Know,Y not to bottle-feed

Supplementation of the Breastfed Baby
"Just One Bottle Won't Hurt"-- or Will It?

Marsha Walker, RN, IBCLC
Background

* The gastrointestinal (GI) tract of a normal fetus is sterile
* the type of delivery has an effect on the development of the intestinal microbiota
o vaginally born infants are colonized with their mother's bacteria
o cesarean born infants' initial exposure is more likely to environmental microbes from the air, other infants, and the nursing staff which serves as vectors for transfer
o the primary gut flora in infants born by cesarean delivery may be disturbed for up to 6 months after birth (Gronlund et al, 1999)
* babies at highest risk of colonization by undesirable microbes or when transfer from maternal sources cannot occur are cesarean-delivered babies, preterm infants, full term infants requiring intensive care, or infants separated from their mother
o infants requiring intensive care acquire intestinal organisms slowly and the establishment of bifidobacterial flora is retarded
o a delayed bacterial colonization of the gut with a limited number of bacterial species tends to be virulent
o control and manipulation of the neonatal gut with human milk can be used as a strategy to prevent and treat intestinal diseases (Dai & Walker, 1999)
* major ecological disturbances are observed in newborn infants treated with antimicrobial agents
o one way of minimizing ecological disturbances in the NICU is to provide these babies with fresh breast milk (Zetterstrom et al, 1994)
* breastfed and formula-fed infants have different gut flora
o breastfed babies have a lower gut pH (acidic environment) of approximately 5.1-5.4 throughout the first six weeks that is dominated by bifidobacteria with reduced pathogenic (disease-causing) microbes such as E coli, bacteroides, clostridia, and streptococci
o flora with a diet-dependent pattern is present from the 4th day of life with breast milk-fed guts showing a 47% bifidobacterium and formula-fed guts showing 15%. Enterococci prevail in formula-fed infants (Rubaltelli et al, 1998)
o babies fed formula have a high gut pH of approximately 5.9-7.3 with a variety of putrefactive bacterial species
o in infants fed breast milk and formula supplements the mean pH is approximately 5.7-6.0 during the first four weeks, falling to 5.45 by the sixth week
o when formula supplements are given to breastfed babies during the first seven days of life, the production of a strongly acidic environment is delayed and its full potential may never be reached
o breastfed infants who receive supplements develop gut flora and behavior like formula-fed infants
* The neonatal GI tract undergoes rapid growth and maturational change following birth
o Infants have a functionally immature and immunonaive gut at birth
o Tight junctions of the GI mucosa take many weeks to mature and close the gut to whole proteins and pathogens
o Intestinal permeability decreases faster in breastfed babies than in formula-fed infants (Catassi, et al, 1995)
o Open junctions and immaturity play a role in the acquisition of NEC, diarrheal disease, and allergy
o sIgA from colostrum and breast milk coats the gut, passively providing immunity during the time of reduced neonatal gut immune function
o mothers' sIgA is antigen specific. The antibodies are targeted against pathogens in the baby's immediate surroundings
o the mother synthesizes antibodies when she ingests, inhales, or otherwise comes in contact with a disease-causing microbe
o these antibodies ignore useful bacteria normally found in the gut and ward off disease without causing inflammation
* infant formula should not be given to a breastfed baby before gut closure occurs
o once dietary supplementation begins, the bacterial profile of breastfed infants resembles that of formula-fed infants in which bifidobacteria are no longer dominant and the development of obligate anaerobic bacterial populations occurs (Mackie, Sghir, Gaskins, 1999)
o relatively small amounts of formula supplementation of breastfed infants (one supplement per 24 hours) will result in shifts from a breastfed to a formula-fed gut flora pattern (Bullen, Tearle, Stewart, 1977)
o the introduction of solid food to the breastfed infant causes a major perturbation in the gut ecosystem, with a rapid rise in the number of enterobacteria and enterococci, followed by a progressive colonization by bacteroides, clostridia, and anaerobic streptococci (Stark & Lee, 1982)
o with the introduction of supplementary formula, the gut flora in a breastfed baby becomes almost indistinguishable from normal adult flora within 24 hours (Gerstley, Howell, Nagel, 1932)
o if breast milk were again given exclusively, it would take 2-4 weeks for the intestinal environment to return again to a state favoring the gram-positive flora (Brown & Bosworth, 1922; Gerstley, Howell, Nagel, 1932)
* in susceptible families, breastfed babies can be sensitized to cow's milk protein by the giving of just one bottle, (inadvertent supplementation, unnecessary supplementation, or planned supplements), in the newborn nursery during the first three days of life (Host, Husby, Osterballe, 1988; Host, 1991)
o infants at high risk of developing atopic disease has been calculated at 37% if one parent has atopic disease, 62-85% if both parents are affected and dependant on whether the parents have similar or dissimilar clinical disease, and those infants showing elevated levels of IgE in cord blood irrespective of family history (Chandra, 2000)
o in breastfed infants at risk, hypoallergenic formulas can be used to supplement breastfeeding; solid foods should not be introduced until 6 months of age, dairy products delayed until 1 year of age, and the mother should consider eliminating peanuts, tree nuts, cow's milk, eggs, and fish from her diet (Zieger, 1999; AAP, 2000)
* in susceptible families, early exposure to cow's milk proteins can increase the risk of the infant or child developing insulin dependent diabetes mellitus (IDDM) (Mayer et al, 1988; Karjalainen, et al, 1992)
o human insulin content in breast milk is significantly higher than bovine insulin in cow's milk; insulin content in infant formulas is extremely low to absent; insulin supports gut maturation
o in animal models oral administration of human insulin stimulates the intestinal immune system generating active cellular mechanisms that suppress the development of autoimmune diabetes
o the lack of human insulin in infant formulas may break the tolerance to insulin and lead to the development of type 1 diabetes (Vaarala et al, 1998)
o the avoidance of cow's milk protein for the first several months of life may reduce the later development of IDDM or delay its onset in susceptible individuals (AAP, 1994)
o infants who are exclusively breastfed for at least 4 months have a lower risk of seroconversion leading to beta-cell autoimmunity
+ short-term breastfeeding and the early introduction of cow's milk based infant formula predispose young children who are genetically susceptible to Type 1 diabetes to progressive signs of beta-cell autoimmunity (Kimpimaki et al, 2001)
o sensitization and development of immune memory to cow's milk protein is the initial step in the etiology of IDDM (Kostraba, et al, 1993)
+ sensitization can occur with very early exposure to cow's milk before gut cellular tight junction closure
+ sensitization can occur with exposure to cow's milk during an infection-caused gastrointestinal alteration when the mucosal barrier is compromised allowing antigens to cross and initiate immune reactions
+ sensitization can occur if the presence of cow's milk protein in the gut damages the mucosal barrier, inflames the gut, destroys binding components of cellular junctions, or other early insult with cow's milk protein leads to sensitization (Savilahti, et al, 1993)

