IBCLC Detailed Content Outline: Development and Nutrition / Maternal Focused CERPs - Section I B

Did you know that a mother who breastfeeds her child is more likely to “match” as an organ donor than a mother who does not breastfeed her child? How does that happen? The answer may lie in the Maternal-Newborn Microbiome, AKA “The Oro-boobular” axis. The scientific world is exploding with excitement over the discovery of the microbiome. While it appears clear that a suckling infant’s intestinal microbiome communicates with the mother’s lactocyte and perhaps beyond, little is known about the effects of this communication in practical terms. This presentation will review what is known and attempt to explain what it means, both now and in the future.

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.

As humans evolved, the milk specific to nourishing, protecting, and developing their babies went through an incredible transformation. The unique demands of having placentas, growing large brains, and making milk for infants that required rapid maturation post-delivery led to a unique set of neohormones. Neohormones not only facilitate reproduction in the mammal, but they direct the development of mammary tissue and are a significant component of human milk. Neohormones interact with the epigenome and microbiome, targeting certain genes to lead to reproductive success for the mammal. Human milk prepares the infant’s epigenome and microbiome for long-term health and adaptation to the environment. Learn about these fascinating components in human milk and the extraordinary role they play in human development.

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.

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.

Many preterm infants remain vulnerable following discharge from the neonatal intensive care unit (NICU). Health challenges persist beyond the NICU including respiratory illness, breastfeeding progression, bottle feeding incoordination, behavior and development issues, impaired growth, infrequent stooling, and gastroesophageal reflux. Preterm infants are up to two times more likely than full term infants to be hospitalized in the first year of life. Parents are challenged to transition their premature baby home and to keep them home!

Community-based, specialized follow-up services following NICU discharge have a powerful impact. The Neonatal Transition Team in Calgary, Alberta, Canada provides post-NICU follow-up for very-low-birth-weight infants and their families. The team consists of community health registered nurses with advanced skill in premature infant outcomes, feeding and neurodevelopmental assessment, and a consultation partnership with nutritional and feeding specialists. While home visits have been the backbone of this service, the team questioned the feasibility and acceptance of virtual care and completed a three month quality improvement pilot. This virtual care pilot demonstrated optimization of health-care resources by providing safe, high-quality care at a reduced operational cost. The pilot was instrumental in the team’s management during the SARS-COVID-19 pandemic. Virtual care has been fully operationalized into the service delivery model and expanded to serve other newborns with feeding or growth challenges.