งานนำเสนอกำลังจะดาวน์โหลด โปรดรอ

งานนำเสนอกำลังจะดาวน์โหลด โปรดรอ

พญ. วรางค์ทิพย์ คูวุฒยากร หน่วยทารกแรกเกิด ภาควิชากุมารเวชศาสตร์ คณะแพทยศาสตร์ มหาวิทยาลัยเชียงใหม่

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งานนำเสนอเรื่อง: "พญ. วรางค์ทิพย์ คูวุฒยากร หน่วยทารกแรกเกิด ภาควิชากุมารเวชศาสตร์ คณะแพทยศาสตร์ มหาวิทยาลัยเชียงใหม่"— ใบสำเนางานนำเสนอ:

1 พญ. วรางค์ทิพย์ คูวุฒยากร หน่วยทารกแรกเกิด ภาควิชากุมารเวชศาสตร์ คณะแพทยศาสตร์ มหาวิทยาลัยเชียงใหม่

2 Questions Why breast milk is the best? How milk is produced ? What are human breast milk compositions? Does it different from cow’s milk? What are protective components in human breast milk?

3 Benefits of breastfeeding

4 Effect of breastfeeding on the mothers Decrease postpartum hemorrhage Decrease breast, ovarian and endometrial cancer Decrease osteoporosis More rapid return to pre-pregnancy weight

5 Decrease infection in children Diarrheaถ่ายเหลว Respiratory tract infectionติดเชื้อทางเดินหายใจ Otitis mediaหูชั้นกลางอักเสบ Bacteremia ติดเชื้อแบคทีเรียใน กระแสเลือด Bacterial meningitisเยื่อหุ้มสมองอักเสบจาก แบคทีเรีย Urinary tract infectionติดเชื้อทางเดินปัสสาวะ Late onset sepsis in ติดเชื้อในกระแสเลือด preterm infant ในทารกก่อนกำหนด Necrotizing Enterocolitisลำไส้เน่าเปื่อย from AAP.Breast feeding and the use of human milk:Pediatrics.2005;115(2):506 from American Academy of Pediatrics. Breast feeding and the use of human milk:Pediatrics.2005;115(2):506

6 Decrease non-infectious disease Asthma หอบหืด Overweight and obesity โรคอ้วน Insulin dependent DM (type I)เบาหวาน Non insulin dependent DM (type II)เบาหวาน Hypercholesterolemia ไขมันสูง Lymphomaมะเร็งต่อมน้ำเหลือง Leukemiaมะเร็งเม็ดเลือดขาว Hodgkin diseaseมะเร็งต่อมน้ำเหลือง Sudden Infant Death Syndrome (SIDs) from American Academy of Pediatrics. Breast feeding and the use of human milk:Pediatrics.2005;115(2):506

7 Neurodevelopment Anderson JW, Johnstone BM, Remley DT, 1999 Meta-analysis 20 studies Significantly higher levels of cognitive function were seen in breast-fed than in formula-fed children at 6–23 mo of ages Higher IQ 3.16 points in term (95%CI 2.15,3.17) Higher IQ 5.18 points in preterm (95%CI 3.59,6.77) American Journal of Clinical Nutrition, Vol. 70, No. 4, , October 1999

8 WHO and UNICEF 1. Infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health 2. Infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond. “ กินนมแม่เพียงอย่างเดียวจนถึงอายุ 6 เดือน หลังจากนั้น กินนมแม่ควบคู่กับอาหาร เสริม จนถึงอายุ 2 ปีหรือมากกว่า “

9 Contraindications to breastfeeding HIV positive mother HTLV type I and II positive Active tuberculosis disease Herpes simplex infection on a breast Drugs of abuse Expose to radioactive materials Receiving diagnostic or therapeutic radioactive isotropes Receiving antimetabolites or chemotherapeutic agents AAP.Breast feeding and the use of human milk:Pediatrics.2005;115(2):506 American Academy of Pediatrics.Breast feeding and the use of human milk. Pediatrics 2005;115(2):506

10 Exclusive breastfeeding is defined as no other food or drink, not even water, except breast milk (including milk expressed or from a wet nurse) for 6 months of life, but allows the infant to receive ORS, drops and syrups (vitamins, minerals and medicines). ให้ทารกกินนมแม่อย่างเดียวโดยไม่ให้อาหารอื่นๆแม้แต่น้ำ เป็นระยะเวลา 6 เดือน ยกเว้นน้ำเกลือแร่ ยา หรือ วิตามินเสริม

11 แหล่งที่มา : สำนักนโยบายและยุทธศาสตร์ กระทรวงสาธารณสุข อัตราการเลี้ยงลูกด้วยนมแม่ อย่างเดียว 6 เดือน ระหว่างประเทศ ร้อยละ

