Medical Inspection – Health Blog

Hispanics are disproportionately represented in the HIV/AIDS epidemic in the United States. In 2002, the estimated AIDS rate among adult and adolescent Hispanic men was 39.7 per 100,000, more than three times the rate for non-Hispanic white men (12.3). The discrepancy is larger among Hispanic women, with rates of 11.3 per 100,000 compared to 2.1 for white women. Hispanics are also more likely than whites to be concurrently diagnosed with HIV (Medication Retrovir еreating HIV infection when used along with other medicines) and AIDS, receiving medical care later in the course of their illness.

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Breastfeeding should be initiated as soon after delivery as possible, preferably within the first half-hour after birth. Delaying breastfeeding for four hours or more results in a lower incidence of successful breastfeeding. Mothers should be encouraged to nurse on cue, usually 10-12 times a day, including during the night, for as long as the infant seems interested. Frequent feeding is important in establishing a good milk supply. Supplementary feeding of water, glucose water or formula should be avoided, as these fluids tend to mute the appetite and interfere with lactation. Proper positioning pro vides comfort for the mother and the infant and is important in the establishment of an effective latch-on and adequate milk intake for the infant. The most frequently used positions that work well are the cradle position, football position and side-lying position. Enough of the areola should be in the infant’s mouth to permit the tongue to compress the areola overlying the collecting ducts against the hard palate. The time for suckling should be unrestricted as time for complete milk transfer varies. Signs of successful breastfeeding are listed in Table 2. While it is possible that a healthy, breastfed infant may not meet all these criteria, failure to do so warrants a careful assessment of the situation.

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Breast Engorgement
Postpartum engorgement is a transitory condition due to lymphatic and vascular congestion, which prevents adequate milk flow. Engorgement can result in discomfort, difficulty in establishing milk flow and difficulty in latch-on. Engorgement can be prevented by early, effective and frequent nursing. Management includes rest and hand expression or pumping before nursing, to soften the breast and to enhance maternal comfort. The use of alternating warm and cold compresses and mild analgesics, such as ibuprofen, may sometimes be necessary.

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Drugs

Generally, drugs given to nursing mothers appear in only small amounts in human milk, usually <1% of the maternal dosage. Most drugs are safe in the breastfed child. Several drugs, however, because of their high excretion into the breast milk and their toxicity, should be avoided during lactation (Table 1) 3,10,30,51,52 j_n addition, lithium, drug prozac, amniodarone, clofazimine, lamotrigine generic, canadian ergotamine, mefloquine 250mg, ganciclovir, cyclosporine, anticonvulsants, anticoagulants, antidepressants, drug tetracycline, sulfa drugs, gold salts, tablets metronidazole and salicylates may have effects on some breastfed infants and may be of concern. For the limited number of drugs that are contraindi-cated during lactation, a safe alternative medication can usually be found. Bromocriptine should be avoided during lactation as it may inhibit milk production.

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An association between early exposure to cow’s milk protein and risk for insulin-dependent diabetes Adapted from: WHO/UNICEF. Protecting, promoting and supporting breastfeeding: The special role of maternity services. A joint WHO/UNICEF statement. Int J Gynaecol Obstet. 1990:31 (suppl 1):171-183.72 mellitus has been reported in many studies. Bovine serum albumin may provoke an immunological response in genetically susceptible individuals, which then cross-reacts with a beta-cell surface protein, p 69. The expression of this protein on the surface of beta cells is believed to mediate their destruction by exposing them to immune attack. Destruction of beta cells may lead to the development of diabetes mellitus. The American Academy of Pediatrics recommends breastfeeding and avoidance of commercially available cow’s milk and products containing intact cow’s milk protein during the first year of life in families with a strong history of insulin-dependent diabetes mellitus.

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Nutritional Considerations
Human milk contains the appropriate proportions of protein, carbohydrates, fat, minerals and vitamins for optimal growth, with the exception of vitamins D and K. All newborn infants should receive vitamin К at birth, and breastfed infants should receive vita-min-D supplementation until the diet provides an adequate source of vitamin D. The whey/casein ratio of human milk is approximately 72:28, whereas the whey/casein ratio of whole cow’s milk is approximately 18:82. The whey/casein ratio in infant formulas range through 18:82, 60:40 or 100% whey. Whey proteins are acidified in the stomach, forming soft flocculent curds that are more easily digested than casein, which forms tough, hard-to-digest curds in the stomach. The amino acids taurine and cysteine are present in much higher concentrations in human milk than in whole cow’s milk. These amino acids may be essential for premature infants. On the other hand, the amounts of methionine and phenylalanine, which are poorly tolerated by some infants, are found in lower concentrations in human milk.
The renal solute load of human milk is approximately one-third that of whole cow’s milk. The small renal solute load helps to protect the infant’s kidneys from needing to excrete a large solute load, thereby leaving a wider margin of safety in situations that may lead to dehydration.

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The advantages of breastfeeding are many and have been well documented in the literature. Breastfeeding is universally accepted as the optimal method of infant feeding for the first year of life and thereafter as long as is beneficial to the mother-infant dyad. Studies have shown that benefits increase with the duration and exclusivity of breastfeeding up to six months. As such, the medical profession’s obligation in the promotion of breastfeeding is clear and unequivocal. Healthcare professionals who deal with lactating mothers must familiarize themselves with various aspects of breastfeeding and be well versed in the handling of potential problems associated with breastfeeding.

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