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A mothers experience

It was really a great day for me,i saw a mother who came to tone her abdomen muscles,when i was getting her history it was so surprising for me that she delivered a 4.1kg baby in a normal delivery in a private hospital.
Its really a hands off to the obstetrician ,i've requested the mother to share her experience with other mothers,hope so she does it soon.
Hope it'll be inspiring for other mothers who has a thought of heavy weight babies has to go for C-section only
Waiting for the post just like you

Pulmonary Embolism during pregnancy

Hello ,i felt this is very important for everyone to know,kindly read it without fail
This condition has an increased potential with prolonged immobility causing alterations in normal blood flow (stasis)

for example:

· long flights or bus journeys, this is why it is so important to get up and walk around every few hours whether you are pregnant or not!

· over use or prescribing of bed rest in pregnancy

Another reason to remember, stay active in your pregnancy, this advise is not just given to keep you from gaining too much weight, there are real medical benefits to exercising! To get the blood flowing go walking, swimming, join a prenatal yoga class!



Another factor is Increased blood clotting potential this can be caused by:

birth control pills containing estrogen,

smoking,

genetic predisposition,

cancer,

pregnancy (including 6-8weeks postpartum),

surgery, (A national review of severe obstetric complications from 1998-2005 found a significant increase in the rate of pulmonary embolism associated with the increasing rate of cesarean delivery)-emedicine.medscape. com

·



The incidence of PE is extremely rare, however when it does occur, it usually it happens as Priyanka described, without much warning other then sharp pain in the leg and it is usually fatal.



Incidences reported from the emedicine.medscape. com are also follows:

· Fatal events may occur rarely, 1-2 cases per 100,000 pregnancies.

· Estrogen-containing birth control pills have increased the occurrence of venous thromboembolism (PE) in healthy women to the absolute risk of 20-30 cases per 100, 000 persons per year.

Meaning if you are on birth control pills you have a higher possible incidence rate then if you are pregnant, especially if you are on estrogens birth control pills and smoking. This is why it is so important when considering birth control options that you have a doctor who thoroughly takes your medical, family history before prescribing.


And for a little perspective, the National Weather Service, states the odds of being struck by lightning -- in your lifetime -- are 1 in 5,000.


When such tragic events occur, it is an opportunity for the rest of us to remember how important it is to give thanks and feel gratitude everyday for our health and the health of those we love.


Let us not, sit around feeling frightened of this or that or what could happen to us, fear is the opposite of courage and this life takes a lot of courage! Go for a walk instead and be careful when crossing the street


Sending buckets full of courage out to all you pregnant mammas!


From
Red Miller

All India Conference call meeting

Subject: Conference Call Meeting on May 29
Event: LLL Pan-India Conference Call Meeting
Type: Meetings - Informational Meeting
Date: Saturday, May 29, 2010
Time: 3:00pm - 4:00pm
Location:At you home

Description: All moms across India are welcome to attend the conference call meeting right from your living room with your baby.

Please RSVP if you wish to attend this conference meeting as the number of members who can attended is limited.

RSVP here http://www.facebook.com/group.php?gid=122495022326

For any questions regarding this event please feel to contact me on my email id lllpanindia@gmail.com or call +919819890069

Conference call details will be sent out once I have the confirmation.

The call will be a local call in the city you reside. The facility covers the following cities while other cities may need to call the nearest main city listed here:

• Mumbai
• Bangalore
• Delhi
• Chennai
• Hyderabad
• Kolkata

La Leche League International is the foremost authority in the world for breastfeeding information and the meetings are a great place to interact and learn from other mothers.

Breastfeeding Today

Breastfeeding Today

Thank You

With great support and blessings from all i am here to introduce to my website HAPPY MOM.www.happymom.in
I need to thank all my Gynaecologists,Obstericians and Paediatricians for supporting my work all through out the time.
My sentence does'nt complete without my parents and god,its all because of them i am here,i am really honored to be their child as for now they've been supportive and encouraging to all my thoughts and decisions.
Thank you to all