Academic Day for Neos: CHOC
Date: Nov 12 – Nov 12, 2014
Location: TBD


Neonatal Pharmacology Conference
Date: Nov 12 – Nov 14, 2014
Location: TBD


Fetus And Newborn
Date: Nov 12 – Nov 15, 2014
Location: Las Vegas, NV


Quality Summit
Date: Nov 20 – Nov 22, 2014
Location: San Diego, CA


NCANN Conference
Date: Dec 5 – Dec 5, 2014
Location: San Francisco


Hot Topics in Neonatalogy
Date: Dec 7 – Dec 10, 2014
Location: Washington D.C.


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January 2014

Greetings from the Prolacta Team

LATCH… "to acquire understanding of, to comprehend"

Prolacta Bioscience continues its work as a pioneer and leader in providing educational opportunities in the use of human milk in term and preterm infants. The First International Conference on Human Milk Science and Innovation was recently held in Southern California. This inaugural meeting, sponsored by Prolacta Bioscience, focused on progress towards evidence-based nutrition, scientific advancement, and clinical experience with a human milk diet in the neonatal intensive care unit (NICU). This new scientific forum for the latest thinking in human milk studies was well attended by renowned scientists and neonatologists from the United States., Canada and Europe. It will be an annual consortium dedicated to innovation and scientific advance in the field of human milk.

The conference was co-chaired by J. Bruce German PhD, Professor in Food Science and Technology, Director, Foods for Health Institute, UC Davis, and Dr. William Rhine, Professor of Pediatrics, Stanford University. The program covered a broad array of topics from innovative basic research, to more advanced human milk-related clinical research. This two-day conference delivered data that had not been previously presented in a public forum. Topics included Milk: A Model of Diet and Health for the 21st Century; Gut Health Studies and Human Milk; Use of Human Cream to Boost Calories in Breast Milk; and A New Standard for Quality and Safety in Human Milk Collection and Processing.

"The First International Conference brought scientists from around the world to see a whole new vision for infant nourishment and protection in the NICU for the 21st century,"said Dr. German. "The scientific studies of human milk, revealed by the tools of genomics, are making it possible to understand infant nourishment as never before and provide premature infants with a better path to lifelong health." The event marks the first of its kind, focusing on collaboration in the science of human milk as it relates to extremely premature infants. It comes at a period of burgeoning interest in the use of human milk in the NICU, particularly among premature infants born weighing less than 1250 grams. "The conference was both educational and motivating," said Dr. Rhine. "By discussing numerous studies about human milk with our basic science and clinical colleagues, we now have a better understanding of the biology and medical evidence that should be driving our nutritional choices for babies."

Prolacta Bioscience remains committed to extend its mission of "making a meaningful difference in the lives of thousands of the most vulnerable infants through world class research and innovative products" by providing the health care professional with education on evolving research, current clinical issues, and emerging practice strategies relevant to the care of the premature infant and sick newborn.

Terry S. Johnson, APN, NNP-BC, MN, CLEC
Neonatal Nurse Practitioner
Editor, Prolacta eNewsletter

Necrotizing Enterocolitis Risk Assessment with GutCheckNEC
 

An increasingly vocal cohort of NICU clinicians has been successful in reducing necrotizing enterocolitis (NEC) incidence (Benjamin, Chong, Reynolds, & Gordon, 2012; El-Dib, Narang, Lee, Massaro, & Aly, 2011; Patole, McGlone, & Muller, 2003; Sullivan 2009). Leaders in units with low NEC rates have prioritized feeding of human milk, use of a feeding protocol, and judicious use of antibiotics to avoid over-exposure. A recent quality improvement collaborative in California reported a reduction in NEC from 7% to less than 3% when a change package of prevention practices - including colostrum for oral care, preferential human milk feeding, and use of a standardized feeding protocol - was adopted across 11 NICUs. This initiative was heavily reliant on nursing involvement (Lee et al., 2012).

Nurses are powerful patient advocates and can work with physician leaders to encourage the adoption of a standardized approach to feeding (Gephart & Hanson, 2013) and to make donor milk available when mother's milk is not. In addition the nurse's critical role and physical proximity to the premature infant affords early assessment of changing clinical status in the infant. University of Arizona College of Nursing assistant professor Sheila M. Gephart, RN, PhD, is refining a first-of-its-kind early recognition score for NEC called GutCheckNEC (http://www.nann.org/enews/May-2013/feature.html). The working hypothesis for this three phase PhD dissertation study is that NEC risk increases when multiple risk factors occur.

