Contraindications to breastfeeding

Contraindications to breastfeeding on the part of the mother

Breastfeeding is contraindicated in cases of such diseases of the mother:

• oncological diseases;
• an open form of tuberculosis with bacilli;
• especially dangerous infections (smallpox, anthrax);
• HIV-positive mother status; 
• acute mental illness;
• hepatitis C in the active phase of the disease.

Contraindications to breastfeeding

Disease	Breastfeeding is contraindicated
Cardiovascular pathology	With chronic heart failure IIB (according to Vasilenko-Strazhesko classification) / The question of the possibility of preserving lactation and breastfeeding with heart failure can be solved individually, taking into account the peculiarities of hemodynamics, the condition of the patient under the supervision of a cardiologist. With infective endocarditis. With all acquired heart defects of IV and V stage (at stage III, exclude night feeding). With all the "blue" heart defects. For all heart defects with manifestations of pulmonary hypertension. With severe heart rhythm disturbances. With rheumatic heart disease. With dilated cardiomyopathy. With arterial hypertension II stage. In severe cases, the presence of acute or severe chronic impairment of cerebral circulation
Kidney disease	In the presence of acute or chronic renal failure of all stages
Liver disease	With the development of liver function deficiency, portal hypertension, enlarged veins of the esophagus
Disease of the respiratory system	With the development of respiratory failure stage II and beyond
Diabetes	In severe forms of the disease in the stage of decompensation (diabetic ketoacidosis)

[1], [2], [3], [4],

Contraindications to breastfeeding on the part of the child

[5], [6]

Newborns that do not meet their gestational age

Such children may have only low body weight for this gestational age, but also a developmental delay. It depends on the factor that affected during pregnancy. It is known that the mother's arterial hypertension in the III trimester causes a delay in the increase in the body weight of the fetus, and the transfer of rubella in the first trimester is a delay in growth. The greater the growth retardation in a newborn during pregnancy, the greater the problem when feeding such a child. In newborns of this group, hypocalcemia, hypothermia, hypoglycemia develop more often. Breast milk contributes to the full development of the digestive tract. 

Pathological conditions of the fetus and hypoxia of the newborn

Newborns, the condition of which requires observation or intensive care, have a low Apgar score. Depending on the clinical condition, the application to the breast should be delayed for 48 hours. Sometimes this period can be extended to 96 hours. Hypoxia leads to a decrease in intestinal motility and a decrease in the level of stimulating hormones. Such newborns may have neurological problems and do not always respond adequately to attempts to breastfeed later. For such children, the pose of a ballerina or a soccer ball may be the optimal position near the mother's breast. When the child is in front of the mother, the child's head and face are stabilized by the mother's hand and are directly opposite her breast.

Gastrointestinal disorders

Disturbances from the digestive tract are found quite often both in newborns receiving breast milk and in newborns that receive the mixture. The only rule is that newborns should receive breastmilk as soon as possible in the event of a disease. Breast milk is a physiological diet that does not cause dehydration and hypernatremia. The mother of the child needs a corrective diet. Allergy to mother's milk is rare.

Lack of tolerance to lactose

Lactose is the main carbohydrate of milk, hydrolyzed by hydrolytic enzyme lactose floretinucoside, enzyme of the small intestine. Congenital lactose deficiency is an extremely rare disorder, inherited by an autosomal recessive type. The enzyme hydrolyzes lactose, floreating lukoside, glycosylceramide.

In most cases, the clinical manifestations decrease at the age of 3-5 years. Prematurely born babies have no tolerance to lactose, it is necessary to correct the mother's diet, the introduction of lactose hydrolysed breast milk.

Galactosemia is a disease caused by a deficiency of galactose-1-phosphate-uridine transferase. Refers to congenital pathologies. Clinical manifestations:

• jaundice;
• vomiting;
• loose stools;
• brain disorders:
• electrolyte disturbances;
• decrease in body weight.

It is necessary to transfer the baby to the feeding with therapeutic artificial mixtures, because high levels of lactose in milk contribute to increase of glucose and galactose in the blood of the child.

