Mother contraction of Varicella zoster virus (chicken pox) during the first two trimesters of pregnancy.
Symptoms (in X % of cases):
skin lesions in dermatomal distribution (76%)
neurologic defects (60%)
eye diseases (51%)
skeletal anomalies (49%)
- 30% of infants born with these lesions died in the first months of life.
- Zoster immunoglobulins
Indications for breastmilk expression and collection:
- To collect milk for an infant unable to suckle eg. premature infant
- Relief of engorgement
- To collect for duration when mother is unable to breastfeed eg. contraindicated post-medical procedure or when returning to work
- To stimulate and increase milk production volume
- To empty breasts if infant is unable to suckle properly
- Efficiently drains the breast
- Intermittent vacuum suction cycle (prevents tissue trauma)
- Ease of use
- Easy to clean
- Comfortable to use
- Available spare parts
- Milk out at room temperature: use within 4 hours
- Refrigerator: store and use within 48hrs
- Self-defrosting freezer: use within 2-3 months
- Deep-freezer: Use within 6 mo
- Date all containers.
- Under running water
- In fridge, to be used with 24 hrs
Caution for breastmilk defrosting:
- Do not refreeze previously frozen milk
- Do not defrost in microwave as this destroys nutrient and immunologic components
There are several factors to gauge the infant is receiving adequate breastmilk intake to meet its metabolic and growth demands.
- Number of bowel movements
- Number of wet diapers daily: 6-8
- weight gain
- mood: contentedness between feeding periods
- frequent feedings are normal: 8-12 feedings/24hrs
Breast milk Functions:
- Affects biochemistry
- provides passive immunity
- destroys pathogens
- Thymus plays a role in immune system development
- The thymus is the location of T-cell differentiation and maturation
- At 4 months of age the thymus of exclusively breastfed infants is double the size of exclusively formula fed infants.
- Size, symmetry and shape have little bearing on breastfeeding ability
- hypoplasic breast tissue combined with large distance between breast is correlated with insufficient lactation
- Skin of the breast should be inspected for any abormalities
- Skin turgor and elasticity can be assessed by gently pinching the skin
- assess for lateral inscision scars made during breast augmantation or reduction surgery
- an incision in the vicinity of the cutaneous branch of the fourth intercostal nerve (5 oclock position on the left breast and 7 ocolock position of the right breast) may nerve dysfunction of this nerve path innervating the areola and nipple and hinder lactation
- Assess for areas of skin thickening or dimpling of breast or nipple, this could be signs of neoplasia
- Assess hormonal changes and breast tissue response to these changes with questions such as `Have your breasts grown during pregnancy` and `Have you experienced any tenderness or soreness`
- Nipple inversion should be assessed for and functional infant nursing assessment should be performed
- wash hands prior to assessment
- assess nipple by compressing or palpating the areola between forefinger and thumb just behind the base of the nipple
- Nipple retraction inwardly when stimulated may be indicative of underlying connective tissue lesions
- Promote and support successful breastfeeding
- Establish protocols for the assessment of hyperbilirubinemia
- Measure total serum bilirubinemia or trancutaneous bilirubinemia of jaundiced infants within 24hrs
- Visual estimation of jaundice degree can lead to inaccurate assessment
- Interpret labs results of hyperbilirubinemia with respect to infant’s age in hours old
- Infants <38 weeks gestation, particularly those with inadequate milk intake in poor breastfeeding, those with congenital defects and infections such as hepatitis are at higher risk, requiring heightened monitoring.
- Perform a systematic assessment on all infants before discharge for severe hyperbilirubinemia risk.
- Educate parents to assess for newborn jaundice
- Provide follow-up and home visits for those at higher risk
- Treat newborns with severe hyperbilirubinemia with phototherapy and or exchange blood transfusion.