthe next feeding also it&#8217;s important to<br \/>\n07:22<br \/>\nallow the nipple to be completely dry<br \/>\n07:24<br \/>\nfollowing feeding after rubbing in the<br \/>\n07:26<br \/>\nbreast milk or some lanolin cream and to<br \/>\n07:28<br \/>\nchange breast pads regularly women will<br \/>\n07:31<br \/>\nwant to avoid tight-fitting bras<br \/>\n07:32<br \/>\ntight-fitting clothes and also avoid<br \/>\n07:35<br \/>\nusing any harsh soaps or fragrances on<br \/>\n07:38<br \/>\nthe breast or the nipple a blocked milk<br \/>\n07:41<br \/>\nduct will present as a tender or sore<br \/>\n07:44<br \/>\nlump in the breast and it&#8217;s important to<br \/>\n07:46<br \/>\nmake sure that there&#8217;s no signs of an<br \/>\n07:47<br \/>\ninfection because that&#8217;s a whole<br \/>\n07:48<br \/>\ndifferent thing but they&#8217;ll have no<br \/>\n07:50<br \/>\nredness or really fever or anything like<br \/>\n07:53<br \/>\nthat just a tender sore lump in the<br \/>\n07:54<br \/>\nbreast what&#8217;s happened here is that<br \/>\n07:56<br \/>\nthere&#8217;s a blockage of the lactiferous<br \/>\n07:58<br \/>\nduct with milk building up behind it the<br \/>\n08:01<br \/>\ntreatment here is actually to keep the<br \/>\n08:03<br \/>\nbreast milk flowing through the like<br \/>\n08:05<br \/>\nTiferet duct and hopefully undo that<br \/>\n08:07<br \/>\nblockage moms will want to frequently<br \/>\n08:10<br \/>\nfeed on the involved breast and also of<br \/>\n08:13<br \/>\nsome gentle massage from behind the mask<br \/>\n08:15<br \/>\npushing towards the nipple can push the<br \/>\n08:17<br \/>\nbreast mucked out and hopefully open up<br \/>\n08:18<br \/>\nthat blockage when we can also use heat<br \/>\n08:21<br \/>\nand it&#8217;s important to avoid here and<br \/>\n08:24<br \/>\nunderwire or tight-fitting bra one of<br \/>\n08:27<br \/>\nthe other long-term consequences of<br \/>\n08:29<br \/>\nthese bot ducts is something called a<br \/>\n08:31<br \/>\nGalactus seal which is a retention cyst<br \/>\n08:33<br \/>\nwith milk this can be during breast<br \/>\n08:36<br \/>\nfeeding this can also happen after<br \/>\n08:37<br \/>\nbreast feeding these can sometimes<br \/>\n08:40<br \/>\nresolve on their own but if they&#8217;re<br \/>\n08:42<br \/>\npersistent and tender they either can be<br \/>\n08:44<br \/>\naspirated with the fine needle or<br \/>\n08:46<br \/>\ncompletely excised as these pockets of<br \/>\n08:50<br \/>\nbreast milk can predispose to secondary<br \/>\n08:52<br \/>\ninfection or even rupture<br \/>\n08:54<br \/>\nmastitis is an infection of the breast<br \/>\n08:56<br \/>\nthis presents with fever pain and<br \/>\n08:58<br \/>\nredness it usually happens in the first<br \/>\n09:00<br \/>\ntwo to three weeks postpartum and is<br \/>\n09:03<br \/>\nassociated with milk stasis the most<br \/>\n09:06<br \/>\ncommon bacterial agents here that cause<br \/>\n09:09<br \/>\nmastitis are Staphylococcus species<br \/>\n09:11<br \/>\nstreptococcus species and e-coli<br \/>\n09:15<br \/>\nthe treatment is to continue<br \/>\n09:17<br \/>\nbreastfeeding similar to the block milk<br \/>\n09:19<br \/>\nduct to pull that breast milk out from<br \/>\n09:22<br \/>\nthe breast breastfeeding and pumping is<br \/>\n09:24<br \/>\nimportant the baby still can drink this<br \/>\n09:26<br \/>\nmilk