IBCLC Detailed Content Outline: Pathology Focused CERPs - Section III
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The Golden Hour of Neonatal Life: Improving Outcomes Through Evidence-Based Interventions
Dr. Ankur Bio Update - Dr. Kumar Ankur, MD, DNB is working as an Associate Director & Head of the Department of Neonatology at BLK MAX Super Speciality Hospital Delhi, India. He has been working in the field of neonatology with private and non-goverment organisations for improving neonatal healthcare in the country. He is the national faculty and trainer for FBNC (Facility based neonatal care), Neonatal Resuscitation, Kangarroo Mother Care (KMC) and the national assessor for Neonatology Fellowship accreditation programme of India. He has been invited as an expert speaker, faculty, chairpersons for various national and state level conferences and workshops. He has many publications in national & international journal and authored many chapters, guidelines published by Indian Academy of Pediatrics & National Neonatology of Forum Delhi & India. He is also the co-editor of Handbook of Neonatal Clinical Practices. He is also running training program in neonatal Fellowship for postgraduate students & neonatal nurses. Currently he is also the Secretary of prestigious National Neonatology Forum, Delhi. National Neonatology Forum (NNF) is a strong and large body of more than 8000 neonatologists across India and abroad. NNF has been actively involved in advocacy, policy making, research and ensuring quality health care to newborn for the last 4 decades. He had been past Secretary (2014) & President (2018) of Indian Academy of Pediatrics (IAP), Central Delhi Branch.
Topic: Tongue-Tie and the NICU: A Neonatologist Perspective - [View Abstract]
Prematurity is the leading cause of death across the globe, mainly in low resource settings. Infants born at less than 32 weeks gestation, are prone to developing hypothermia, hypoglycemia, and hospital acquired infections after birth. For them, the initial 60 minutes of holistic approach is crucial for long-term outcomes. The “Golden Hour” of neonatal life is defined as the first hour of post-natal life in both preterm and term neonates. This concept includes practicing particular evidence based interventions in the initial sixty minutes of postnatal life for better long-term outcomes like marked reduction in hypothermia, hypoglycemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). This presentation will provide a look at the various components of neonatal care that are included in the “Golden hour” of preterm and term neonatal care. Healthcare professionals attending the birth of high risk infants like VLBW (very low birth weight, less than 1500 grams) or high-risk term neonates should be well trained in attending such deliveries and should be able to implement all the management protocols during the golden first 60 minutes of life.
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Dr. Scott is the coordinator of the advanced practitioner group for Mednax Medical Group in Nashville, Tennessee as well as the coordinator of the neonatal transport service at Centennial Medical Center, also in Nashville. She is also an assistant professor in the neonatal nurse practitioner program at Vanderbilt University School of Nursing. For the last few years, she has become interested in the use of telemedicine in neonatal care and works with a Neonatology practice that actually practices using telemedicine in Level I and II facilities. She is also involved in quality improvement at the state level through her work with the Tennessee Initiative for Perinatal Quality Care.
Patti received her Bachelor’s Degree in Nursing from Vanderbilt University in 1988. Her Masters of Science Degree in Nursing with a specialty in neonatal critical care was completed in 1993 from Vanderbilt University and her Doctorate in Nursing Practice from the University of Tennessee Health Science Center. She has successfully completed the National Certification Corporation's Neonatal Nurse Practitioner, Neonatal Pediatric Transport, and the Neonatal Intensive Care examinations.
Patti is a member of several nursing, advanced practice, and neonatal professional organizations. She is an active NRP and S.T.A.B.L.E. instructor and has developed and provided numerous neonatal educational courses for staff.
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.
Lisa Marasco has been working with breastfeeding mothers for 35 years and has been Internationally Board Certified since 1993. She holds a Master’s degree in Human Development with specialization in Lactation Consulting and was designated a Fellow of ILCA in 2009.
