NEONATE AND PARENTS 15

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jeannette_ruiz
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18841
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NEONATE AND PARENTS 15
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2010-05-12 14:54:18
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NEONATE PARENTS
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NEONATE AND PARENTS 15
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  1. NEWBORN BONDING
    • • Bond:
    • – Unique relationship between two people that
    • endures time
    • • Bonding:
    • – tie between parent & infant
    • • Attachment:
    • – tie between infant to parent
    • – feelings that bind one person to another in
    • either direction
  2. Newborn-parental attachment & bonding
    • Study by Spitz shows that
    • absence of loving care-taking/affection
    • ↓↓ infant growth
    • ↑ infant death
  3. NEWBORN BONDING
    • Early 1970s: Family-centered care in
    • early 1970s in delivery room and in
    • NICU (Neonatal Intensive Care Unit)
    • 1980s: rooming in of infant with mom
  4. BENEFITS OF VAGINAL DELIVERY FOR INFANT
    • Vaginal delivery stimulates infant to
    • prepare her/him to adjust to aerobic
    • environment
    • Squeezes fluid out of infants lungs
  5. Benefits of vaginal Birth for Infants
  6. Fetus produces high levels of norepinephrine
    • & epinephrine
    • → stimulates the cardiovascular system
    • → facilitates immediate adjustment to the
    • aerobic environment
    • Fetus produces high levels of beta-endorphins
    • → facilitates attachment of infant parents
  7. Cesarian-section Results in:
    • More fluid in babies’ lungs
    • Lower levels of norepinephrine,
    • epinephrine, and beta-endorphins in
    • baby’s blood
  8. Physiology of mom & infant at birth & post-partum
    • Beta-endorphins
    • Both mom & infant have peak levels of betaendorphins
    • Beta-endorphins facilitate bonding and
    • attachment between infant & parents
  9. PHYSIOLOGY OF MOM AND INFANT AT BIRTH AND POST-PARTUM
    • Epidural anesthesia
    • → ↓ endogenous beta-endorphin levels in mother
    • → ↓ ability of mother to bond to infant
    • → ↓ endogenous beta-endorphin levels in mother
    • → ↑ incidence of post-partum depression
    • Epidural anesthesia
    • → ↑ incidence of depression in mothers at six months
  10. Physiology of mom & infant at birth
    • Oxytocin facilitates bonding and attachment
    • between infant & parents
    • Mothers’ levels of oxytocin are 10 mcg/dl
    • minutes after birth
  11. Physiology of mom and infant at birth
    • Oxytocin:
    • when infant touches & massages mom’s nipple with
    • her/his hand → ↑ mothers oxytocin
    • When infant suckles nipple:
    • → ↑↑ mothers oxytocin level
    • → facilitates bonding/attachment between infant and
    • mother
    • also → ↑ milk ejection from nipple
    • also → ↓ post-partum bleeding in the mother
  12. Oxytocin labor during labor
    • If mother’s nipple is massaged
    • → ↑ endogenous production of oxytocin
    • → ↑ progression of labor
  13. First Hour after Birth
    Quiet Alert State:
    • Forty minutes out of first hour of life, babies are in a
    • quiet alert state
    • During this time, babies rarely move and their eyes are
    • wide open and (if given the opportunity) they look
    • directly at the mother or father and their tiny hands
    • may touch the parents skin.
    • In this state, motor activity is minimal and baby’s
    • energy is focused on seeing, hearing, responding, and
    • deepening its level of bonding and attachment to its
    • parents.
    • During first week of life about 10 % of each 24 hour day,
    • the baby is in receptive quiet alert state.
  14. Location of baby immediately after delivery
    • Standard hospital practices have been to separate
    • baby from mother very soon after delivery to
    • examine, weigh, bath, give Vitamin K injection,
    • apply eye ointment, and draw blood glucose from
    • the baby. The baby and the mom would often not
    • be reunited until hours after the delivery.
    • Unfortunately, this prevents the baby from being
    • with the mother during this important period
    • shortly after birth.
  15. Location of baby immediately after delivery
    • Immediately after delivery baby should be dried off with
    • a soft warm towel and immediately placed on the
    • mothers abdomen & chest for skin to skin contact.
    • When the baby is dried it is best to not use soap and
    • water, as studies have shown that the smell of amniotic
    • fluid sooths the newborn.
    • The mothers soft warm skin and her caressing hands are
    • soothing & comforting for baby.
    • The mothers body provides heat for the baby as well and
    • warms up the baby faster than an incubator.
  16. Location of baby immediately after delivery
    • If given the opportunity, the baby will
    • typically spontaneously touch, smell, lick,
    • and latch onto breast by her/his own
    • efforts & start breast feeding in early
    • minutes of life
    • Early breastfeeding behavior can be
    • disturbed by labor analgesia and/ c-section
  17. Location of baby immediately after delivery
    • Women who are able to nipple newborn
    • in the first hour of life have
    • • have easier time breast feeding
    • • breast feed more frequently
    • • breast feed more months of babies life
  18. SIDS
  19. Infant room sharing with parents at home in
    • early months of life
    • → ↓ risk of sudden death infant syndrome
    • (SIDS)
  20. Animal studies on maternal attention versus deprivation
    • Neglected animals (absence of mother)
    • → neurons died at twice the rate as animals kept with
    • mother
    • Presence of mother also reduces the levels of stress
    • hormones
    • Simple act of mother animals licking infants triggers a
    • dramatic reduction in the levels of stress hormones

