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LACTATION

LACTATION. Topics to be covered. What is lactation Anatomy of the breast Development of the breast Histology of the lactating mammary gland Hormonal control of Breast growth and lactation Composition of milk. What is lactation?.

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LACTATION

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  1. LACTATION

  2. Topics to be covered • What is lactation • Anatomy of the breast • Development of the breast • Histology of the lactating mammary gland • Hormonal control of Breast growth and lactation • Composition of milk

  3. What is lactation? • Feeding human breast-milk to provide for the nutritional needs of infants • An alternative to human breast milk is by using formula feeding which is food products designed to provide for the nutritional needs of infants. They include powders, concentrates or ready-to-use forms

  4. Milk Formula • Should contain the right balance of nutrients according to the age of the infant or child and formulated as close as possible to breast milk i.e., • nutrient contents automatically changes with babies’ needs • DHA (Docosahexaenoic Acid), Protein, Sialic acid, choline, taurine, other omega 3 and 6, inulin dietary fibr, calcium, iron, essential vitamins and vital minerals in quantities appropriate for infants and children developmental needs. • Some also contains L Bifidus, a type of friendly and beneficial bacteria found in the intestinal tract which enables the child to obtain all the goodness from food for growth & development. • Available in either regular, honey, mild chocolate or fine cereals • Some powders which are soya based are formulated for lactose intolerance babies. Soya based milk is quite expensive.

  5. Examples of milk formula/powder in Malaysia

  6. Breast milk is the best!!!! Milk glands Proper latching on Areola

  7. Anatomy of breast External structure • Breast situated on the anterior chest wall between 2nd and 6th ribs, extended to the sternum and axilla • In the centre-erectile structure-nipple • Has 15-29 opening of lactiferous duct. • The areola is area of loose skin with 18-20 sebaceous gland.

  8. Anatomy Internal structure • Mature breast consist of glandular tissue, ductal tissue, fibrous tissue and fatty tissue A. Glandular tissue • Produce milk • Acinar secretory cell are arranged to alveolus • Alveolus will form lobules • Lobules will form lobes • There are 15-20 lobes, each consist of 20-40 lobules which include 10-100 alveoli

  9. B. Ductal tissue • Transport milk • Group of alveoli empty their milk into distal lactiferous duct • Many lactiferous duct units to form major duct. • Each major duct widen to form an ampulla (lactiferous sinus) as it reach the areola • Each ampulla narrow to formseparateopening on the nipple

  10. C. Fibrous tissue • Support the breast • Chest wall superficial fascia condenses to form multiple fascial bands ( Cooper ligaments) D. Fatty tissue • comprises of 85% of breast • Responsible for bulk and shape

  11. Picture 1: Breast structure

  12. Formation of mammary glands • During birth, mammary glands consists of sparse alveoli and abundant lactiferous ducts • After puberty, under the influence of estrogen, these ducts will produce branches which ends in polyhedral granular cells that are dense, small and circular (true alveoli) • E and P4 will stimulate the growth of ductal-lobular-alveolar system and breast enlargement with fat deposition and growth of connective tissue

  13. Breast changes during pregnancy • Breast hypertrophy occur with pregnancy • Size increase 400g each • Blood flow double • Areola enlarged and pigmented • Montogomery glands becomes prominent. • Increase fat deposition and retention of fluid and electrolyte

  14. Hormonal control of breast and lactation • Breast growth during pregnancy is associated with increase levels of oestrogen, progesterone, hPL and prolactin from maternal pituitary • Oestrogen promote duct growth • However alveolar development require full complex of hormones • Oestrogen and progesterone inhibit lactogenic effects of hPL and prolactin • After delivery, rapidly decreasing level of steroidsmilk secretion occur

  15. Histology of lactating breast • Alveolar epithelium consists of short columnar cells with microvillous surface • There is a prominent endoplasmic reticulum and golgi apparatus at the base of cells • Both fat droplet and vesicle(lactose&protein) from GA fuse with the cell membrane and discharged into lumen. • Milk are stored alveoli, duct and cistern • When lactation ceases extensive degeneration of lactogenic cells, a phagocytic reaction and fatty tissue infiltration

  16. Milk ejection reflex • Suckling stimulates release of prolactin and oxytocin via neurological pathways between nipple and the hypothalamus. • Milk ejection is brought about by the contraction of myometrial cells around the alveoli and ducts under influence of pituitary oxytocin.

  17. This sharp increase in prolactin secretion, diminishes progressively over 3 months of BF • No direct relationship between prolactin level and milk yield • The most important factors are removal of the milkpromotes further milk production • In the absence of suckling, maternal level of prolactin reduced slowly to reach non pregnant value after 2-3 weeks

  18. Milk ejection reflex • MER – a neuroendocrine reflex and a conditioned reflex • Apart from touch and pressure on the nipple, stimulation from a baby’s cry for milk, thoughts of your baby and lactation times can cause milk let-down • This conditioned reflex is more for release of oxytocin and not prolactin • Stimulation to vagina and cervix can also cause milk let-down

  19. MER can be inhibited due to pain after labour, anxiety and worries whether you are feeding the baby enough • All these will cause inhibition of oxytocin release

  20. Fertility during lactation • Some women assumes their menstrual cycle right after puerperium • Some women may have no menses for almost a year or as long as baby is breast-feeding (Prolactin inhibits the hormones for control of regular menstruation) • May be use as a natural contraceptive

  21. Advantages of breast milk • Free • Comes at the right temperature • Release on demand • Changes to suit baby’s needs • Comes in an attractive package

  22. Stage of lactation(Summary)

  23. Colostrum • Is a yellow fluid containing fat laden cells and large quantity of protein and minerals. • Secreted first 24 – 48 hours of life • Highest absorption occurs in first 24 hours of life • Contains relatively higher levels of IgG, IgM, and IgA including antibodies to bacteria esp E.coli • After 1st week, predominant IG is secretory IgA

  24. Composition of human milk (produced 2 to 3 days post delivery)

  25. When lactation stops, the involution of the mammary glands occur after three months • Distension and mechanical atrophy occurs to the epithelial structure, rupture to the alveoli wall and formation of cavities in the mammary tissue • Alveolar distension will cause alveolar hypoxia • After phagocytosis of dead cells, the lobular-acinar structure becomes smaller and the ductular system predominates • The alveolar lumen decreases and dissapears and the surface changes to a double non-secretory layer • Milk production can also be terminated by a lactation depressant using bromocriptine, an agonist receptor Dopamine D2 that inhibits prolactin release

  26. Other Breast milk benefit

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