Ebook Breastfeeding management for the clinician (4E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Breastfeeding management for the clinician (4E): Part 2
Ebook Breastfeeding management for the clinician (4E): Part 2
Chapter 6Beyond the Initial 48-72 Hours: Infant ChallengesINTRODUCTIONA number of breastfeeding problems and issues must be addressed immediately and Ebook Breastfeeding management for the clinician (4E): Part 2 throughout the initial hospital stay, whereas other issues may have their origins in the early days but become apparent after discharge. Some are conditions that require an ongoing need for specialized lactation support postdischarge. This chapter discusses situations that require close follow-up a Ebook Breastfeeding management for the clinician (4E): Part 2nd intense support, including hyperbilirubinemia (jaundice), dehydration, weight gain/loss issues, and breastfeeding late preterm and preterm infants.Ebook Breastfeeding management for the clinician (4E): Part 2
NEONATAL JAUNDICENeonatal jaundice is a common condition and generally self-limiting in the newborn. It is estimated that 60-70% of term infants will Chapter 6Beyond the Initial 48-72 Hours: Infant ChallengesINTRODUCTIONA number of breastfeeding problems and issues must be addressed immediately and Ebook Breastfeeding management for the clinician (4E): Part 2enson, & Oski, 1998; Maisels & McDonagh, 2008). Neonatal hyperbilirubinemia increases during the hours after birth and usually peaks at 96-120 hours after discharge from the hospital. Approximately 5% reach levels > 17 mg/dl. (290.7 imnol/L; Harris, Bernbaum, Polin, Zimmerman, & Polin. 2001), and ar Ebook Breastfeeding management for the clinician (4E): Part 2ound 2% of these newborns reach a total serum bilirubin level of > 20 mg/dl. (342 mmol/L; Newman et al., 1999). Estimated rates of high-risk bilirubinEbook Breastfeeding management for the clinician (4E): Part 2
levels (> 25 mg/dl. [427 mmol/L]) vary from 1:700 (Newman et al., 1999) to 1:1,000 (Bhutan!, Johnson, & Sivieri, 1999a). Jaundice is a frequent reasoChapter 6Beyond the Initial 48-72 Hours: Infant ChallengesINTRODUCTIONA number of breastfeeding problems and issues must be addressed immediately and Ebook Breastfeeding management for the clinician (4E): Part 2erm newborns is a benign condition that resolves over the first week or 2. However, extremely high levels of bilirubin (> 25-30 mg/dL [427.5-513 mmol/L]) can be toxic to the brain, producing a condition known as kernicterus. Kernicterus involves bilirubin toxicity to the basal ganglia and various br Ebook Breastfeeding management for the clinician (4E): Part 2ainstem nuclei when extreme amounts of bilirubin cross the blood-brain barrier, then infiltrate and destroy nerve cells.Bilirubin MetabolismBilirubinEbook Breastfeeding management for the clinician (4E): Part 2
is an orange or yellow pigment, 80-90% of which is derived from the breakdown of hemoglobin from aged or hemolyzed red blood cells. Heme is a constituChapter 6Beyond the Initial 48-72 Hours: Infant ChallengesINTRODUCTIONA number of breastfeeding problems and issues must be addressed immediately and Ebook Breastfeeding management for the clinician (4E): Part 2Chapter 6 Beyond the Initial 48-72 Hours: Infant Challengeserythrocytes, is initially converted Io biliverdin through the action of the enzyme heme oxygenase, and then is reduced further to bilirubin that is transported in the circulation tightly bound to albumin. In the liver, bilirubin is conjugat Ebook Breastfeeding management for the clinician (4E): Part 2ed by another enzyme, uridine diphosphoglucuronosyl transferase (ƯDPGT); released into the bile duct; and delivered to the intestinal tract for eliminEbook Breastfeeding management for the clinician (4E): Part 2
ation through the stool (also termed direct bilirubin). However, some unconiugaled (indirect) bilirubin remains unbound to albumin and circulates as fChapter 6Beyond the Initial 48-72 Hours: Infant ChallengesINTRODUCTIONA number of breastfeeding problems and issues must be addressed immediately and Ebook Breastfeeding management for the clinician (4E): Part 2t is neurotoxic and can transiently or permanently' affect neurons (Volpe. 2001).The production, conjugation, and excretion of bilirubin are affected by' conditions unique to the newborn that cause an imbalance in this metabolic process, predisposing the newborn to hyperbilirubinemia. As the newborn Ebook Breastfeeding management for the clinician (4E): Part 2 moves from the low oxygen environment of the uterus to the relatively high oxygen environment of room air, excess fetal red blood cells arc no longerEbook Breastfeeding management for the clinician (4E): Part 2
needed. Infants produce more bilirubin than they' can eliminate, a situation exacerbated by prematurity, bruising or hematoma formation, infection, mChapter 6Beyond the Initial 48-72 Hours: Infant ChallengesINTRODUCTIONA number of breastfeeding problems and issues must be addressed immediately and Ebook Breastfeeding management for the clinician (4E): Part 2ations in and to this process include the following:•Production: High bilirubin production (twice that of an adult) occurs because fetal erythrocytes are overabundant, have a short lifespan, and their breakdown rapidly creates an excess of heme for the newborn liver to process.•Conjugation: Conjugat Ebook Breastfeeding management for the clinician (4E): Part 2ion undergoes delays because the activity of ƯDPGT is limited and hepatic uptake of bilirubin is decreased.•Excretion: The small intestine of the newbEbook Breastfeeding management for the clinician (4E): Part 2
