Management of common breast-feeding problems

The benefits of breast-feeding have been well documented in the literature: it reduces morbidity from many illnesses and is considered the ideal nutrition for the newborn infant. This paper reviews common breast-feeding problems that family physicians may be called upon to manage: maternal problems, infant problems, and problems related to the need for maternal medication. Ensuring proper position of the infant at the breast and attention to the let-down reflex is the recommended method for prevention and treatment of nipple soreness. Prompt identification and treatment of blocked ducts, mastitis, and monilial infection of the nipple can prevent complications and allow uninterrupted nursing. Poor weight gain in the infant is managed by more frequent nursing. Neonatal jaundice or infant gastroenteritis rarely requires discontinuation of breast-feeding. Although physicians frequently recommend that women discontinue breast-feeding because of the administration of some maternal medications, maternal illness can often be managed with medications that do not interfere with nursing. Given proper advice and support, many mothers continue to breast-feed even after returning to work.

Lactation failure

Seventy five mothers with lactation failure were studied, whose less than 4-month-old babies were admitted to the hospital. Partial lactational failure (94.7%) was noted more often than complete lactational failure (5.3%). Initiation of breastfeeding was delayed for 2 to 5 days usually for traditional reasons (77.3%) and because the mothers felt that the milk output was inadequate (92%). The various causes of lactation failure were determined and the relationship to various factors was analyzed. The commonest cause of lactation failure was insufficient milk or no milk (80%). The age, parity, education, socio-economic status, religion, family structure and urban vs rural status of mother--all had a bearing on the occurrence of lactation failure. An attempt was made to relactate all these mothers. The outcome was successful in 69.3 cases and failed in only 4% cases. In 26.7% cases, we cannot predict the outcome as the mothers hospital stay was very brief with no follow up.

Pathogenesis, prevention, and treatment of lactational insufficiency in sows

Lactational insufficiency is one of the major problems in swine production, and the consequences on the growth of the litter must be emphasized. Pathophysiology involves neuroendocrinologic interactions and the role of target organs such as the mammary glands, uterus, bladder, and gut. The complexity of these interactions and the fact that all interactions are not well understood leads to a broad approach. Some risk factors and their associations with lactational insufficiency are described to help the practitioner in the clinical approach to such a problem.

[Local oxygen therapy combined with ultraviolet irradiation of the suppurative wounds in lactation mastitis]

A method of local oxygenation of wounds of the mammary glands in combination with UV irradiation with the help of the device proposed by the authors was used in the complex treatment of 72 patients with purulent lactation mastitis. The curative effect resulted from a considerable elevation of oxygen saturation of the mammary gland tissues which reduced tissue hypoxia, better microcirculation which results in the accelerated process of regeneration of the wounds. UV irradiation exerts bactericidal effect on microflora of the wounds.

Massive prolactinoma with galactorrhoea in a prepubertal boy

An 8 year old prepubertal boy presented with raised intracranial pressure, left proptosis and was noted to have galactorrhoea. Cranial computerized tomography revealed a large pituitary tumour infiltrating the cavernous sinus and left orbit. The serum prolactin was 180,600 mU/l (normal value less than 360 mU/l). Prolactinomas are rare in children and galactorrhoea has not previously been reported in a prepubertal child. The management of massive prolactinomas is difficult, but the child presented has made an impressive response to a combination of treatment with surgery, dopamine agonist therapy and radiotherapy.

[Hypogalactia: therapeutic possibilities]

Having briefly summarized the physiology of lactogenesis and gactopoiesis, the authors stress the fundamental role played by prolactin. In this context, they suggest medical treatment intended to improve mammary function in cases of deficient lactation. Two different types of treatment were tried: direct administration of prolactin or administration of antidopaminergic drugs capable of increasing endogenous prolactin production. In addition to confirming once more the usefulness of early physiological stimulation by suckling, experience in a group of puerperae showed that treatment apt to increase prolactin serum levels was the best therapeutic choice.

Management of hypernatremic dehydration due to insufficient lactation

Critical malnutrition and hypernatremic dehydration resulting from inadequate breast-feeding have previously been reported; the finding of elevated sodium concentration in expressed samples of mother's milk from these infants is found concurrently. This is the first case report describing successful relactation following management of hypernatremic dehydration in a breast-fed infant. Mother's milk was of inadequate volume and had a high sodium content. Treatment of the primary cause of this disorder, insufficient lactation, was effective in allowing successful relactation; a nursing supplementer is described.

Effects of cyproterone acetate, LHRH agonist and ovarian surgery in McCune-Albright syndrome with precocious puberty and galactorrhea

We have studied the endocrinological pattern in a girl with McCune-Albright syndrome. The young patient showed: normal prepubertal serum levels of gonadotropins, fluctuating estrogen concentrations, which sometimes were similar to the levels in adult women of fertile age, hyperprolactinemia with galactorrhea, ovarian cysts. The effects of treatment with antiandrogen drug, cyproterone acetate, and of a LHRH agonist, buserelin (less than D-Ser[TBU(8)6-des-gly NH2.10 greater than LHRH ethylamide), were studied. Cyproterone acetate with or without buserelin did not fully suppress estradiol concentrations. On the other hand, surgical resection of these cysts resulted in both clinical and endocrinological remission. It is likely that in this case of McCune-Albright syndrome precocious puberty was a result of ovarian estrogen secretion, while pubertal activation of the hypothalamus-pituitary axis was absent. Hyperprolactinemia, which appeared after the beginning of the combined therapy with buserelin and cyproterone acetate, was probably due to the elevated estrogen levels.

[Importance of the indices of immunity for predicting the course and assessing the effectiveness of the treatment in acute suppurative lactation mastitis]

The examination of 47 patients with acute purulent lactation mastitis and 14 patients with the resulting sepsis has shown a decreased level of nonspecific resistance factors. Generalization of the purulent process is characterized by disturbed humoral and cellular links of immunity. The dynamic research of immunity factors can give an estimation of the effectiveness of the chosen treatment and prognosis of possible complications. The general bactericidal activity of blood may be considered one of the most informative indices showing the direction of the process.

Contemporary breast-feeding management

This article updates clinicians in the successful initiation and practical management of nursing couples. Routine breast-feeding anticipatory guidance is provided, and specific problem-solving techniques offered for commonly encountered lactation problems. The physiologic basis of normal lactation is emphasized and related to specific problems. Issues addressed include the management of lactation in the presence of maternal employment, infant failure-to-thrive, maternal drug therapy, and infant prematurity.

Resolution of acromegaly, amenorrhea-galactorrhea syndrome, and hypergastrinemia after resection of jejunal carcinoid

A young woman presented with acromegaly and amenorrhea-galactorrhea with hypersomatotropinemia and hyperprolactinemia. In addition, she had hypergastrinemia with abnormal secretory dynamics and evidence of a large pituitary tumor with suprasellar extension and erosion of the floor of the sella turcica. Evaluation of secretory diarrhea revealed a large abdominal tumor, which on removal was found to be a carcinoid of the jejunum. Postoperatively, the acromegaly, amenorrhea-galactorrhea, and hypergastrinemia resolved, and the pituitary returned to normal size, with regrowth of the sella floor. The carcinoid tumor was shown by immunoperoxidase staining to contain GH-releasing hormone.