CLE Maternal & Infant Health Considerations 3 — Questions and Answers
Question 1: Which of the following best describes the composition of colostrum compared to mature breast milk?
- Higher in fat and lactose, lower in protein
- Higher in immunoglobulins and protein, lower in fat and lactose (Correct answer)
- Lower in all nutrients but higher in water content
- Similar in composition but produced in larger volumes
Correct answer: Higher in immunoglobulins and protein, lower in fat and lactose
Colostrum is rich in secretory IgA, lactoferrin, leukocytes, and protein while containing lower levels of fat and lactose than mature milk.
Question 2: A mother who had a cesarean birth under general anesthesia is concerned about breastfeeding initiation. She should be advised that:
- Breastfeeding must be delayed at least 24 hours after general anesthesia
- She can breastfeed as soon as she is alert and able to position the infant safely (Correct answer)
- General anesthesia permanently reduces milk supply
- The infant should not receive milk for 12 hours due to anesthesia transfer
Correct answer: She can breastfeed as soon as she is alert and able to position the infant safely
Anesthetic agents used in general anesthesia transfer minimally to breast milk; the mother can breastfeed once she is sufficiently alert to hold the baby safely.
Question 3: Breast milk jaundice (as distinct from breastfeeding jaundice) typically occurs:
- In the first 3 days of life and resolves by day 7
- After the first week, peaks at 2 weeks, and may persist for several weeks (Correct answer)
- Only in formula-fed infants
- As a result of ABO blood type incompatibility
Correct answer: After the first week, peaks at 2 weeks, and may persist for several weeks
Breast milk jaundice is caused by substances in mature milk that inhibit bilirubin conjugation; it appears after day 4-7, peaks around 2 weeks, and can last 3-12 weeks.
Question 4: Which maternal condition is an absolute contraindication to breastfeeding in the United States?
- Hepatitis B infection
- HIV infection (Correct answer)
- Active cytomegalovirus (CMV) infection
- Group B streptococcus (GBS) colonization
Correct answer: HIV infection
In the U.S., HIV-positive mothers are advised not to breastfeed because breast milk can transmit HIV to the infant, unlike in resource-limited settings where benefits may outweigh risks.
Question 5: What is the primary purpose of the 'Ten Steps to Successful Breastfeeding' as outlined by WHO/UNICEF in the Baby-Friendly Hospital Initiative?
- To regulate formula marketing in hospitals
- To establish evidence-based hospital practices that protect, promote, and support breastfeeding (Correct answer)
- To mandate exclusive breastfeeding for all infants regardless of medical need
- To train lactation consultants in clinical skills
Correct answer: To establish evidence-based hospital practices that protect, promote, and support breastfeeding
The Ten Steps provide hospitals with a framework of evidence-based practices shown to significantly increase breastfeeding initiation and duration rates.
Question 6: A late preterm infant (35 weeks) who appears to be nursing frequently but is losing more than 10% of birth weight should be evaluated for:
- Normal growth patterns requiring no intervention
- Ineffective milk transfer due to neurodevelopmental immaturity (Correct answer)
- Overproduction of milk by the mother
- Lactose intolerance
Correct answer: Ineffective milk transfer due to neurodevelopmental immaturity
Late preterm infants have immature oral motor skills, reduced stamina, and sleepier behavior that can result in ineffective sucking and inadequate milk transfer despite frequent nursing attempts.
Question 7: Which supplemental feeding method is generally preferred over bottle feeding when a breastfed newborn requires supplementation in the early postpartum period?
- Cup feeding or spoon feeding (Correct answer)
- Standard bottle with fast-flow nipple
- Nasogastric tube feeding
- Intravenous glucose solution
Correct answer: Cup feeding or spoon feeding
Cup or spoon feeding avoids nipple confusion by not requiring the infant to use a rubber nipple, helping preserve the infant's ability to latch at the breast.
CLE Maternal & Infant Health Considerations 3
Which of the following best describes the composition of colostrum compared to mature breast milk?