Lisa is co-author of Making More Milk: The Breastfeeding Guide to Increasing Your Milk Production, a contributing author to the Core Curriculum for Interdisciplinary Lactation Care, and a Cochrane Collaborative author. She is employed by WIC of Santa Barbara County while she continues to research, write and speak. In addition, Lisa is affiliated with La Leche League of So. Calif/Nevada, and serves on the Breastfeeding Coalition of Santa Barbara County.
Topic: Deciphering the Lactation Curve - [View Abstract]
Topic: Developing An Action Plan for Mammary Hypoplasia: Improving our Understanding to Optimize Care - [View Abstract]
Topic: Getting a Better Grip on Prolactin - [View Abstract]
Topic: Recognizing When Things Are Heading South - [View Abstract]
Topic: The Mysterious Milk Ejection Reflex - [View Abstract]
Milk removal drives milk production and feeds the baby. The ability of a baby or pump to remove milk from the breast depends strongly on the milk ejection/letdown reflex. While normally robust, a number of factors can influence this reflex, some more obvious than others. When milk flow suddenly becomes an issue, the rush is on to determine why and what to do about it. This session will take a deeper look at how this reflex works, factors that can affect it positively or negatively, and potential strategies to help.
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Emily Hills is co-author and co-founder of Sensory Beginnings Ltd, she is a Clinical Specialist Neonatal Occupational Therapist at Royal Free London NHS Foundation Trust. Emily is a certified neonatal therapist (CNT). She has completed her MSc in Advanced Neonatal Studies at Southampton University. Emily is NIDCAP certified and lectures on The Family and Infant Neurodevelopmental Education (FINE) programme in the UK. Emily has completed Neonatal Touch and massage certification (NTMC) and has completed the advanced course in The Prechtl General Movement Assessment. She is a senior Brazelton trainer and lectures on both the Neonatal Behavioural Assessment Scale (NBAS) and Newborn Behavioural Observation (NBO). She is an Advanced Practitioner in Sensory Integration.
Lindsay Hardy is the Director of Clinical Services at PACE, where she leads a multidisciplinary team of therapists, providing therapy to children from 0- 19 years and support to their families. Lindsay has led the development of the Pace Early Intervention Service for children 0-3 years and their families. Lindsay has designed content and taught post-graduate courses in the field of paediatric occupational therapy, sensory integration, cerebral palsy, early intervention & developmental neurology. Lindsay was involved in the start-up of national organisations Sensory Integration Network UK & Ireland and EISMART. She is co -founder and co-author of Sensory Beginnings Ltd
Human neurobiology is highly sensitive to stressors. Adverse early life experiences create stress that have the possibility to change brain chemistry, anatomy and gene expression. These changes can predispose a baby to impaired emotional regulation, poor cognitive development, and increased risk of cardiovascular, metabolic and immune system dysfunction. In addition, chronic stress can become trauma and have a long term effect. In the neonatal unit the infant, parents and staff are experiencing stress. This presentation will focus on the role of sensation and how we can use sensory experiences to create healing environments, enhance optimal development and minimise stress and trauma.
Laurel Wilson, IBCLC, CLE, CCCE, CLD is a TEDx and international speaker, author, pregnancy and lactation expert, and consultant. She served as the Executive Director of Lactation Programs for CAPPA, the Childbirth and Postpartum Professional Association for 16 years and now is on the Senior Advisor Board. She served on the Board of Directors for the United States Breastfeeding Committee from 2016-2019. She also is on the Advisory Board for InJoy Health. She owns MotherJourney, focusing on training perinatal professionals on integrative and holistic information regarding pregnancy, childbirth, and breastfeeding. She has her degree in Maternal Child Health: Lactation Consulting and is an internationally board certified lactation consultant. As the co-author of two books, The Attachment Pregnancy and The Greatest Pregnancy Ever, original Editor of the CAPPA Lactation Educator Manual, and contributing author to Round the Circle: Doulas Talk About Themselves, she loves to blend today’s recent scientific findings with the mind/body/spirit wisdom. Laurel has been joyfully married to her husband for nearly three decades and has two wonderful grown sons, whose difficult births led her on a path towards helping emerging families create positive experiences. She believes that the journey into parenthood is a life-changing rite of passage that should be deeply honored and celebrated.