Phenylketonuria is a violation of the exchange of the amino acid phenylalanine, in which it accumulates due to the absence of the enzyme. A child with phenylketonuria has a low birth weight, microcephaly, congenital heart disease. The levels of phenylalanine in human milk are from 29 to 64 mg in 100 ml. For infants with this pathology, it is necessary to feed breast milk with the addition of a mixture of Lofenalac (low in phenylalanine).

Female milk has a low content of phenylalanine in comparison with artificial mixtures. The prognosis of mental development is favorable if the treatment is started early and the level of phenylalanine in the blood does not exceed 120-300 mmol / l. To enter a dense meal probably not earlier than in 6 months.

Cystic Fibrosis

Breastfeeding is carried out with the addition of proteolytic enzymes. In severe cases it is possible to use hydrolyzed mixtures.

[7], [8], [9], [10], [11]

Enteropathic acrodermatitis (Danbolt-Closs syndrome)

Acrodermatitis enteropathica is a rare, unique disease transmitted autosomal recessive type, characterized by a symmetrical rash around the mouth, genital organs, in the area of limb folds. Rash - acute vesiculobullous, eczematous, often comes secondary infection C. Albicans.

The disease is observed during excommunication, accompanied by diarrhea, hair lotteries, excitement, low level of zinc in the blood, Female milk contains less zinc than cow's milk. The treatment should include zinc preparations in the form of gluconate or sulfate.

[12]

Down Syndrome

Newborns with Down's syndrome can not always effectively suckle the breast. It is necessary to help the mother and the medical personnel to teach the child how to properly and appropriately take the breast. It is necessary to use the position of the child near the mother's breast, in which the child's support is provided, taking into account the hypotonia of his muscles, which is corrected by the coordinated movements of the mother. You can use a pillow to correct the position of the child. The mother's care in the care of the child is provided by a pediatrician, cardiologist, geneticist, nurse and other medical experts. Especially important for these children is breastfeeding, because they are prone to infection and have an increased level of development of generalized infection.

[13], [14], [15]

Hypothyroidism

Newborns with hypothyroidism need breastfeeding, since milk has high levels of thyroid hormones.

Hyperplasia of the adrenal glands

Newborns who received breast milk during the neonatal period had a lower incidence of regurgitation, a stable clinical condition.

Breastfeeding a newborn with perinatal pathology

If a sick newborn child does not receive breast milk, then:

• there is a longer duration of the disease, especially perinatal infections, sepsis;
• high level of complications of invasive therapy;
• the child loses more in the mass and renews it longer;
• requires a longer period of the infusion therapy, partial parenteral nutrition;
• the newborn does not receive immunobiological protection factors with the mother's milk, which predetermines both the long duration of the disease and the greater amount of medication, including antibacterial and immuno-substitution therapy;
• there is no psychoemotional contact with the mother, the child does not receive emotional pleasure in feeding. Today it is known that the contact of the mother and the sick newborn child helps improve the blood circulation of the child's brain;
• decreases the amount of breast milk in the mother;
• a newborn can refuse to suckle after breastfeeding; expressed by milk.

Endorphins, whose level increases in the case of psychoemotional contact between the mother and the child, reduce the spasm of blood vessels, including the brain, intestines, and lungs, which may be one of the mechanisms for improving the results of intensive care and nursing preterm infants and infants with perinatal pathology who received a breast milk in constant contact with the mother,

If the sick child continues to suckle or breast milk, this makes it possible:

• maintain the optimal water-electrolyte balance;
• reduce the duration of treatment of the child and the length of his stay in the hospital;
• reduce the volume of invasive procedures, namely, infusion therapy, parenteral nutrition;
• reduce the number of medicines (economic effect for healthcare institutions);
• reduce iatrogenic effects on the child;
• to receive emotional pleasure and psychological comfort at feeding;
• support and resume lactation with the mother during breastfeeding;
• Provide immunobiological homeostasis of the child's body.

[16], [17], [18], [19],