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| FAQs |
Here are some commonly asked questions. Click on any item for the answer.
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Q: Should I be counseling mothers who smoke cigarettes not to breastfeed?
A. Answer: The benefits of breastfeeding on the short and long-term health for both the mother and child are profound. Despite public awareness of the benefits of breastfeeding the myth still exists that smokers shouldn’t breastfeed because it will hurt the baby. That is simply not true. The breastfed baby, regardless of their mothers smoking status, clearly benefits in numerous ways from breastmilk. According to a recent study, the risk for respiratory illness was 7 times greater in infants whose mothers smoked and did not breastfeed than for those who smoked and did breastfeed (2).
Multiple studies have shown that women who smoke are less likely to intend to breastfed, are less likely to initiate breastfeeding, and more likely to breastfeed for a shorter duration than nonsmokers (1). As health care providers (HCP’s) our goal should be a smoke-free mother and environment and a breastfed child. Expectant and postpartum women need to hear a clear message encouraging them to stop smoking and the importance of establishing a smoke-free home. They must have access to ongoing support from HCP’s as they move through the process of quitting smoking. Women who stop smoking before or during pregnancy are just as likely to start breastfeeding as non-smokers (1).
Nicotine is readily found in the breastmilk of smokers and can be found in the milk of nonsmokers exposed to ETS. Nicotine concentrations in breastmilk have been found to be 3 times that found in maternal blood. Snuff users had double the amount of nicotine in their milk than smokers. The half-life of nicotine in milk was found to be around 95 minutes. The time between breastfeeding and smoking/snuff use influences the concentration of nicotine found in milk (3). Cotinine, the by-product of nicotine, is found in the urine of infants exposed to tobacco. The highest levels of urine cotinine were found in breastfed infants whose mothers smoked and exposed their babies to ETS. Cotinine has been found to have minimal or no cardiovascular or endocrine effects in humans. The cotinine found in breastmilk is unlikely to result in any significant health problems for the infant, while it may have some stimulating behavioral effect on the baby (7).
Infants of women who choose to use nicotine replacement therapy (NRT) while they quit smoking will benefit from nicotine/cotinine levels up to 70% less than what is found in women who smoke 17 cigarettes/day (7). The baby’s nicotine exposure can be reduced even more if their mothers remove the NRT patch while they sleep. Women should be encouraged to wait until just after breastfeeding to smoke and to wait until after the next feeding before smoking again to lessen the nicotine exposure to the infant. Mothers should be counseled to never smoke while breastfeeding and to avoid ETS by not smoking in the car and smoking outside the home.
1. Amir L, Donath, S. Does maternal smoking have a negative physiological effect on breastfeeding? Birth. 2002; 29:2:112-122.
2. Becker A, Manfreda J, et al. Breast-feeding and environmental tobacco smoke exposure. Arch Pediatr Adolesc Med. 1999; 153:689-691.
3. Dahlstrom A, Ebersjo C, Lundell B. Nicotine exposure in breastfed infants. Acta Paediatr. 2004; 93:810-816.
4. Donath S, Amir L, et al. The relationship between maternal smoking and breastfeeding duration after adjustment for maternal infant feeding intention. Acta Paediatr. 2004;93:1514-1518.
5. Hopkinson J, Schanler J, et al. Milk production by mothers of premature infants: influence of cigarettes on smoking. Pediatrics. 1992;90:934-938.
6. Horta B, Kramer M, Platt, R. Maternal smoking and the risk of early weaning: a meta-analysis. Am J Epidemiol. 1997;54:128-133.
7. Ilett K, Hale, T, et al. Use of nicotine patches in breastfeeding mothers: transfer of nicotine and cotinine into human milk. Clin Pharma & Therapeu. 2003;74:6:516- 524.
8. Leung G, Ho L, Lam T. Maternal, paternal and environmental tobacco smoking and breastfeeding. Paediatr and Perinatal Epidemiol. 2002;16:236-245.