12 Thai Breastfeeding Center Foundation 2012 เปรียบเทียบกับทั่วโลก อัตราการเลี้ยงลูกด้วยนมแม่อย่างเดียว 6 เดือน ประเทศไทยจัดอยู่ในกลุ่มที่มีอัตราน้อยกว่าร้อย ละ 20 ( สีแดง )

13 แผนภูมิแสดงการกินนมแม่ของเด็กไทย ปี

14 Anatomy of the breast

15

16 The Lactation cycle Mature Pregnancy Involution Lactation Pubertal development Embryogenesis Mammary development GH, estrogen progesterone, prolactin, HPL Prolactin, oxytocin progesterone, prolactin, HPL progesterone

17 Mammary development

18 Lactogenesis I & II

19 Lactogenesis II- Prolactin

20 Anatomy of the breast

21 Lactogenesis II- Oxytocin

22 Cellular mechanisms for milk synthesis and secretion 1. Exocytosis Most of the components of the aqueous fraction eg. Protein- casein, CHO- lactose 2. Fat synthesis and secretion 3. Transport across apical membrane Ions and water 4. Transcytosis of interstitial molecules Immunoglobulin A 5. Paracellular pathway

23 The pathway of milk synthesis and secretion

24 Colostrums, transitional and mature milk Colostrums 1-4 day after parturition Transitional milk 4-10 days after parturition Mature milk After 10 days

25 Colostrums, transitional and mature breast milk

26

27 Colostrums ingredients

28

29 Composition of breastmilk

30 Carbohydrate in human milk Mainly carbohydrate is lactose Increasing amount correlate with milk volume Provides galactose A sugar involved in brain and nervous system development Low risk of causing dental caries

31 Fat in human milk g/L, 97-98% is triglyceride Major energy for a baby (45-55% of total calories) Synthesis and development of retinal and neural tissues Essential fatty acid (FAs) Linoleic acid (8-17%) α-Linolenic acid ( %) Arachinodic acid ( %) (LC-PUFA) Docosahexaenoic acid ( %) (LC-PUFA) Fat digestion is aids by gastric lipase and bile-salt dependent lipase in human milk

32 Factors influencing human fat content and composition Factor Duration of gestation Stage of lactation Parity volume feeding Maternal diet Maternal energy status Influence BM of the mother who deliver preterm infant has more LC- PUFAs PL and Cholesterol are highest in early lactation High parity is associated with reduced endogenous FA synthesis High volume is associated with low milk fat content Human milk fat content progressively increases during a single nursing A diet low in fat increase endogenous synthesis of MC-FA High weight gain in pregnancy is associated with increased milk fat

33 Foremilk vs Hindmilk

34 Protein in Human milk 15.8 g/L (colostrums)  9.0 g/L (mature milk) Whey : Casein = 60 :40 Total protein Protein nitrogen Non-protein nitrogen (20-25%) free amino acid, Carnitine, taurine, Aminosugars Nucleic acids, nucleotides Polyamines

35 Human milk protein functions Growth Protective factors Carries for vitamins and hormones Enzyme activities Biological activities

36 Vitamins in human milk Corresponding to maternal status Fat soluble vitamins Vitamin A ( mg/L) Decreases with advancing lactation Vitamin D ( ug/L) Maternal intake, sunlight, northern latitudes Supplement vitamin D 10 ug/L is recommended in a baby at risk

37 Fat-Soluble vitamins Vitamin K (1-9 ug/L) Tran placental transfer is minor Maternal dietary intake bears little relationship to milk vitamin K content Maternal supplementation of 5-20 mg/day increases in milk and infant plasma levels

38 Water-Soluble vitamins Vitamin C (100 mg/L) 8-10 fold higher than the maternal plasma concentration Vitamin B 6 Low levels in mothers with a long-term history of OCT uses

39 Water-Soluble vitamins Vitamin B 12 Vitamin B 12 deficiency was found in infants nursed by mothers who were strict vegetarians Folate Interfere by maternal diet and medication

40 Minerals and trace elements in human milk Not correlate with amounts in the maternal diet or maternal serum Calcium, phosphorus and magnesium Sodium, potassium and chloride Iron (0.3mg/L), copper and zinc Iron from HM is absorbed 5-fold more efficiently Lactoferrin

41 Immunomodulating agent Affect the development of newborns’ immune system cytokines Enhance inflammation TNF-α, IL-1, IL-6, IL-8, interferon-γ Suppress inflammation IL-10 Soluble receptors TNF-α1, TNF-α2

42 Anti-inflammatory components Antioxidants: vitamins A, C, E Enzymes : catalase, glutathione peroxidase E prostaglandins Enzymes inhibitors: Platelet Activating Factor (PAF) Protease inhibitor Anti-inflammatory cytokine: IL-10