orn delays bilirubin excretion through the activity of the enzyme beta-glucuronidase, which converts conjugated bilirubin back to its unconjugated staChapter 6Beyond the Initial 48-72 Hours: Infant ChallengesINTRODUCTIONA number of breastfeeding problems and issues must be addressed immediately and Ebook Breastfeeding management for the clinician (4E): Part 2zed with the bacteria needed to degrade bilirubin into urobilinogen that cannot be reabsorbed. The longer direct (conjugated) bilirubin remains in the intestine, the greater the likelihood of its conversion back to indirect bilirubin (unconjugated), which is sent back to the liver for reprocessing ( Ebook Breastfeeding management for the clinician (4E): Part 2Blackburn, 1995). Al birth, the intestines can contain as much as 200 g of meconium, including up to 175 mg of bilirubin, half of which is in the indiEbook Breastfeeding management for the clinician (4E): Part 2
rect form, an amount that is 4 to 7 times the daily' rate of bilirubin production al term (Bartolclli, Stevenson, Ostrander, & Johnson, 1979).•GeneticChapter 6Beyond the Initial 48-72 Hours: Infant ChallengesINTRODUCTIONA number of breastfeeding problems and issues must be addressed immediately and Ebook Breastfeeding management for the clinician (4E): Part 2e for the enzyme required for bilirubin conjugation contributes to the increased predisposition of some Asian infants (-20%) for severe neonatal hyperbilirubinemia (Akaba et al., 1998). ƯDPGT 1A1 was shown to be asso dated with hyperbilirubinemia in Asian infants but not Caucasian infants (Long, Zha Ebook Breastfeeding management for the clinician (4E): Part 2ng, Fang, Luo, & Liu, 2011). In a population of Asian infants, Chang, Lin, Liu, Yeh, and Ni (2009) found that male breastfed infants with a variant nuEbook Breastfeeding management for the clinician (4E): Part 2
cleotide 211 of the UGT 1A1 gene had a high risk for developing prolonged hyperbilirubinemia. Sato and colleagues (2013) studied 401 exclusively breasChapter 6Beyond the Initial 48-72 Hours: Infant ChallengesINTRODUCTIONA number of breastfeeding problems and issues must be addressed immediately and Ebook Breastfeeding management for the clinician (4E): Part 2 mutations of UGT 1 Al (genotypes G71R and TA 7). They demonstrated that the effect of G71R mutation on neonatal hyperbilirubinemia was significant in infants, with 5% or greater maximal weight loss, and its influence increases in parallel with the degree of maximal weight loss. This study indicates Ebook Breastfeeding management for the clinician (4E): Part 2 that optimal breastfeeding, breastfeeding management, and milk intake may overcome the genetic predisposition factor G71R for the development of hypeEbook Breastfeeding management for the clinician (4E): Part 2
rbilirubinemia in exclusively breastfed Asian infants. Prolonged jaundice, often termed breastmilk jaundice, has also been shown to occur in a signifiChapter 6Beyond the Initial 48-72 Hours: Infant ChallengesINTRODUCTIONA number of breastfeeding problems and issues must be addressed immediately and Ebook Breastfeeding management for the clinician (4E): Part 2nfants who experience 10% or greater body weight loss during the neonatal period. Inadequate breastmilk intake may increase the bilirubin burden in infants with polymorphisms in the genes that are involved in the transport or metabolism of bilirubin (Sato et al., 2015). Multiple genetic modifiers of Ebook Breastfeeding management for the clinician (4E): Part 2 bilirubin metabolism may interact in the presence of breastfeeding in an infant of Asian descent (Yang et al., 2015), making it important to monitorEbook Breastfeeding management for the clinician (4E): Part 2
breastfeeding not only in the hospital but also following discharge to assure adequate milk intake.•Microbiological content of breastmilk: The microbiChapter 6Beyond the Initial 48-72 Hours: Infant ChallengesINTRODUCTIONA number of breastfeeding problems and issues must be addressed immediately and Ebook Breastfeeding management for the clinician (4E): Part 2um species may be protective against neonatal jaundice, whereas low concentrations of these microorganisms may facilitate the development of jaundice (Tuzun, Kumral, Duman, & Ozkan, 2013).•Weight loss: Birth weight loss during the first 3 days following birth may be a clinical indicator of a predisp Ebook Breastfeeding management for the clinician (4E): Part 2osition to significant jaundice at 72 hours. One study found that weight loss of 4.48% on day 1,7.6% weight loss on day 2, and 8.15% weight loss on daEbook Breastfeeding management for the clinician (4E): Part 2
y 3 were useful cutoff values in predicting significant jaundice at 72 hours (Yang et al., 2013). These values may aid clinicians in determining the nChapter 6Beyond the Initial 48-72 Hours: Infant ChallengesINTRODUCTIONA number of breastfeeding problems and issues must be addressed immediately and Ebook Breastfeeding management for the clinician (4E): Part 2irubin pigment is deposited in subcutaneous tissue, producing the characteristic yellowing of the skin and sclera. The type of jaundice typically seen in full-term neonates is termed physiological jaundice, where bilirubin levels rise steadily during the first 3-4 days of life, peak around the 5th d Ebook Breastfeeding management for the clinician (4E): Part 2ay, and decline thereafter. In preterm infants bilirubin levels may peak on day 6 or 7 and resolve over a more extended period of time. Total serum biEbook Breastfeeding management for the clinician (4E): Part 2
lirubin levels are influenced by a number of factors such as race, gestational age, type of feeding, and drugs or medications given to the mother or iGọi ngay
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