9. Ludvigsson JF, Ludvigsson J. Socio-economic determinants, maternal smoking and coffee consumption, and exclusive breastfeeding in 10205 children. Acta Paediatr. 2005; 94:1310-1319.
Submitted by Debbie Ward Gordon, RN, MSN, IBCLC, LCCE
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Q: Which infants, discharged from Neonatal Intensive Care Units, are followed in developmental clinics?
A. All infants should be discharged with a known medical home that will assume monitoring and surveillance on a schedule determined by the individual needs of the infant and family. Each intensive care unit in North Carolina has established criteria for infants who will be scheduled in a special follow-up clinic to supplement the care provided through the medical home.
Sample inclusion criteria for a neonatal developmental follow-up clinic are:
- IVH Grade III and IV with or without ventricular dilatation; Grade II with ventricular dilation.
- PVL
- Apgar < 4 at 5 minutes of life who required epinephrine and/or chest compressions
Perinatal asphyxia defined as:
- umbilical cord ph <7.0
- multi-organ involvement (liver-kidney, heart-CNS (seizures)
- Burst suppressions on EEG
- Post-op patients of major congenital heart disease
- Patients with severe BPD defined as oxygen dependent at the time of discharge or on oxygen at 36 weeks PCA
- PPHN patients
- Infants with severe hyperbilirubinemia that required exchange transfusion
- Infants with neurological abnormalities and/or seizures
- Patients with symmetric IUGR or as having weight below the 10th percentile
- Infants with diagnosed meningitis and/or TORCH syndrome
- Infants involved in clinical research protocols
- Infants with endocrine disorders (Hypothyroidism etc)
A concern about the development of any infant can be discussed with professionals in the North Carolina Early Intervention Program. The website provides contact information by county of residence for each Children’s Development Services Agency (CDSA). |
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Q: What are the recommendations for outlets and floor space for Neonatal Intensive Care Unit beds?
A. According to the Guidelines for Perinatal Care, Fifth Edition (1) “Incubators or overhead warmers should be separated by at least 6 ft, and aisles should be 8 ft. wide. The area should have 150 net sq. ft. of floor space for each neonate, plus space for desks, cabinets, and corridors.” Additionally, “each patient station needs 16-20 electrical outlets, 3-4 oxygen outlets, 3-4 compressed-air outlets, and 3-4 suction outlets.”
In North Carolina, contact the Division of Facility Services through their web site for regulations and guidance.
(1) Guidelines for Perinatal Care, Fifth Edition, American Academy of Pediatrics, The American College of Obstetricians and Gynecologists, 2002, pg 45.
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Q: Does Erythromycin ointment prevent opthalmia neonatorum due to Chlamydia Trachomatis?
| A. C. trachomatis is an intracellular pathogen that does not respond to topical antibiotics (or the application of silver nitrate). A neonate with Chlamydia trachomatis opthalmia neonatorum should be treated with systemic antibiotics (oral erythromycin is effective) to prevent corneal infiltrates and scarring of the conjunctiva (American Academy of Pediatrics, 1997). |
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Q: Can you direct me to a clear concise summary of the risks of prematurity to share with people at my worksite?
| A. There is a summary here on the March of Dimes website. |
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Q: Is there any work being done to develop a vaccine to protect newborns from Group B Strep infections?
| A. According to the Group B Strep Association, about 8,000 babies are born every year with a serious GBS disease and upt to 800 of them die. Approximately 10 to 30% of pregnant women carry the bacteria in their vagina or rectum. During the birth process, a fetus can be colonized as it travels through the birth canal.
Currently, the CDC recommends universal screening of pregnant women around 37 weeks gestational age and treatment of carriers in labor (cdc.gov/groupbstrep/). Current prevention strategies have been highly
successful: in 1970 up to 50% of infected babies died; today the rate is less than 4%. However, researchers are looking to reduce the risk even greater by producing a protective vaccine. The vaccine is currently in phase II clinical trials which means that it is being tested on non pregnant women to determine its likely impact. Watch "Breaking News" for information regarding progess in GBS vaccine.
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