EARLY PROGNOSIS OF HYPOGALACTIA IN BREASTFEEDING MOTHERS: NEW OPPORTUNITIES FOR PRIMARY PREVENTION.

An increase in the hypogalactia frequency diagnosis in breastfeeding mothers is one of the world-spread medical and social problems and is especially high in women with risk factors of lactation disorders. Early estimation of risk factors creates opportunities for physicians to diagnose the lactation problem that mothers face and solve it. Aim - to identify and calculate prognostic criteria for determining the risk of hypogalactia in breastfeeding mothers and strategies to help women overcome them. Twenty-two factors that cause the most significant impact on the development of hypogalactia were selected, and their frequency was determined in 208 mothers with hypogalactia (group 1) and 388 mothers with normal lactation (group 2). The sequential Wald analysis, which compares the frequencies of distribution of traits in the study groups and determines their informativeness by calculating prognostic coefficients (PK) for different risk factors and estimating the individual risk of hypogalactia was used. The elder age of the breastfeeding mother (36-40 years and elder) and its lower educational level promoted hypogalactia. Low security of the mother was associated with hypogalactia (PC -1,4). It was also found that mothers engaged in heavy physical labor suffer from hypogalactia more often than employees. Mothers' return to work, have been reported as factors that influence breastfeeding. Occupational hazards (noise, dyes, vibration, lead soldering, dust factors) and bad habits caused hypogalactia (PC -5,4). Prenatal breastfeeding education has been shown to prevent hypogalactia. A burdensome obstetric history (PC -3,9), habitual miscarriage (PC-1,4), and female genital diseases worsen the prognosis of lactation. Extragenital pathology was characterized by negative PC of hypogalactia, especially rheumatic fever, compensated heart defect (PC -3,2), chronic cardiovascular insufficiency (PC -11,4), congenital heart disease (PC -11,4), obesity (PC -4,8), diabetes mellitus (PC -5,8). The time of the first application to the breast affected the mothers' milk production. The mathematical model of the individual prognosis of lactation in mothers contributes to the early detection of hypogalactia and the corresponding correction.

[CURRENT APPROACHES TO PREVENTION OF BLEEDINGS, ASSOCIATED WITH VITAMIN K DEFICIENCY IN NEWBORNS AND INFANTS].

In the article intended for neonatologists, general practitioners and family doctors, the main causes of hemostatic disorders that lead to the development of hemorrhagic syndrome in newborns and infants are given. The emphasis is on the different forms of neonatal hemorrhagic disease (HD), which is based on the deficiency of vitamin K1, and therefore the bleeding that is observed in children who are breastfed in the first half of life is mostly associated, namely, with vitamin K deficiency. Risk factors of HD depending from the time of the beginning, of the action of one or another factor. The main clinical manifestations of both early and late forms of HD are described, it is shown which of them are mistakenly diagnosed that lead to the appointment of the wrong treatment. The assessment of the need for prevention of late form of bleeding associated with vitamin K deficiency is carried out by determining the concentration in the blood of a functional coagulation marker - PIVKA II. Modern methods of prevention of late bleeding associated with vitamin K1 deficiency, based on nosological units - chronic cholestasis, cystic fibrosis, are presented. The current recommendations on the use of vitamin K1 in newborns and infants of the American Academy of Pediatrics, the scientific community of Canada, Netherlands, Switzerland, Germany, France, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), the World Health Organization, which are clearly followed by the effects of local peculiarities are described and interpreted. on approaches to the prevention of bleeding associated with vitamin K1 deficiency, which affects the choice of a single dose, the duration of the prophylactic course and the route of administration of vitamin in K1 (phytomenadion). The role of parents in the prevention of vitamin K deficiency is emphasized.