IBCLC Detailed Content Outline: Development and Nutrition / Infant Focused CERPs - Section I A

This presentation will cover skills & strategies of conducting assessments of oral dysfunction in a telehealth setting, a situation many Lactation providers were thrusted into due to Covid-19. Through real life examples of processes & strategies I use in my location-independent practice which specializes in oral dysfunction, the learner will gain practical insight to improve the quality of the virtual lactation visits they provide.

The use of telemedicine is an emerging trend in health care, this includes neonatal care. Benefits include real-time access to experts routinely and during emergency situations such as delivery room resuscitations and stabilizations, the ability for families to stay connected to their newborn in the Newborn Intensive Care Unit (NICU) after the mother has been discharged from the hospital, and to assist in the decision for transport of the newborn to a higher level of care. Several studies have documented the reduction in transfers from community hospitals since telehealth has been implemented in the nursery. Limitations include the need for knowledgeable and experienced providers to be at bedside, physicians who are familiar with advance practice providers and their abilities, and the technical challenges that can present and have to remedied.

The historical evolution of infant feeding includes direct breastfeeding, wet nursing and bottlefeeding. Before the invention of bottles/ vessels to feed babies, wet nursing was the safest and most common alternative way to feed a baby. As bottles and nipples were developed, scientific advancement improved formulas, wet nursing fell out of favor. It gradually went from being widely accepted as the most normal way to feed a baby to where we currently are as a modern society. It is negatively seen as being weird and risky behavior. When mothers do not breastfeed or give their babies human milk, they use formula to feed their babies. Given the current knowledge of lack of complete nutrition formula has more mothers are showing an interest and actively pursuing wet/cross nursing. This presentation will help us understand the history of wet nursing and offer reasons to support, advocate and be encouraging to mothers who want to participate in the practice of wet/cross nursing.

Evolution has created human milk as a way to protect the baby postnatally, patterning the immune system and microbiome, and providing diverse developmental cues for each organ system to develop normally. Milk also provides nutrition. When screened donated human milk (DHM) is available, mothers facing the most stressful circumstances of having an ill premature baby tend to have high chances of establishing breastfeeding. If donor milk is used appropriately as a bridge to lactation, they are less likely to perceive that their bodies have failed. The work of the Hearts Milk Bank over 18 months have laid the foundation for a UK-centred drive to upscale milk bank capacity, facilitate research to determine the optimal use of donor milk, and support a shift in perception about the role of human milk, underpinned by the latest science.

This presentation will focus on the nurturing care of extremely preterm infants and their parents. Parent-infant separation is commonplace in NICUs and even more if the infant is born extremely preterm. Parent’s presence could be restricted by the rules and routines in the neonatal intensive care environment and skin-to-skin contact is not always possible due to the infant’s condition. Early and extensive contact between the infant and the parents enables the parents to get to know their infant and to feel and act like parents. At the NICU in Uppsala, Sweden, our experience is that parents, even those who have an extremely preterm infant want to be present and to stay close, 24/7, to their infant during the infants NICU stay. The aim of this presentation is to report clinical experiences from the NICU in Uppsala about how the NICU environment and NICU staff can facilitate or hinder parental presence, parental participation, and skin-to-skin contact when the infant is born extremely preterm.

Mother’s milk is the unequalled nutritional source for the preterm or medically fragile neonate. Beyond its nutritional impact, it contains a myriad of bioactive molecules that are of particular health importance for the sick neonate. A majority of mothers who are pump dependent with an infant in a neonatal intensive care unit have an incomplete supply of their own milk. In this instance, human donor milk is an important supplement to have available while the mother is supported to increase her own milk supply. This lecture will focus on various aspects of the use of human donor milk including a review of the differences between mother’s milk and donor milk and the current methodologies used for processing donor milk. Recommended clinical guidelines will be discussed that are based on the evidence for short and long term health outcomes following the use of donor milk in the neonatal period. Future considerations will be explored including ethical issues with respect to donor milk use.

Early life adversity and the associated toxic stress literally gets under our skin and is embedded in our biology. Authentic nurturing experiences during early life, or the lack of them, are directly linked to mental health outcomes. The sense of touch plays a salient role in social relationships with important neurodevelopmental and psycho-socio-emotional outcomes. Healing presence and authenticity underlie caring actions, attitudes and behaviors. This talk will introduce the biological underpinnings of our unique therapeutic value in the clinical setting.

Although human milk confers important health promotion benefits to all infants, vulnerable babies admitted to an NICU stand to benefit even more. Their parents are typically strongly motivated to provide their own milk, although for a variety of reasons, such as parental ill health and stress (often complicated by the pandemic), parents may not have a full volume of their own milk. In this case, donor milk is the recommended supplement to bridge until parent’s milk is available. There is strong research evidence to support the use of human donor milk in preterm infants to prevent necrotizing enterocolitis, while there is less available evidence for the use of donor milk in late preterm infants. There are important differences between parent’s milk and donor milk with respect to their nutrient and non-nutrient components which may be secondary to processing techniques used in creating batches of donor milk. It is important to understand these differences and be able to interpret nutritional labelling on donor milk. Newer techniques in pasteurization may address some of the losses of bioactive molecules in human milk.

We know that responsive feeding gets breastfeeding off to the best start. New parents are told that breastfed babies often feed 8 – 12 times a day, but in practice many new mothers will find themselves breastfeeding more frequently than this. Research exploring breastfeeding frequency is however conducted primarily with younger infants, focuses simply on breast versus bottle, or was funded by industry.

This presentation reports novel findings from a research study of 18,000+ mothers with a baby or child aged 0 – 5 years old. It examines how often babies feed during the day and night for each age range by milk feeding type, mode, and approach (e.g. schedule versus responsive) and how frequent day and night feedings remain the norm for breastfed babies into the preschool years. The data also explores differences in maternal perceptions of infant variations in hunger e.g. in response to growth spurts, variations over different days, and cluster feeding, highlighting how breastfeeding mothers describe a more varied pattern of infant feeding compared to those formula feeding.

Together the findings challenge notions that most babies breastfeed between 8 – 12 times per 24 hour and that irregular patterns or varied numbers of feeds are normal for breastfed infants. Although many breastfeeding practitioners will recognise this pattern, these findings will provide both an addition and challenge to the scarce existing research literature on infant feeding patterns.

Preterm infants are at increased risk for impaired neurodevelopmental outcomes (Stoll et al, 2010). There is evidence supporting the differences in outcomes related to how we provide care to preterm infants and the effects of the environment in which the care takes place. One of the most effective ways to reduce impaired infant outcomes is inviting parents to actively participate in care activities and provide Kangaroo Care (Boundy et al., 2016; Charpak et al., 2017). Despite international recommendations, empirical evidence, and an implementation science project focused on strengthening Kangaroo Care in neonatal intensive care units in British Columbia, Canada, implementation has been slow due to various barriers to uptake (Charpak et al., 2020; Coutts et al., 2021; WHO, 2020). A ‘one size fits all’ approach cannot guide Kangaroo Care implementation as it is a complex intervention and each NICU presents unique barriers and enablers. The uptake of Kangaroo Care relies on the involvement of parents and healthcare providers and their understanding and commitment to the evolving paradigm shift in neonatal care. This transition requires environmental and social supports, systems level change of philosophies of care, and assistance for healthcare providers to recognize their changing role.