it is okay for the baby even though<br \/>\n09:28<br \/>\nthere is an infection the baby&#8217;s stomach<br \/>\n09:31<br \/>\nacid will kill the infection of the<br \/>\n09:33<br \/>\nbreast milk massage again towards the<br \/>\n09:36<br \/>\nnipple is helpful to keep that breast<br \/>\n09:37<br \/>\nmilk coming out and then these patients<br \/>\n09:39<br \/>\nare often started on broad-spectrum<br \/>\n09:41<br \/>\nantibiotics like dicloxacillin unless<br \/>\n09:43<br \/>\nthey have an allergy and these patients<br \/>\n09:45<br \/>\nneed to be followed up closely to make<br \/>\n09:47<br \/>\nsure that they don&#8217;t develop an abscess<br \/>\n09:50<br \/>\nbreast abscess is a rare complication of<br \/>\n09:52<br \/>\nbreast feeding but it can be pretty<br \/>\n09:54<br \/>\nserious and it presents in point five<br \/>\n09:56<br \/>\npercent of breastfeeding mothers it will<br \/>\n09:58<br \/>\npresent with a painful swelling and<br \/>\n10:00<br \/>\npersistent systemic symptoms of fever<br \/>\n10:02<br \/>\nand chills and body aches despite<br \/>\n10:04<br \/>\nantibiotics on physical exam there can<br \/>\n10:07<br \/>\neither be a palpable sort of squishy<br \/>\n10:09<br \/>\nflexure mass and this can be confirmed<br \/>\n10:12<br \/>\non ultrasound with a hypoechoic<br \/>\n10:15<br \/>\ncollection of fluid in the breast tissue<br \/>\n10:18<br \/>\nonce the breast abscess is developed<br \/>\n10:20<br \/>\nthis needs to be treated with aspiration<br \/>\n10:22<br \/>\nor incision and drainage as antibiotics<br \/>\n10:24<br \/>\nalone are not sufficient that said the<br \/>\n10:26<br \/>\nantibiotics are important to help treat<br \/>\n10:28<br \/>\nof any overlying cellulitis and to treat<br \/>\n10:31<br \/>\nany systemic symptoms fungal infection<br \/>\n10:35<br \/>\nof the breast is also common this can<br \/>\n10:39<br \/>\nhappen and present with sore nipples<br \/>\n10:41<br \/>\ndespite a good latch it&#8217;s always<br \/>\n10:43<br \/>\nsomething to think about when a woman<br \/>\n10:44<br \/>\nhas continued sore nipples despite a<br \/>\n10:46<br \/>\ngood latch on physical exam she may have<br \/>\n10:49<br \/>\nflaky shiny itchy nipples or cracked<br \/>\n10:52<br \/>\nnipples and she can even have these<br \/>\n10:54<br \/>\nsmall little blisters like you see in<br \/>\n10:55<br \/>\nthe photograph this is caused by a<br \/>\n10:57<br \/>\ncandida species and Candida loves warm<br \/>\n11:00<br \/>\nand wet environments breast milk also<br \/>\n11:02<br \/>\nhas a lot of sugar and Canada loves that<br \/>\n11:05<br \/>\nthe treatment here is a topical<br \/>\n11:07<br \/>\nantifungal cream<br \/>\n11:08<br \/>\nthat has put on in between the breast<br \/>\n11:10<br \/>\nfeedings and wiped away so the baby can<br \/>\n11:13<br \/>\nbreastfeed these creams are safe for the<br \/>\n11:15<br \/>\nbaby for these women they&#8217;re gonna want<br \/>\n11:18<br \/>\nto thoroughly wash all of their clothes<br \/>\n11:20<br \/>\nincluding their bras and their shirts<br \/>\n11:21<br \/>\nand to make sure that the pumping<br \/>\n11:23<br \/>\nsupplies are clean because the Canada<br \/>\n11:25<br \/>\nthat can stick around on all this stuff<br \/>\n11:26<br \/>\nand it&#8217;s important to have a new clean<br \/>\n11:29<br \/>\nand dry bra daily and