43 Hormones and growth factors Higher in early mammary secretion (colostrum) Some hormones are synthesized in mammary cells, transfer from maternal circulation or modified by mammary cells Mammary synthesis : PRL, GnRH, thyroxine(T4), Triiodothyronine(T3), PTH-rP, estrogen Transfer from maternal circulation : TRH, progesterone Modified by mammary cell : increase resistance to digestion in infants’ GI tract : PRL Growth factors stimulate GI growth in the newborn

44 Enzymes in human milk Protective function Lysozyme Peroxidase Antiprotease, catalase, glutathione peroxidase, PAF-acetylhydrolase Digestive function Amylase Bile salt-stimulate lipase

45 Comparison of the macronutrient contents of human milk and bovine milk ComponentHuman milkBovine milk Carbohydrate (g/dL) Lactose Oligosaccharides Protein (g/dL) Caseins α-lactalbumin Lactoferrin Secretory IgA β-lactoglobulin Trace 0.5 Lipids (%) Triglycerides Phospholipids From Neville MC.Physiology of lactation.Clin Perinatol1999;26:257

46 Comparison of the macronutrient contents of human milk and bovine milk ComponentHuman milkBovine milk Minerals and others(nM) Sodium Potassium Chloride Calcium Magnesium Phosphate Bicarbonate From Neville MC.Physiology of lactation.Clin Perinatol1999;26:257

47

48 Protective nutrients in human milk NutrientsAmountFunction Protein sIgA IgM IgG Lactoferrin Lysozyme α-lactalbumin casein mg/dl 2 mg/dl 1 mg/dl mg/dl 5-25 mg/dl mg/dl Immune protection Anti-infective, iron carrier Anti-infective Iron carrier (Ca2+), part of lactose synthase Iron carrier, inhibit microbial adhesion to mucosal membrane

49 Protective nutrients in human milk NutrientsAmountFunction Carbohydrate Lactose Oligosaccharides Glycoconjugates g/L g/L - Energy source Microbial ligands Microbial and viral ligands Fat Triglyceride LC-PUFA FFA g/L - Energy source Essential for brain and retinal development and for infant growth Anti-infective

50 Immune protection SIgA – secretory immunoglobulin A is the main component Protects mucosal surfaces eg digestive and respiratory tract Composed of specific antibodies against bacteria that mother has encountered in the environment Includes specific antibodies against diarrhea: giardia, toxigenic E coli, Vibrios, Campylobacter

51 Enteromammary Immune system

52 Secretary IgA

53

54 Non immune protection Broad spectrum of anti-infective activity Lactoferrin Single-chain glycosylated protein 692-amino-acid 79 -kD

55 Protective function of Lactoferrin neutrophil macrophage Lactoferrin Airway Epithelium Respiratory Tract CD14-TLR4 complex LPS Anti-Inflammatory Bacterial Killing Pseudomonas Pseudomonas Biofilm Anti-Biofilm HIV, CMV Anti-Viral Candida Fungicidal  Rogan et al. Respiratory Research :29

56 Lysozyme 130-amino-acid- containing glycoprotein Hydrolyzes the 1-4 linkage between N- acetyl glucosamine and N-acetylmuramic acid Lyses mostly gram positive and few gram negative bacteria Increases with prolong lactation

57 K-casein Antiadhesive H. pylori, S. pneumoniae, H. influenzae Casein macropeptide Strong growth promoting factor for B. bifidum

58 α-lactalbumin Important whey protein in BM 3 polypeptide fragments were recently found to have antimicrobial activity These peptides are generated after exposure to protease in GI tract E.coli, K. pneumoniae, S. aureus, S. spidermidis C.albican

59 Glycoconjugates and oligosaccharides StructureDistribution in milk Function OligosaccharidesSkim milkProtect against heat stable E.coli enterotoxin, attachment of H.influenzae and S.pneumoniae to respiratory epithelium, v.cholerae hemagglutinin activity Glycoproteins Mucin Lactadherin MFGM/ skim milk MFGM MFGM/skim milk Prevent binding of V.cholerae Prevent binding of S.fimbriated E.coli Prevent binding of Rotavirus GangliosidesMFGMReceptor analogs for heat labile toxin of V.cholerae and E.coli Glycosaminoglyc an MFGMInhibits binding of HIV gp 120 to CD4 receptors

60 How oligosaccharides block attachment of bacteria to epithelial cells

61 Lipid Milk fat globules protect infants from infection by The membrane glycoconjugates acts as specific bacteria and viral ligands FFA have a detergent like lytic action on enveloped viruses (HIV, HSV type I), bacteria, fungi and protozoa

62 Comparison human & cow’s milk


ดาวน์โหลด ppt พญ. วรางค์ทิพย์ คูวุฒยากร หน่วยทารกแรกเกิด ภาควิชากุมารเวชศาสตร์ คณะแพทยศาสตร์ มหาวิทยาลัยเชียงใหม่

งานนำเสนอที่คล้ายกัน


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