NURS 233 Lecture Notes - Lecture 9: Apgar Score, Infant Formula, Erythromycin
Perinatal week 9 – infant feeding
Stuff from last week
Apgar – know apgar scale because we will score it. and it tells the baby how is
adjusting. Minute 1,5, and 10 it is done. If minute 1 and 5 is great minute 10 is not
doen all the time. It takes time for the babies to come around so we try to give them
time. Muscle tone should be rebounded and moving, its obvious when the baby
comes out with a low apgar. Know what the scoring is. If apgar is low then maybe
they needed recesitation and it can affect feeding and attachemet to mother if they
needed help.
Vit K – preventing internal bleeding. )t’s a clotting medication, they can have it up to
hours after delivery, baby can be with om and doesn’t need to happen right away.
It is IM in vastis lateralis. Know side effects. Know dose
Erythromycin- not manadotry in NS, gel but in eye and its squeezed into the lower
lid. Its for preventing the transmission of gonorrhea and chlamydia. Its no longer
recommended but some provinces it is mandatory. We can wait to give it 1-2 hours
after birth. There needs to be concent and it isn’t the best day to treat it.
Heel prick- babies do feel pain and pain needs to be controlled. Skin to skin and
mother baby bonding and breastfeeding can really help the baby.
THIS WEEK:
Recommended Infant Nutrition
◦ Breastfeed exclusively, on-demand, for the first 6 months of life (Health Canada,
2014).- when the baby is hungry feed them. Don’t listen to the myths.
◦ If breastfeeding, give Vitamin D supplement (400 IU) until 1 year of age.- best is
the one drop stuff
◦ If infants are weaned before age 12 months, they should receive iron-fortified
infant formula.
◦Cows milk isn’t good to do until at least 9 months of age
Human Milk
◦ Designed specifically for human infants; it is nutritionally superior to any
alternative.
◦ Considered living tissue because it contains almost as many live cells as blood.
It surrounds to the environment!
◦ Bacteriologically safe and always available.
◦ Nutrients are more easily absorbed than those in formula.
Breast fed babies poop more and their poop is easier to pass.
Contraindications of Breastfeeding
◦ Maternal cancer therapy or diagnostic and therapeutic radioactive isotopes
◦ Active tuberculosis not under treatment
◦ HIV positive
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◦ Maternal herpes simplex lesion on a breast
◦ Galactosemia in infant- rare metabolic disorder that doesn’t allow the baby to
metabolize galactose
◦ Maternal substance use of narcotics
◦ Maternal human T-cell leukemia virus type 1
◦ Some medications may affect infant.- there are usually alternatives so go to these
resources:
◦ Consult with health care provider or Pharmacist.
◦ Motherisk or Lactmed webistes
◦ (ale’s Medications and Mother’s Milk book
supplementation:
there is a cart on the power point!
Infant conditions- hypoglycemia that fails to respond to optimal breastfeeding
Materal conditions
Breastfeeding is contraindicated – HIV +, certain infant metabolic conditions
Lactogenesis
◦ Ductules enlarge into lactiferous ducts and sinuses, where milk collects behind the
nipple.
◦ Each nipple has pores through which milk is transferred.
◦ After birth, a decrease in estrogen and progesterone triggers release of prolactin
from the anterior pituitary gland.
◦ Prolactin levels highest during first 10 days after birth but Gradually decline but
remain above baseline levels for duration of lactation
◦ Prolactin produced in response to infant suckling and emptying of breasts.
Triggers letdown reflex. if you don’t use your breasts milk wont be produced
◦ Lactating breasts never completely empty. (milk is always being produced)
◦ Milk is constantly produced as the infant feeds.
Oxytocin
◦ Other main hormone essential to lactation (the other is prolactin)
◦ As nipple is stimulated by suckling infant, posterior pituitary prompted by
hypothalamus produces oxytocin
◦ Responsible for milk-ejection reflex or let-down reflex
◦stress can affect this and it affects if they have the let down and ejection reflex. We
need to calm the mother down for everything to start working.
◦if you hear another baby cry you get a let down reflex so you should wear breast pads.
Unique Properties of Human Milk
◦ Contains immunologically active components.
◦ Composition changes during each feeding
◦ Colostrum
◦ More concentrated than mature milk
◦ Extremely rich in immune globulins
◦ Higher concentration of protein, fat-soluble vitamins, and minerals
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find more resources at oneclass.com
◦ Less fat than mature milk
◦you have enough milk for you baby before they come out! The babies belly is the size of
a chick pea when it comes out. The colostum is liquid gold and the sooner you feed the
baby the soner your milk will come in.
LATCH Score- know this acronym.
◦ L- latch
◦ A- audible swallowing- it makes a swallowing sound
◦ T- type of nipple- inverded? Everted? Flattened isn’t good it means baby isn’t
latching right. Nipple needs to be behind the hard palate.
◦ C- comfort (breast/nipple) – its going to hurt a little but not too bad!
◦ H- hold (positioning/help)
Breastfeeding: Assessment
◦ Positioning
◦ Latch
◦ Milk ejection or let-down
◦ Frequency of feedings ( you need to feed your baby lots in the first part to get your
milk supply a lt) so babies cant sleep a lot and you need to wake them up to feed
tehm)
◦ Duration of feedings
◦ Indications of effective breastfeeding- latch score, baby feeding cues it isn’t
always crying)
baby should be sucking on the breasts not the nipple.
Asymmetrical latch- you want the lows jaw to take most of the breast tissue , you
don’t want a bulls eye, to rhythmically move the breast tissue and milk into their
mouth they need the lows jaw.
Laid back breastfeeding- mom laying back and baby falls on breastfeeding, gravity
will help and you can do hands off breastfeeding, it’s the best thing to do to prevent
nipple damange and to get a deep latch
First 6 weeks of breast feeding are the hardest, no routine but after that things get
better.
Pumping- hands on pumping; compressing the breast like you are milking a cow
really helps. Its like a bulls eye and it needs to fit right and the nipple shouldn’t be
irritated, and if they do they need a bigger size. Turn it up to where it is
uncomfortable and then you come back to where it is confortable to get the most
milk. Twice the amount of milk with hands on pumping.
Storing breast milk- it is its own microbacterial agencies so it can stay out at room
temp for 3-4 hours. But can stay in a depe freeze for 6-12 months
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Apgar know apgar scale because we will score it. and it tells the baby how is adjusting. If minute 1 and 5 is great minute 10 is not doen all the time. It takes time for the babies to come around so we try to give them time. Muscle tone should be rebounded and moving, its obvious when the baby comes out with a low apgar. If apgar is low then maybe they needed recesitation and it can affect feeding and attachemet to mother if they needed help. )t"s a clotting medication, they can have it up to (cid:888) hours after delivery, baby can be with om and doesn"t need to happen right away. after birth. There needs to be concent and it isn"t the best day to treat it. Erythromycin- not manadotry in ns, gel but in eye and its squeezed into the lower lid. Its for preventing the transmission of gonorrhea and chlamydia.
