Advancing Human Milk & Breastfeeding Practices in the NICU Lecture Pack
Human milk and breast/chestfeeding are of critical importance for premature and medically fragile infants. Research in recent years has greatly enhanced knowledge of immunoprotective and immunomodulating properties of human milk. This package focuses on nutritional and medicinal aspects of human milk, along with the practicalities of pumping and handling milk and at breast/chest feeding in the NICU.
This lecture package was originally offered as part of the GOLD Neonatal Online Conference 2022.
Amber Valentine is a Speech-Language Pathologist who graduated from the University of Kentucky with her MS in Communication Disorders. She is a Board Certified Specialist in Swallowing and Swallowing Disorders and an International Board Certified Lactation Consultant, as well as a Certified Neonatal Therapist (CNT). She worked for Baptist Health Systems, Inc for 8 years before moving to Florida where she worked for Wolfsons Children’s Hospital and Mayo Florida. She is now back in Kentucky working for Baptist Health Lexington. She has experience in adults and pediatrics with feeding and swallowing difficulties including: bedside swallow evaluations, Modified Barium Swallow studies, FEES, and pediatric feeding evaluations including NICU. She has experience with head and neck cancer patient including evaluation and treatment of swallowing difficulties, PMV use, and voice after total laryngectomy including TEP. She has provided guest lectures for the University of Kentucky, Eastern Kentucky University, and the University of Louisville on feeding and swallowing topics. She has presented at the hospital, local, state, national, and international levels on pediatric feeding/swallowing and breastfeeding.
Topic: Breastfeeding Medically Complex Infants in the Neonatal ICU - [View Abstract]
Topic: Building a Successful Breastfeeding Program in the NICU: Challenges and Practical Solutions - [View Abstract]
1. Identify at least three populations at risk for feeding difficulty.
2. Explain at least two commonly seen characteristics in each of these populations that may adversely impact feeding.
3. List at least two strategies for each of the populations to enhance feeding success either at bottle or breast.
Feeding is the most complex task of infancy, even in term babies with no complications. There are many diagnoses, conditions, syndromes, and co-morbidities that can impact feeding in neonates and infants. This talk will briefly highlight many of those, but we will focus on three specific populations of interest –Cleft lip and palate, Infants of Diabetic Mothers, and Down Syndrome. We will discuss the specific implications these conditions can have on feeding, why these infants may have difficulty, and the classic symptoms one could expect to see. The differences between delayed and disordered feeding will also be addressed. Strategies and adaptions for both breast and bottle feeding will be discussed. Positioning, nipple flow rate, and external strategies will be explained. Case studies will be shared at the end of the presentation.
Dr.Fayrouz Essawy Pediatrician, Neonatologist, IBCLC • Neonatology Consultant • Bachelor of Medicine and surgery - Cairo University 2004 • Master degree of pediaterics - Ain shams University 2012 • Egyptian neonatology fellowship 2015 • IBCLC 2015 • LCCC course instructor & developer 2016 • Breastfeeding medicine specialist. • Baby friendly coordinator. • Harvard Graduate of Training of trainee program 2020. • Member of the Egyptian Society of Pediatrics • Member of the Egyptian lactation consultant association (ELCA) • Member of the academy of breastfeeding medicine (ABM) • Member of the international lactation consultant Association (ILCA)
1. Describe and differentiate the different types of human milk storage containers.
2. List the human milk storage times in different temperature for NICU use and for preterm and hospitalized babies in the room temp., refrigerator and freezer.
3. Describe how health care providers can handle breastmilk safely, thaw and use it in different settings and situations.
4. List 3 types of BM fortification and discuss how to handle fortified breastmilk.
The feeding of breast milk during the NICU admission reduces the risk of short-and long-term morbidities especially in premature infants. Breastmilk provides immunological, anti-infective, anti-inflammatory, epigenetic, and mucosal membrane protecting properties. The mechanisms by which human milk provides its protection are varied. These mechanisms include immunological and specific unique human milk components that are not present in formula. Thus, the feeding of mother’s own breastmilk should be a NICU priority and every NICU should have a breastmilk storage and handling policy. In this presentation we will discuss how we can counsel parents about the infection control measures and guidelines related to storage, handling and administration of breastmilk to babies in the NICU. Learn more about hospital grade pumps, pumping at home vs pumping in hospital setting, prevention and management of potential mistakes such as giving a child another mother’s milk and how to handle and store fortified breastmilk.