really the<br \/>\n11:31<br \/>\nimportant thing to do here is to keep<br \/>\n11:33<br \/>\nthe breasts dry inverted flat or<br \/>\n11:37<br \/>\nenlarged nipples can be an issue for<br \/>\n11:39<br \/>\ninfant feeding this can either be<br \/>\n11:42<br \/>\nsomething that&#8217;s congenital especially<br \/>\n11:43<br \/>\nthe enlarged nipples or secondary due to<br \/>\n11:47<br \/>\nengorgement so when we can have totally<br \/>\n11:49<br \/>\nnormal nipples and then with breast<br \/>\n11:50<br \/>\nengorgement have them become more flat<br \/>\n11:52<br \/>\nor even become an inverted nipple<br \/>\n11:56<br \/>\nmassage nipple stimulation and<br \/>\n11:57<br \/>\nstretching can draw the nipple out with<br \/>\n12:01<br \/>\njust a little bit of exposure of the<br \/>\n12:03<br \/>\nnipple infants can often latch on the<br \/>\n12:05<br \/>\nareola with a good effect and be able to<br \/>\n12:08<br \/>\nbreastfeed there are these small suction<br \/>\n12:11<br \/>\ndevices and nipple shields that can help<br \/>\n12:12<br \/>\npull the nipple out more these moms also<br \/>\n12:15<br \/>\nsometimes need to use hand expression<br \/>\n12:17<br \/>\nand pumping to get milk flowing and get<br \/>\n12:19<br \/>\nthem up out of the nipple and then with<br \/>\n12:22<br \/>\nthat little bit of milk there the infant<br \/>\n12:23<br \/>\nis more likely to latch on finally I<br \/>\n12:27<br \/>\nwanted to talk a little bit about<br \/>\n12:28<br \/>\nRaynaud&#8217;s of the nipple this is an<br \/>\n12:30<br \/>\nuncommon condition but it can be seen<br \/>\n12:33<br \/>\nit&#8217;s caused by vasospasm leading to<br \/>\n12:36<br \/>\ndecreased blood supply to the nipple<br \/>\n12:38<br \/>\nthis causes very intense nipple pain<br \/>\n12:41<br \/>\nwith the latch and then in between<br \/>\n12:43<br \/>\nbreastfeeding you&#8217;re going to seem to<br \/>\n12:44<br \/>\npile blanching like you see in the<br \/>\n12:46<br \/>\npicture this is either caused by early<br \/>\n12:48<br \/>\ntrauma to the nipple from initiating<br \/>\n12:50<br \/>\nbreastfeeding so things like nipple<br \/>\n12:53<br \/>\ncracks and bleeding or again Candida<br \/>\n12:57<br \/>\ninfection can predispose to Raynaud&#8217;s of<br \/>\n12:59<br \/>\nthe nipple this is treated with nipple<br \/>\n13:02<br \/>\nmassage avoiding cold and sometimes<br \/>\n13:05<br \/>\nnedeth nifedipine which can be used for<br \/>\n13:07<br \/>\nReynaud so the hand is also helpful with<br \/>\n13:09<br \/>\nRaynaud&#8217;s at the nippon all right<br \/>\n13:12<br \/>\neverybody well that&#8217;s about it you can<br \/>\n13:15<br \/>\nsee we covered some of the common<br \/>\n13:17<br \/>\ninfectious and non-infectious<br \/>\n13:18<br \/>\ncomplications of breastfeeding<br \/>\n13:20<br \/>\nwe discussed the risk factors for<br \/>\n13:21<br \/>\nmanagement<br \/>\n13:22<br \/>\nthese conditions and we describe the<br \/>\n13:24<br \/>\nimpact that these complications can have<br \/>\n13:26<br \/>\non both a lactating mother and the<br \/>\n13:28<br \/>\nnursing infant I hope you found this<br \/>\n13:30<br \/>\nvideo educational good luck with your<br \/>\n13:32<br \/>\nstudies and we&#8217;ll see in class<br \/>\n13:35<br \/>\n[Music]<br \/>\nUp