    • As mother physically comforts her
    • newborn
    • → ↑ production of biochemicals that
    • → ↓ production of CRH (corticotropinreleasing
    • hormone)
  21. Animal studies on maternal
    attention versus deprivation
    • As mother physically comforts her newborn
    • → ↑ production of biochemicals that
    • → ↓ production of CRH (corticotropinreleasing hormone)
  22. Male fetuses are more vulnerable to
    stress than females
    • • Generally, more maternal stress leads
    • to a lower ratio of male to female births
    • • When pregnant mother is stressed, she
    • is more likely to have a spontaneous
    • abortion or a miscarriage if the fetus is
    • male versus female
  23. Male infants are more vulnerable to stress than females
    • • International studies on malnutrition and
    • infant survival have shown that male
    • infants have a lower survival rate than
    • female infants
  24. Human breast milk
    • • Fresh & readily available at optimal
    • temperature
    • • Has not been pasteurized and thus the
    • peptides and immunoglobulins have not been
    • broken down
    • • No time needed for preparation
    • • Free of contaminating bacteria that cause
    • diarrhea (especially important in developing
    • countries where un-boiled water may be used
    • to prepare cows formula)
  25. Breast feeding & ovulation
    • • Nippling stimulates prolactin which suppresses
    • ovulation
    • • Lactating mothers who breast feed their infants
    • at least 10 times a day have are likely to
    • suppress ovulation
    • • Lactating mothers who breast feed their infants
    • less than 6 times a day are unlikely to suppress
    • ovulation
  26. Human breast milk components
    • • Protein
    • • carbohydrates
    • • fats
    • • vitamins
    • • minerals
    • • hormones
    • • growth factors
    • • neuropeptides
    • • immunoglubulins/antibodies
  27. Nutrition Hormones:
    • substances formed in one organ or part of the
    • body and carried in the blood to another
    • organ or part of the body
    • Growth factors:
    • substances that increase endothelial cell,
    • collagen, and smooth muscle development
    • Neuropeptides:
    • peptides found in brain tissue e.g., endorphins,
    • enkephalins
  28. Human breast milk components Hormones:
    • Placenta provides a rich source of hormones &
    • growth factors that regulates the growth &
    • differentiation of the embryo & fetus
    • The breast is the post-birth counterpart of the
    • placenta that picks up where the placenta
    • leaves off and provides continuity in the supply
    • of the human growth factors and hormones that
    • are essential for optimal growth & development
    • Beneficial hormones from the mothers blood are
    • concentrated in breast milk
    • Human breast tissue also produces
    • neuropeptides & hormones
  29. Human breast milk components
    • Colostrum:yellowish fluid that breast secretes for 2 – 4 days after delivery that is rich in
    • – hormones/growth factors
    • – protein
    • –minerals (e.g., calcium)
    • – immunoglobulins
    • by day 2 – 4, a transitional form of breast milk is produced that gradually develops into “mature” breast milk by week 3 - 4
  30. Human breast milk components
    • Melatonin: helps body establish circadian rhythms
    • Thyroid hormones: may help alleviate congenital hypothyroidism
    • Oxytocin: helps facilitate loving bond between mother & infant
    • Endorphins: neuropeptides that help facilitate loving bond between mother & infant
  31. Human breast milk components
    • Mamotrope differentiating hormone
    • – appears to foster maturation of cells of pituitary gland which supplies hormones to the body
    • Insulin-like growth factors; Growth factors/neuropeptides
    • – both enhance development of brain, liver, intestines, pancreas & other organs
    • Surface area of intestine is increased in both
    • – breast feeding infants &
    • – lactating mothers
  32. Human breast milk components
    • Leptin
    • • Hormone thought to control obesity in humans
    • • Present in human breast milk
    • • May help set the stage for weight regulation in childhood and later in life
    • • Cow’s formula fed babies have higher rates of obesity as children & adults
  33. Human breast milk components
    • Gonadotropin Releasing Hormone (GnRH)
    • – exists in human milk far above the levels in mothers’ blood
    • – nursing mothers’ breast tissue generates this hormone
    • – GnRH influences the development of newborns’ sex organs
    • – GnRH may influence brain regions that effect sexual behavior