Topic: Epigenetics and Breastfeeding: The Potential Longterm Impact of Breastmilk - [View Abstract]
Topic: Hold the Phone! Diet Does Matter During Breastfeeding: Implication of Diet on Fatty Acid Composition and Other Nutrients - [View Abstract]
Topic: Postpartum Mood Disorders, Breastfeeding and the Epigenetic Links from Past Into Future - [View Abstract]
Topic: Talk To Me: How Breastmilk Acts as a Communication and Gene Expression Tool Between Mother and Child - [View Abstract]
Topic: The Milk Sharing Conundrum - The Grey Area Between Scope and Need - [View Abstract]
Topic: The Placenta and Breastmilk-Unraveling the Mysterious World of the Intelligent Organs that Protect our Babies - [View Abstract]
Topic: Understanding Zika and Lyme and Breastfeeding - [View Abstract]
Topic: Unraveling the Mysteries of Human Milk: The Fascinating Role of Neohormones, Epigenetics, the Microbiome and More! - [View Abstract]
With the recent spread of the virus, Zika and the bacterial infection, Lyme Disease, many pregnant and breastfeeding families worry about the potential impact on their babies. There is a great deal of inaccurate information on the internet regarding these diseases that many parents encounter. Having good resources and current information on these emerging diseases is imperative for new families. This presentation will address transmission of the diseases, risks to babies prenatally and during breastfeeding, and precautions for pregnant and breastfeeding mothers to take.
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Dr. Unger is a neonatologist at Sinai Health in Toronto, Canada. She is the medical director of the Roger Hixon Ontario Human Milk Bank and a professor of pediatrics at the University of Toronto. She is a co-primary investigator for the Canadian Institutes of Health Research funded MaxiMoM: Maximizing Mother’s own Milk Program of research. Dr Unger graduated from medical school at Dalhousie University on the east coast of Canada. She is the proud mother of three teenage daughters.
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.
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Virus Killing by White Blood Cells in Breast Milk: How Breastfeeding Is Protective Against HIV
Rebecca LR Powell, PhD, CLC is an Assistant Professor in the department of Medicine, Division of Infectious Diseases, at the Icahn School of Medicine at Mount Sinai Hospital. Currently Dr. Powell is analyzing the phagocytosis responses of various cell types to better understand the effects of phagocytosis receptor profiles and the impact of antibody specificity on the elicitation of biologic function. Additionally, Dr. Powell is studying the contribution of breast milk leukocytes to the relatively low rate of HIV transmission in infants exclusively breastfed by their HIV-infected mothers. She received her PhD in Microbiology from the Sackler Institute, New York University School of Medicine, and her CLC from the Healthy Children Project.
Unless access to clean water and appropriate infant formula is reliable, the World Health Organization does not recommend HIV-infected mothers stop breastfeeding. Remarkably, only about 15% of babies exclusively breastfed by their HIV-infected mothers become infected with HIV. This suggests that although breast milk is a vehicle for HIV transmission, the milk itself exhibits a strong protective effect against infection. Breastfed babies ingest 100,000 - 100,000,000 maternal cells every day via breast milk; what remains largely unclear is the contribution of these cells to the milk’s anti-viral qualities. A large study has been undertaken to isolate cells from human milk in order to measure the ability of these cells to engulf and destroy HIV by a mechanism known as phagocytosis. Over 50 samples of breast milk obtained from healthy women have been analyzed. Phagocytosis of HIV was detected in all samples. Activity did not appear to correlate with stage of lactation. Various cell types known for phagocytic capacity were identified and measured, including granulocytes, monocytes, macrophages, and dendritic cells. All samples exhibited strong granulocyte activity.These data further demonstrate that phagocytosis of HIV by immune cells from breast milk can be measured. This information will be critical for design of therapeutic vaccines capable of reducing the likelihood of mother-to-child transmission of HIV in areas where breastfeeding is essential.