next<\/p>\n<p><\/div>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/n7hrp35CSZA\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration 10:01<\/p>\n<input type='hidden' bg_collapse_expand='69e9b57f03f995016348515' value='69e9b57f03f995016348515'><input type='hidden' id='bg-show-more-text-69e9b57f03f995016348515' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b57f03f995016348515' value='Hide Transcript'><button id='bg-showmore-action-69e9b57f03f995016348515' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#fcf7f7;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b57f03f995016348515' ><\/p>\n<p>00:06<br \/>\nhello everybody this is Chris murasky<br \/>\n00:09<br \/>\nand this is a brief video on drugs and<br \/>\n00:11<br \/>\nbreastfeeding the majority of the<br \/>\n00:13<br \/>\ncontent for this video was obtained from<br \/>\n00:16<br \/>\nNeil hotham and Elizabeth Hoffman and<br \/>\n00:19<br \/>\ntheir article titled drugs and<br \/>\n00:20<br \/>\nbreastfeeding this was published an<br \/>\n00:22<br \/>\nAustralian prescriber in 2015 I highly<br \/>\n00:24<br \/>\nrecommend checking it out it&#8217;s a short<br \/>\n00:26<br \/>\narticle it&#8217;s a great review and it<br \/>\n00:28<br \/>\nincludes all the details of this video<br \/>\n00:30<br \/>\nplus more the learning goals and<br \/>\n00:32<br \/>\nobjectives of this video are to review<br \/>\n00:33<br \/>\nthe contraindications to breastfeeding<br \/>\n00:35<br \/>\naccording to the Centers for Disease<br \/>\n00:37<br \/>\nControl to describe the effect of drug<br \/>\n00:39<br \/>\npharmaceutical properties on the<br \/>\n00:41<br \/>\nconcentration of the drug in the breast<br \/>\n00:43<br \/>\nmilk to understand what influences the<br \/>\n00:45<br \/>\nrisks of adverse effects of a particular<br \/>\n00:48<br \/>\ndrug on the baby and share available<br \/>\n00:50<br \/>\nresources for more information on drug<br \/>\n00:52<br \/>\nsafety in breastfeeding at the end of<br \/>\n00:56<br \/>\nthe day most medications are safe and<br \/>\n00:58<br \/>\nbreastfeeding most drugs themselves are<br \/>\n01:00<br \/>\nactually safe for the baby<br \/>\n01:02<br \/>\nmost lactating women rarely take<br \/>\n01:04<br \/>\nmedications in fact and those that do<br \/>\n01:07<br \/>\nusually only take them intermittently<br \/>\n01:09<br \/>\nalthough almost every drug is<br \/>\n01:12<br \/>\ntransferred somewhat to the breast milk<br \/>\n01:14<br \/>\nthe amount is usually small and not<br \/>\n01:16<br \/>\nenough to affect the baby so at the end<br \/>\n01:19<br \/>\nof day the big question is what are the<br \/>\n01:20<br \/>\nactual contraindications to<br \/>\n01:22<br \/>\nbreastfeeding according to the Centers<br \/>\n01:25<br \/>\nfor Disease Control there are a few rare<br \/>\n01:28<br \/>\ncontraindications to breastfeeding to<br \/>\n01:31<br \/>\nbegin there are certain mothers who<br \/>\n01:33<br \/>\nshould not breastfeed or feed their<br \/>\n01:35<br \/>\nexpress milk to their infants in the<br \/>\n01:38<br \/>\nsetting where the infant is diagnosed<br \/>\n01:40<br \/>\nwith khalaqtu C Mia this is true<br \/>\n01:41<br \/>\nif the mother is affected with human<br \/>\n01:44<br \/>\nimmunodeficiency virus they should not<br \/>\n01:46<br \/>\nbreastfeed or provide the v with express<br \/>\n01:49<br \/>\nmilk this really does depend on the<br \/>\n01:50<br \/>\ncountry in countries like America where<br \/>\n01:53<br \/>\nthere&#8217;s safe access and ready access to<br \/>\n01:55<br \/>\nsafe formulas moms with HIV are<br \/>\n01:58<br \/>\nrecommended not to breastfeed in other<br \/>\n02:01<br \/>\ncountries where formula is not readily<br \/>\n02:03<br \/>\navailable those mothers are still<br \/>\n02:05<br \/>\nrecommended to breastfeed their babies<br \/>\n02:06<br \/>\nmoms were infected with human t-cell<br \/>\n02:08<br \/>\ninfant row flu virus type 1 &amp; 2 if the<br \/>\n02:11<br \/>\nmother is using illicit street drugs<br \/>\n02:13<br \/>\nsuch<br \/>\n02:13<br \/>\njust PCP or cocaine they should not<br \/>\n02:15<br \/>\nbreastfeed the exception here are<br \/>\n02:17<br \/>\nmothers who have an opiate use disorder<br \/>\n02:20<br \/>\nwhen who are on maintenance opioids with<br \/>\n02:22<br \/>\nnegative HIV screening and mothers with<br \/>\n02:25<br \/>\nsuspected or confirmed Ebola virus<br \/>\n02:27<br \/>\nshould not breastfeed the next class are<br \/>\n02:29<br \/>\nmothers who should temporarily not<br \/>\n02:31<br \/>\nbreastfeed or feed express milk this<br \/>\n02:34<br \/>\ninclude mothers that are infected with<br \/>\n02:35<br \/>\nuntreated brucellosis mothers taking<br \/>\n02:38<br \/>\ncertain medications and we&#8217;re going to<br \/>\n02:40<br \/>\ngo over those in this video specifically<br \/>\n02:43<br \/>\nmothers that are undergoing diagnostic<br \/>\n02:45<br \/>\nimaging with certain radio<br \/>\n02:47<br \/>\npharmaceuticals we&#8217;ll talk about that<br \/>\n02:49<br \/>\nlater but those are radioactive<br \/>\n02:50<br \/>\nmedications that are injected into<br \/>\n02:52<br \/>\nmothers and mothers who have active<br \/>\n02:55<br \/>\nherpes simplex virus infection with<br \/>\n02:57<br \/>\nlesions present on the breast finally<br \/>\n03:00<br \/>\nthere are mothers who should temporarily<br \/>\n03:02<br \/>\nnot breastfeed but it&#8217;s okay for them to<br \/>\n03:05<br \/>\nprovide the baby with expressed breast<br \/>\n03:07<br \/>\nmilk if the mother has untreated active<br \/>\n03:10<br \/>\ntuberculosis and if the mother has<br \/>\n03:13<br \/>\nactive varicella infection that<br \/>\n03:14<br \/>\ndeveloped within five days prior to<br \/>\n03:16<br \/>\ndelivery up to the two days following<br \/>\n03:18<br \/>\ndelivery these are mostly respiratory<br \/>\n03:21<br \/>\nprecautions and it&#8217;s okay for the<br \/>\n03:22<br \/>\nexpressed breast milk to be given to the<br \/>\n03:24<br \/>\nbaby although they should temporarily<br \/>\n03:26<br \/>\nnot be breastfeeding until these<br \/>\n03:27<br \/>\ninfections have cleared<br \/>\n03:29<br \/>\nokay returning back to drugs the big<br \/>\n03:32<br \/>\nquestion is what affects the<br \/>\n03:33<br \/>\nconcentration of drugs in the breast<br \/>\n03:35<br \/>\nmilk there are several factors on the<br \/>\n03:37<br \/>\nrole of them individually the first is<br \/>\n03:40<br \/>\nthe maternal plasma concentration drugs<br \/>\n03:43<br \/>\nenter the milk from the maternal serum<br \/>\n03:44<br \/>\nthrough passive diffusion the time<br \/>\n03:47<br \/>\ncourse of milk drug concentration is<br \/>\n03:49<br \/>\nconcordant with the maternal plasma drug<br \/>\n03:51<br \/>\nconcentration the plasma