Jeanette Mesite Frem, MHS, IBCLC, RLC, CCE is an experienced childbirth educator, IBCLC-lactation consultant and retired birth doula. She started her career working with families while serving as a Peace Corps Volunteer in Côte d'Ivoire, West Africa in the early 90s. She loved that work so much she went on to receive a public health masters degree from Johns Hopkins School of Public Health, focusing her studies on nutrition for maternal and child health. Her two children were breastfed for more than 2 years each and Jeanette has experience pumping at work for both children and has supported more than a thousand families with feeding and pumping over the last 20 years.
Jeanette provides prenatal childbirth and breastfeeding classes at her office in Northborough, Massachusetts, as well as providing virtual and office feeding consultations. She also enjoys leading workshops for perinatal health professionals and mentoring those who work with families. If you have questions, feel free to email [email protected].
Topic: Pumping for Hospitalized Babies: 12 Keys to Supporting Families - [View Abstract]
1. List four basic principles of effective pumping for the hospitalized baby.
2. Explain the names of the parts of the pump and how to put them together.
3. List four smaller flange sizes that often work better for many pumping parents.
4. Describe the three main factors (FIT: feel, intensity and tempo) and multiple sub-factors that go into an effective pumping session.
Perinatal professionals in hospitals have great influence over how much human milk a baby receives, as well as how encouraged parents feel related to pumping and initiating and maintaining their milk production and eventually meeting their infant feeding goals. When hospital staff help with pumping in the early hours, days, and weeks of a new and fragile baby’s life—especially when at breast, chest or body feeding isn’t possible—getting that professional support is likely to make a difference in the long-term health of that child as well as the health of their parent. Healthcare providers can facilitate milk collection and provision of it to babies and support parents with specific and updated guidance on pump choices, pump usage, flange fit and milk storage. Those who work in hospitals with families can make an important positive impact on long-term breastfeeding and human-milk feeding rates. This session will cover 12 simple ways (including the what, why, how, when and where of pumping) that healthcare providers can support parents who pump for their hospitalized baby.
Mariana Colmenares Castano was born in Mexico City, and from an early age she was fascinated by animals and nature.She studied medicine at the National University of Mexico (UNAM), and foundher passion as a pediatrician doing her residency at the National Pediatric Institute. When her first child was born she witnessed the lack of knowledge and commitment to breastfeeding within the medical profession, and so she decided to specialize in breastfeeding medicine. She certified as a Lactation Consultant (IBCLC) in 2011.Mariana is a member of the International Lactation Consultant Association, the Academy of Breastfeeding Medicine, and a proud founding member of the National Lactation Consultant Association of Mexico (ACCLAM), where she served on the Board of Directors as Education Coordinator (2014-2019). She is part of board director for the Academy of Breastfeeding Medicine for a 3 year period (2019-2022) and recently named as secretary for the Academy of Breastfeeding Medicine. Mariana is a member of the team for Breastfeeding Country Index BFCI, a project from Yale University and Universidad Iberoamericana. She is consultant for the National Health Institute in Mexico and has collaborated with UNICEF in breastfeeding projects and part of the steering committee for the WHO. She has spoken at national and international conferences, co-published numerous articles and co-authored a chapter for the National Academy of Medicine. At the moment she is a Clinical Fellow in Community Paediatrics in London.
Topic: Breastfeeding The Baby With Congenital Heart Disease - [View Abstract]
Topic: Breastfeeding with Insufficient Glandular Tissue - [View Abstract]
Topic: Clinical Assessment and Management of Jaundice in the Newborn - [View Abstract]
Topic: Oral Colostrum Care as an Immunological Intervention in the NICU - [View Abstract]
1. Analyze the literature about oral colostrum care.
2. Explain the importance of immunity, neurosensorial integration and feeding in preterm babies.
3. Describe the clinical administration of oral colostrum care.
Breastmilk must be the food for every human on earth. During the last decades we have been learning much more about the immunoprotective and immunomodulating properties of human milk, specifically colostrum. With advancements in neonatal care, we also have new challenges. As health care professionals it is an ethical responsibility to protect and promote breastfeeding practices for every family. Oral colostrum care is the use of own mother's colostrum in the cheeks and mouth of the baby not for a feeding purpose. It is an opportunity to initiate an immunological intervention in small or sick babies, allowing interaction of immunological properties with the linfoid tissue, promoting and improving microbiome and immune response. The mother and the family can also benefit from this intervention improving and enhancing integral participation and prevalence of breastfeeding in the long term.
After 37 years as an attending neonatologist and 18 years as medical director of lactation services, Nancy retired from clinical practice 2019. She graduated from medical school and did her training in pediatrics at the University of North Carolina, Chapel Hill. She did her fellowships in Neonatal-Perinatal Medicine and ECMO at UCSD Medical Center in San Diego. She has been a board-certified lactation consultant since 1988.