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What a Letdown: Exploring the Physiology of the Milk Ejection Reflex
Briana Tillman received her undergraduate degree in International Relations from the United States Military Academy at West Point. She has been a La Leche League Leader for 9 years and is a board certified lactation consultant. After spending 10 years as a stay-at-home mom, she is currently in her third year of medical school at Rocky Vista University College of Osteopathic Medicine in Parker, Colorado. She loves spending time with her husband and three kids—as a family they like to travel, go camping, and play string instruments in “family ensemble.”
Nick is a 3rd year medical student at Rocky Vista University College of Osteopathic Medicine. He has a background in mechanical and systems engineering but found his calling in medicine after volunteering for Health4Haiti in 2011. He lives in Colorado with his wife and they enjoy hiking, camping and fishing in the great outdoors.
Topic: What a Letdown: Exploring the Physiology of the Milk Ejection Reflex - [View Abstract]
New mothers experience the milk ejection reflex, or “letdown,” in various ways. While some feel no physical symptoms, others experience a tingling sensation and some even have significant pain or sadness. Babies also have different experiences, from the overactive “drink from the firehose” to frustratingly long waiting at feeding time. This presentation explores the multitude of influences on letdown, from internal hormones and chemical signaling pathways to the research related to such external influences as diet, alcohol, stress, and the use of synthetic oxytocin.
Many moms believe that they either do not produce sufficient milk or need a quicker, more effective letdown. Suggestions to deal with these issues range from drinking beer to adding different nutritional supplements to the diet, from hypnosis to oxytocin nasal spray. We will explore the research and unravel the best practices and recommendations we can give to clients related to their concerns about the milk ejection reflex.
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What Is Stopping Us? Kangaroo Care Implementation in Neonatal Intensive Care Units
Sarah Coutts is a registered nurse and lactation consultant with over 10 years experience in the neonatal intensive care unit. She currently is working as a Developmental Care Specialist in a NICU in Vancouver, Canada. Previous to this position Sarah was the Kangaroo Care Coordinator of an implementation science study to improve uptake of Kangaroo Care in NICUs in British Columbia. She is part of team of clinicians and researchers interested in understanding the barriers and enablers to Kangaroo Care from both the healthcare provider and parent perspectives and creating innovative strategies to increase knowledge and practice of Kangaroo Care in the NICU. She is passionate about raising awareness of the positive outcomes of zero separation between preterm and sick infants and their parents in the NICU.
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.
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Yes You Can! Breastfeeding A Baby With Down Syndrome
Educator with the Australian Breastfeeding Association (ABA). She has a particular interest in breastfeeding and Down syndrome after her son was born with Down syndrome in 2014. Her journey of breastfeeding her son included a long inpatient hospitalization stay due to his treatment for cancer. She has worked in disability services for over 20 years including community learning disability nursing in the UK, supporting GPs to manage the heath needs of people with complex health conditions and intellectual disability, medical undergraduate education in intellectual disability and currently works in general practice as a Practice Disability Nurse. Heather facilitates Breastfeeding Education Classes to expectant parents, is a Trainer & Assessor in ABA’s training team and provides guidance and contributes to publications on breastfeeding a baby with Down syndrome.
As a health professional you may find yourself supporting a mother who is breastfeeding or requires support to breastfeed her baby with Down syndrome. Babies with Down syndrome can often have additional health needs, which may affect how successful they are with breastfeeding. Down syndrome or trisomy 21 is the most common genetic cause of intellectual disability for around 1 in 700 births worldwide. People with Down syndrome are not all the same but may have similar characteristic physical features, health and developmental challenges and some level of intellectual disability. Research has shown many benefits associated with breastfeeding a baby with Down syndrome. It contributes to establishing long term skill development, particularly with speech and feeding skills, as well as aiding brain growth. It also provides an opportunity for mother baby bonding during stressful periods after learning of their baby’s diagnosis. Regardless of these known benefits, some mothers may nevertheless be told their baby will not be able breastfeed. This presentation will explore some of the common challenges mothers may face when breastfeeding a baby with Down syndrome and tips on how to address these for the mother and baby. The material presented will also assist health professionals to support mothers with babies who may have similar health/developmental needs.