concentration<br \/>\n03:53<br \/>\nis also affected by the drugs&#8217;<br \/>\n03:55<br \/>\ndistribution in two different tissues a<br \/>\n03:57<br \/>\nhigh volume of distribution will<br \/>\n03:59<br \/>\ncontribute a lower maternal plasma<br \/>\n04:01<br \/>\nconcentration and therefore subsequent<br \/>\n04:04<br \/>\nlower concentration in the breast milk<br \/>\n04:06<br \/>\nmaternal plasma protein binding drug<br \/>\n04:10<br \/>\nbinding the plasma proteins influences<br \/>\n04:12<br \/>\nthe extent of transfer into the breast<br \/>\n04:13<br \/>\nmilk free unbound drugs diffuse readily<br \/>\n04:17<br \/>\nhighly protein bound drugs are unable to<br \/>\n04:19<br \/>\ndiffuse in significant amounts size of<br \/>\n04:23<br \/>\nthe drug molecule most drug molecules<br \/>\n04:25<br \/>\nare small enough to enter the milk for<br \/>\n04:27<br \/>\nample alcohol nicotine caffeine small<br \/>\n04:30<br \/>\nenough go right in<br \/>\n04:31<br \/>\nsome have higher molecular weights and<br \/>\n04:33<br \/>\nwill not enter the milk examples of<br \/>\n04:36<br \/>\nthese are heparin and insulin degree of<br \/>\n04:40<br \/>\nionization drugs cross membranes in an<br \/>\n04:43<br \/>\nonion iced form milk is generally more<br \/>\n04:46<br \/>\nacidic with a pH around 7.2 compared to<br \/>\n04:49<br \/>\nthe mothers plasma which has a pH of 7.4<br \/>\n04:52<br \/>\ntherefore the milk attracts weak organic<br \/>\n04:55<br \/>\nbases<br \/>\n04:56<br \/>\nconversely weak organic acids tend to be<br \/>\n04:59<br \/>\nheld in the maternal plasma lipid<br \/>\n05:01<br \/>\nsolubility in addition to passive<br \/>\n05:04<br \/>\ndiffusion into the aqueous phase lipid<br \/>\n05:06<br \/>\nsoluble drugs have Co secretion by<br \/>\n05:09<br \/>\ndissolution in the fat droplets of milk<br \/>\n05:12<br \/>\nthe fat content of milk also varies<br \/>\n05:14<br \/>\naccording to the age of the infant and<br \/>\n05:16<br \/>\nthe phase of the feed for example for<br \/>\n05:19<br \/>\nmilk versus hind milk with hind milk<br \/>\n05:21<br \/>\nhaving more fat content<br \/>\n05:24<br \/>\nfinally maternal pharmacogenomics<br \/>\n05:27<br \/>\nthere&#8217;s a growing knowledge about the<br \/>\n05:28<br \/>\ninfluence of pharmacogenomics a classic<br \/>\n05:31<br \/>\nexample of this is coding coding is very<br \/>\n05:34<br \/>\noblique metabolized to morphine by<br \/>\n05:35<br \/>\ncytochrome p450 enzyme sip to DES<br \/>\n05:39<br \/>\nultra-rapid metabolizers can produce<br \/>\n05:42<br \/>\nsignificant amounts of morphine with<br \/>\n05:44<br \/>\nrepeated doses of codeine rapid transfer<br \/>\n05:47<br \/>\nof the morphine and the maternal serum<br \/>\n05:48<br \/>\nto the breast milk can result in<br \/>\n05:50<br \/>\nneonatal CNS depression and potentially<br \/>\n05:52<br \/>\nfetal death it is recommended to avoid<br \/>\n05:54<br \/>\ncodeine while breastfeeding now<br \/>\n05:57<br \/>\nbalancing this out the question also is<br \/>\n06:00<br \/>\nwhat influences the effects on the baby<br \/>\n06:02<br \/>\nthere are again several components to<br \/>\n06:04<br \/>\nthis we&#8217;ll take them one by one the<br \/>\n06:07<br \/>\nfirst is the timing of the dose feeding<br \/>\n06:09<br \/>\nthe baby prior to taking a drug results<br \/>\n06:11<br \/>\nin the baby receiving the lowest<br \/>\n06:13<br \/>\npossible dose of the drug this does not<br \/>\n06:15<br \/>\napply however to drugs with longer<br \/>\n06:17<br \/>\nhalf-life so caution is still needed<br \/>\n06:19<br \/>\nhere<br \/>\n06:20<br \/>\ntoxicity premature babies have a lower<br \/>\n06:23<br \/>\ncapacity to metabolize and excrete drugs<br \/>\n06:26<br \/>\nalso if a baby has just been exposed to<br \/>\n06:29<br \/>\na drug in utero further exposure in the<br \/>\n06:31<br \/>\nbreast milk will augment the existing<br \/>\n06:33<br \/>\nconcentration this is used as an<br \/>\n06:35<br \/>\nadvantage with infants experience in<br \/>\n06:37<br \/>\nopiate withdrawal the mothers of infants<br \/>\n06:40<br \/>\nundergoing open<br \/>\n06:41<br \/>\nwithdrawl are recommended to breastfeed<br \/>\n06:43<br \/>\nas long as they have no other<br \/>\n06:44<br \/>\ncontraindications the baby then obtained<br \/>\n06:46<br \/>\nsome of the opiate in the breast milk<br \/>\n06:48<br \/>\nand this helps with the withdrawal the<br \/>\n06:51<br \/>\nfollowing is a list of drugs that are<br \/>\n06:52<br \/>\nactually contraindicated in<br \/>\n06:53<br \/>\nbreastfeeding examples of drugs country<br \/>\n06:56<br \/>\nended in breastfeeding including<br \/>\n06:57<br \/>\namiodarone which has a long half-life<br \/>\n06:59<br \/>\nand may affect thyroid function<br \/>\n07:02<br \/>\nantineoplastic s&#8217; which can cause<br \/>\n07:04<br \/>\nleukopenia and bone marrow suppression<br \/>\n07:06<br \/>\ngold salts can cause rash nephritis and<br \/>\n07:09<br \/>\nhematological abnormalities iodine and<br \/>\n07:12<br \/>\nhigh doses can lead to infant<br \/>\n07:13<br \/>\nhypothyroidism lithium is really not<br \/>\n07:16<br \/>\nrecommended in breastfeeding and it&#8217;s<br \/>\n07:18<br \/>\nreally only feasible with rigorous<br \/>\n07:19<br \/>\nmonitoring as mentioned earlier radio<br \/>\n07:22<br \/>\npharmaceuticals can be a problem as the<br \/>\n07:24<br \/>\nradiation can be put into the breast<br \/>\n07:27<br \/>\nmilk coming into the baby<br \/>\n07:28<br \/>\nretinoids are also associated with<br \/>\n07:30<br \/>\nserious adverse effects back to things<br \/>\n07:34<br \/>\nthat influence the effects on the baby<br \/>\n07:35<br \/>\nanother one is oral bioavailability just<br \/>\n07:39<br \/>\nbecause a drug is present in the breast<br \/>\n07:40<br \/>\nmilk does not mean that it will lead to<br \/>\n07:42<br \/>\na significant exposure to the infant for<br \/>\n07:44<br \/>\nexample the infant gut may very well<br \/>\n07:46<br \/>\ndestroy or degrade the drug and some<br \/>\n07:49<br \/>\ndrugs are not particularly absorbed well<br \/>\n07:51<br \/>\nthrough the infant gut volume of breast<br \/>\n07:54<br \/>\nmilk the amount of breast milk a baby<br \/>\n07:56<br \/>\nreceives also varies for example a baby<br \/>\n07:59<br \/>\nexclusively breastfeeding at two months<br \/>\n08:01<br \/>\nis going to be getting a lot more breast<br \/>\n08:02<br \/>\nmilk than an eleven month old baby who<br \/>\n08:05<br \/>\nis mostly nursing at night for comfort<br \/>\n08:06<br \/>\nand bonding relative infant dose the<br \/>\n08:11<br \/>\nrelevant infant dose is equal to the<br \/>\n08:12<br \/>\ndose received in the breast milk to the<br \/>\n08:14<br \/>\nbaby relative to the mother&#8217;s dose the<br \/>\n08:17<br \/>\nformula for this is relative infant dose<br \/>\n08:19<br \/>\nequals the infant dose which is<br \/>\n08:21<br \/>\nmilligrams per kilogram weight of the<br \/>\n08:24<br \/>\nbaby per day divided by the maternal<br \/>\n08:26<br \/>\ndose which is milligrams per kilogram of<br \/>\n08:29<br \/>\nthe mom per day this is expressed as a<br \/>\n08:32<br \/>\npercent and it keeps in mind two<br \/>\n08:34<br \/>\ndifferent weights of the mom and the<br \/>\n08:35<br \/>\nbaby a relative dose of ten percent or<br \/>\n08:37<br \/>\nabove is a notable level of concern<br \/>\n08:39<br \/>\nalthough it&#8217;s pretty rare also the age<br \/>\n08:42<br \/>\nof the infant most averse effects of<br \/>\n08:45<br \/>\ndrugs and breast milk occur in newborns<br \/>\n08:46<br \/>\nunder two months and rarely occur in<br \/>\n08:49<br \/>\nthose older than six months in infants<br \/>\n08:52<br \/>\nmetabolism and excretion capacity at<br \/>\n08:54<br \/>\nbirth is all<br \/>\n08:55<br \/>\none third of what it is it&#8217;s seven to<br \/>\n08:57<br \/>\neight months the following is not<br \/>\n09:00<br \/>\ncomplete but good list of resources that<br \/>\n09:03<br \/>\nare readily available on the Internet<br \/>\n09:04<br \/>\nthe first is lactMed or toxnet from the<br \/>\n09:07<br \/>\nNational Institutes of Health and the US<br \/>\n09:08<br \/>\nNational Library of Medicine another<br \/>\n09:11<br \/>\ngreat resource is mother to baby which<br \/>\n09:13<br \/>\nis put out by the nonprofit organization<br \/>\n09:15<br \/>\nof teratology information specialists<br \/>\n09:18<br \/>\nalright that about wraps it up I believe<br \/>\n09:21<br \/>\nif we go back to our learning goals and<br \/>\n09:22<br \/>\nobjectives they were all met review the<br \/>\n09:25<br \/>\ncontraindications to breastfeeding<br \/>\n09:26<br \/>\naccording to the Center for Disease<br \/>\n09:27<br \/>\nControl described the effect of drug<br \/>\n09:30<br \/>\npharmaceutical properties on the<br \/>\n09:31<br \/>\nconcentration of the drug in the breast<br \/>\n09:33<br \/>\nmilk understand what influence is the<br \/>\n09:35<br \/>\nrisk of adverse effects of a particular<br \/>\n09:37<br \/>\ndrug on the baby and share available<br \/>\n09:40<br \/>\nresources for more information on drug<br \/>\n09:41<br \/>\nsafety and breastfeeding thanks for<br \/>\n09:44<br \/>\ntaking the time to watch this video I<br \/>\n09:45<br \/>\nhope that you found it informative and<br \/>\n09:48<br \/>\neducational good luck with your studies<br \/>\n09:50<br \/>\nand we&#8217;ll see you in class<\/p>\n<p><\/div>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\ufeff Duration 8:36 Duration 12:26 Duration 13:44 Duration 10:01 &nbsp;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":160,"menu_order":7,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-398","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/398","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=398"}],"version-history":[{"count":0,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/398\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/160"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=398"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}