Neonatology Online Course(s) & Continuing Education

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.

Innovation and change is a constant in healthcare. Nurses are key stakeholders in developing, implementing and executing these changes. Whether the nurse is a formal or informal leader, their presence is vital for effective change. A nurse’s voice, your voice, can drive change by leading, guiding and engaging colleagues in the process. Extraordinary outcomes can be achieved with a clearly articulated vision, an inspired team, knowledge about the change (the why behind the what), and the resources necessary to create change. This presentation focuses on how leaders can prepare for change, move forward using change management strategies and sustain meaningful change in their units. Individual and collective strengths required to lead change will be shared.

To graduate from the Neonatal Intensive Care Unit (NICU) infants are required to be adequate feeders. Feeding is a learned skill for NICU babies that is expected to “be there in waiting” after a long medical and or surgical admission. Effective feeding and subsequent weight gain in the NICU are the measures and skill to which a discharge ticket home is granted. Feeding can sometimes be overlooked in regards to its role in infant well being and parental confidence. Infants are admitted to surgical level 3 NICUs for many reasons, including prematurity, necrotising enterocolitis, intestinal perforations, gastroschisis, duodenal atresia, omphaloceles, therapeutic hypothermia, seizures, and oesophageal atresia /fistulas including genetic or metabolic abnormalities. Many of these illnesses have a very long course toward healing and recovery before oral feeding is introduced.

Lactation Consultants in the NICU are well positioned to ensure support of the family and medical team along the way, to optimize successful oral feeding upon discharge home.

This talk will look at some of the ways that parental presence and mom’s milk is therapeutic in the NICU, and how the progression of breastfeeding can be the ticket to going home.

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.

In this presentation, we will explore grief and baby loss from a first-world, Western perspective. We will reflect on how our attitudes to grief have formed and look at the differences between traditional and contemporary approaches to grief and the tension that lies between them. We will also discuss some of the different ways that baby loss is discussed societally – looking particularly at platitudes, euphemisms and the tendency to minimize a baby’s death. We’ll finish with an exploration of our own approach to supporting bereaved families - our philosophy of care. At the end of this presentation, participants will have an array of concepts to help reflect on the care they give to parents and families who have experienced the tragedy of neonatal death.

After decades of healthcare providers not recognizing newborn infants’ capacity to feel pain and the associated adverse outcomes, we now know that current evidence suggests that repeated procedural pain contributes to long-term changes in stress regulation and brain development in vulnerable preterm infants, after accounting for associated clinical confounders. Many medications are often not effective for the most commonly performed painful procedures, and their repeated and frequent use may have potential short and long-term adverse effects. Recent research has thus focused on finding non-pharmacological interventions or sweet tasting solutions as a substitute to pharmacologic treatments, or as a means to reduce the drug-doses needed for optimal analgesia associated with procedural pain. Several of these interventions involve parents, e.g., skin-to-skin care, breastfeeding, or facilitated tucking. Despite this knowledge, clinicians often struggle with incorporating these strategies into everyday practice. Moreover, most parents and many providers remain unaware of the powerful benefits of integrating parents as active participants in newborn pain management. This presenatation will cover interventions to address the treatment and prevention of procedural pain.

Long NICU stays, invasive oral procedures, chronic lung disease, and gastrointestinal complications can contribute to a complex oral feeding journey for premature infants. Frequently, the NICU journey prioritizes bottle feeding over breast feeding. Breastmilk supply and transfer are challenging for mothers and infants born very premature. At the time of NICU discharge, most very premature infants remain fragile oral feeders with weak breast-feeding and bottle-feeding skills, and some require tube feeding support. Community-based breastfeeding support is often lacking, and breastmilk intake and direct breastfeeding diminish beyond discharge. The authors will highlight four remarkable case studies of very premature newborns who were discharged home on nasogastric tube feeding. All four babies had a complex oral feeding journey in the NICU with minimal opportunity to develop breastfeeding skills. Parent comments will be shared, including barriers and facilitators for breastfeeding. Take away messages will focus on helpful strategies to support families taking home a fragile feeder and progressing toward positive, enjoyable oral feedings and more importantly, weaning from tube support and advancing breastfeeding.

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.