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

This session will highlight important aspects of resuscitation and stabilization of the neonate with an evidence based approach to clinical practice. Through case based examples, the audience will explore how effective communication, interprofessional collaboration and reference to clinical care pathways can promote patient safety and quality of care for the most vulnerable neonatal patients. Learners will gain a better understanding of the triage process and the preparation of patients for acute care transport. The session will conclude with a review of the ‘lessons learned’ from transport case presentations and their outcomes.

How much crying is too much crying? When parents reach out with questions about their babies crying, what parameters are available to help guide them to understand their infants? This session will aim to guide professionals who support the newborn family, including offering guidelines for number of hours that are considered normal, descriptions of high and low criers, timelines of expected crying, and solutions and alternatives when the typical approaches don’t seem to work. Utilizing the research on the Crying Curve--a pattern of crying beginning at about 42 weeks of gestation, peaking at 6-8 weeks of age, and sharply declining by 12-15 weeks--parents can navigate newborn life according to their gestational age. 15 different studies have concluded that this pattern is common across infants of all cultures, gestational ages (based on a 40-week gestation), and parenting styles—and the applications are many in the early parenting world. Help families learn to utilize this model to help assess their newborn. Multiple models of interpreting newborn crying from body language to sound and tone to help interpret newborn needs will be shared. Let’s move beyond reassuring parents that “colic” will end by 3 months and offer them solutions and alternatives.

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.

It’s time to rethink how we teach breastfeeding. This session describes the science on early positioning and its implications to our current epidemic of breastfeeding problems. It includes an overview of research on hands-on versus hands-off help, the hardwiring mothers and babies bring to breastfeeding, and a simplified breastfeeding initiation strategy with checklist designed to reduce the incidence of the three most common early breastfeeding problems: nipple pain, latching struggles, and concerns about low milk production.

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.

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.

Carol will explain how the sources of tongue and oral dysfunction aren’t always in the mouth. Sometimes the gold is buried elsewhere. She will discuss torques and twists in the body that extend into the floor of the mouth and express themselves as a lack of tongue mobility. She will discuss how fetal lie and restricted fetal mobility cause babies to grow in ways that negatively impact their breastfeeding. These things may masquerade as and/or exacerbate tongue mobility issues disguised as short frenula. Carol will also explain the CST treatment approach for these babies.

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.

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.