Nancy co-founded the San Diego County Breastfeeding Coalition in 1994. She was the Breastfeeding Coordinator for AAP CA Chapter 3 from 1992 until 2020, Board Member of HMBANA 2015-2019 and established the first Donor Milk Depot in San Diego over 25 years ago. Nancy is a past president of the Academy of Breastfeeding Medicine. She wrote, and continues to update, the very first ABM Protocol on Hypoglycemia and Breastfeeding.
In 2014 Nancy was awarded the Golden Wave Award by the California Breastfeeding Coalition for her efforts to reduce obstacles to breastfeeding in California, and the WIC Breastfeeding Champion Award in 2017. She received AAP Special Achievement Awards in 1997 and 2021 for her breastfeeding education and promotion efforts.
On a personal note, she is the mother of a (formerly breastfed) archaeology student and lives in San Diego, CA, with her significant other, their dog, Darwin, and a beautiful view of the ocean.
Topic: NICU Nutrition: Best Practice for Best Outcomes - [View Abstract]
Topic: NICU Nutrition: Current Status, Opportunities & Challenges - [View Abstract]
1. Describe the major goals of nutrition for NICU infants.
2. Explain the importance of immediate nutritional support for preterm, low-birth-weight and ill infants.
3. Describe options for fortification for NICU patients, including post-discharge.
4. Describe components of a plan to transition infants to oral feeds.
5. List at least 4 “best practices” for optimal nutrition & outcomes.
In the neonatal period, low birth weight, preterm, and ill infants, regardless of gestational age, have greater nutritional needs than at any other time in their lives. Without the last trimester, the preterm infant faces the most demanding growth period with a nutritional deficit. For any NICU infant, the stress of medical conditions may contribute to increased nutrient needs. Human milk is a complex fluid that simultaneously provides nutrients and bioactive components that facilitate the adaptive, functional changes required for the optimal transition from intrauterine to extrauterine life. We will discuss the goals and methods of providing appropriate nutrition for NICU infants to promote optimal short- and long-term outcomes.
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.
1. Describe the state-of-the-art of human milk banking.
2. Define health protective benefits of pasteurized human donor milk for preterm infants compared to other populations of infants.
3. Compare the nutrient and non-nutrient differences between parent’s own and human donor milk.
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.
Accreditation
CERPs - Continuing Education Recognition Points
Applicable to IBCLC Lactation Consultants, Certified Lactation Consultants (CLCs), CBEs, CLE, Doulas & Birth Educators. GOLD Conferences has been designated as a Long Term Provider of CERPs by IBLCE--Approval #CLT114-07. This program is approved for 6 L-CERPs.
CMEs - Continuing Medical Education Credits for Physicians & Nurses
The AAFP has reviewed the activity and deemed it acceptable for AAFP credit. Term of approval is from 04/23/2023 to 04/03/2024. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity is approved for 6 AAFP Prescribed CME credits.
Dietetic CPEUs - Continuing Professional Education Units
Applicable to Dieticians & Nutritionists, this program is approved for 6 Dietetic CPEUs by the Commission on Dietetic Registration - the credentialing agency for the Academy of Nutrition and Dietetics.
Dietetic credits are valid until 04/03/2026.
Midwifery CEUs - MEAC Contact Hours
This program is accredited through the Midwifery Education & Accreditation Council (MEAC) and is approved for 6 Hours, the equivalent of 0.6 CEUs. Please note that 0.1 MEAC Midwifery CEU is equivalent to 1.0 NARM CEUs.
MEAC credits are valid until 04/03/2025.
Nursing CEUs - Nursing Contact Hours
This nursing continuing professional development activity was approved by the American Nurses Association Massachusetts, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation for 6 Nursing Contact Hours.
Nurse Contact Hours are valid until 05/31/2024.
- View this presentation in its entirety, under your individual GOLD login info
- Successfully complete a post-test (3 out of 3 questions correctly answered)
- Fill out the Evaluation Survey
If you have already participated in this program, you are not eligible to receive additional credits for viewing it again. Please send us an email to [email protected] if you have any questions.
Additional Details
Viewing Time: 4 Weeks
Tags / Categories
(IBCLC) Clinical Skills, (IBCLC) Development and Nutrition, (IBCLC) Education and Communication, (IBCLC) Equipment and Technology, (IBCLC) Infant, (IBCLC) Infant, (IBCLC) Maternal, (IBCLC) Pharmacology and Toxicology, (IBCLC) Physiology and Endocrinology, Breast and Nipple Pain, Breastfeeding Strategies for the Preterm Infant, Donor Human Milk for Preterm Infants, Evidence Based Care in Nicu, Family-Centered Care, Neonatology, NICU Nutrition & Feeding, Probiotics & Gut Microbiome
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