    • Fatty acids in breast milk
    • Omega 3 fatty acids
    • –DHA (docosahexaenic acid)
    • –AA (arachidonic acid)
    • Rich source in breast milk
  34. Omega 3 fatty acids
    • Adults store omega 3 fatty acids and nursing mothers transfer these from stores into breast milk
    • Good dietary sources are walnuts, nuts, grains, flax seed oil, hemp oil, vegetables, salmon, mackerel, sardines, tuna, trout
    • Unfortunately, omega 3 fatty acids are low in the typical USA diet
    • Omega 3 fatty acids levels in breast milk in women in the USA are among the lowest in the world
  35. Omega 3 fatty acids & infant brain development
    • Brain development occurs rapidly in early months
    • Full term infants who are fed on cow’s formula do not have enough omega 3 fatty acids to foster optimal brain & visual development
    • Omega 3 fatty acids enhance neurological and visual development in infants (especially premature infants)
  36. Cow’ milk vs. human breast milk
    • Compared to breast fed babies, babies fed with Cow’s milk formula are at increased risk for:
    • • Allergies
    • • Atopic dermatitis/Eczema
    • • Increased risk for intestinal disturbances & feeding difficulties
    • – diarrhea
    • – intestinal bleeding
    • – colic
    • – spitting up milk
  37. Breast milk benefits
    • Breast milk consumption in infants reduces the risk of following diseases:
    • – sudden infant death syndrome
    • – allergic diseases e.g., eczema (atopic dermatitis)
    • – insulin-dependent diabetes mellitus
    • – inflammatory bowel disease (Crohn’s disease & ulcerative colitis)
    • – chronic digestive diseases
    • – lymphoma

    • Increased proportion of breast fed infants:
    • Breast feeding
    • → ↓ ↓ infant illness at the community level
  38. • Breast milk consumption in infants reduces the risk of following diseases:
    • – diarrhea
    • – lower respiratory infection e.g., pneumonia
    • – otitis media
    • – bacteremia (bacterial infection of blood)
    • – bacterial meningitis
    • – botulism
    • – urinary tract infection
    • – necrotizing enterocolitis
  39. • Substances in human breast milk inhibit growth of viruses:
    • – rotavirus
    • – polio
    • – influenza
    • –mumps
    • – influenza
    • – vaccinia
    • – Japanese B encephalitis
  40. Benefits of breast milk
    • • Glycoprotein lactoadherin in human breast milk:
    • →binds to rotavirus and inhibits its replication
    • →↓ rotavirus infection in humans (rotavirus is the most common cause of diarrhea in infants)

    • • Stool pH lower in breast milk fed babies
    • →inhibits bacterial growth
    • • Intestinal flora in breast milk fed babies
    • →inhibits growth of some strains of Escherichia coli
    • • Xanthine oxidase in breast milk
    • → nitric oxide production
    • → inhibits growth of Escherichia coli & Salmonella enteritides
  41. Immunological benefits of breast milk:
    • • Secretory IgA is predominant immunoglobulin in breast milk
    • – prevents bacterial adherence to epithelial cell surfaces
    • – specific IgA antibodies against
    • Escherichia coli
    • – breast fed babies are less prone to bacterial & viral intestinal infections

    • • Interleukin-6 present in colostrum
    • → stimulates increase in mononuclear macrophage cells in breast milk
    • • Macrophages in colostrum & mature breast milk synthesize
    • – complement
    • – lysozyme
    • – lactoferrin (iron binding whey protein)
    • (lactoferrin inhibits growth of Escherichia coli in intestine)

    • • T lymphocytes & B lymphocytes
    • • Breast milk transfers T lymphocyte immunity → protection against tuberculosis
  42. Main causes of infant mortality in tropical countries
    • • Diarrhea & dehydration
    • • Lung infections (pneumonia, bronchiolitis)
    • • Malaria
  43. Infant survival rates in USA
    • - Largest single contributor to increased
    • infants survival rates in USA in the 1st half
    • of the 20th century was the implementation
    • of enhanced hygiene with microbiologically
    • clean water made available throughout the
    • population
    • • Enhanced maternal-child nutrition also
    • contributed
    • • Development of penicillin, other antibacterials,
    • and immunizations also
    • contributed, but to a much less degree than
    • simple clean water
  44. Emerging problems with maternal child health in USA
    • • Obesity in mothers increased risk of
    • pregnancy
    • • Obesity in children has increased
    • dramatically over the past 20 years
    • • Associated with obesity are higher rates
    • of Type 2 diabetes mellitus,
    • hypertension, and cardiovascular
    • disease
  45. Global infant/child health
    • • Good maternal nutrition
    • • Maintain normal maternal weight before,
    • during, and after delivery (underweight moms
    • and overweight moms increase risks for fetus
    • and infant)
    • • Breast feed at least 2 years
    • • Loving caretakers
    • • Access to clean water
    • • Access to clean air
    • • Diet rich in vegetables and fruits
    • • Diet rich in beta-carotene rich food
    • • Family access to land to grow kitchen garden

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