GutCheckNEC is a 10-item risk assessment originally developed by Dr. Gephart using data from nearly 60,000 infants cared for in 284 NICUs across the United States. During her pre-doctoral fellowship funded by the National Institutes of Health National Institute of Nursing Research, Dr. Gephart found that GutCheckNEC successfully predicted neonatal risk for NEC. Through a unique academic-clinical partnership with Banner Health in Phoenix and the University of Arizona College of Nursing's Laurence B. Emmons Research Fund, Dr. Gephart and her colleagues are determining how GutCheckNEC can best help clinicians diagnose NEC in real time. The three clinical sites for the study are Cardon Children's Medical Center/Banner Desert Medical Center, Banner Thunderbird Medical Center and Banner Estrella Medical Center. Dr. Gephart's ultimate goal is to make GutCheckNEC fully-automated and integrated into electronic health records to alert clinicians as to when NEC is developing.
 

Contaminated Breast Milk Purchased on the Internet



Sharing human milk between those with an abundant supply and those seeking milk for their child has a historical precedent. However, the selling of breast milk has been growing in popularity over the last couple of years, facilitated by Web sites established to link providers and recipients. The Food and Drug Administration (FDA) recommends against feeding milk obtained in this way, and the American Academy of Pediatrics (AAP) discourages feeding preterm infants fresh milk from unscreened donors. Concerns about the informal sharing of unpasteurized milk include the potential for infectious disease and exposure to chemicals, pharmaceuticals, and drugs.

Results from a study led by researchers at Nationwide Children's Hospital found more than three-fourths of breast milk samples purchased over the Internet contained bacteria that can cause illness, and frequently exhibited signs of poor collection, storage or shipping practices. The study, led by epidemiologist Sara Keim, PhD and published in the November issue of Pediatrics, is the first to examine the safety of selling breast milk to others over the Internet (http://www.eurekalert.org/pub_releases/2013-10/nch-ssb101513.php) . It is unknown exactly how common purchasing breast milk online is, but an earlier study cited 13,000 postings were placed on U.S. milk sharing websites in 2011.

The research study was performed with a team from the Center for Biobehavioral Health at the Research Institute at Nationwide Children's Hospital in collaboration with Cincinnati Children's Hospital Medical Center and the Ohio State University. A cross-sectional sample of human breast milk was purchased via a popular US milk-sharing Web site. Individuals advertising milk were contacted to arrange purchase, and milk was shipped to a rented mailbox in Ohio. Sellers were offered the advertised price and encouraged to choose whichever commercial shipper and service, ice, and packing materials they believed to be appropriate. The Internet milk samples (n = 101) were compared with unpasteurized samples of milk donated to a milk bank (n = 20).

Most of the internet milk samples (74%) were colonized with Gram-negative bacteria or had >104 colony-forming units/mL total aerobic count. They exhibited higher mean total aerobic, total Gram-negative, coliform, and Staphylococcus sp counts than milk bank samples. Growth of most species was positively associated with days intransit (total aerobic count [log10 colony-forming units/mL] b = 0.71 [95% confidence interval: 0.38 - 1.05]), and negatively associated with number of months since the milk was expressed (b = 20.36 [95% confidence interval: 20.55 to 20.16]), per simple linear regression. No samples were HIV type 1 RNA-positive; 21% of Internet samples were cytomegalovirus DNA-positive. The study authors concluded that "human milk purchased via the Internet exhibited high overall bacterial growth and frequent contamination with pathogenic bacteria, reflecting poor collection, storage, or shipping practices. Infants consuming this milk are at risk for negative outcomes, particularly if born preterm or are medically compromised".

"I Have Faith in My Milk": The Meaning of Milk for Mothers of Very Low Birth Weight Infants Hospitalized in the Neonatal Intensive Care Unit


The authors of a recent study with the above title appearing in the Journal of Human Lactation (http://www.ncbi.nlm.nih.gov/pubmed/23599267) note that "For women who give birth prematurely, the transition to motherhood often begins with a complicated labor and birth, followed by separation from their critically ill infants and acute emotional vulnerability. Maternal reactions to this situation include shock, sorrow, confusion and uncertainty." There is documentation in the literature that supports focused strategies to facilitate maternal role attainment during the NICU hospitalization including fostering maternal information seeking, skin-to-skin care, direct caregiving, and providing her milk. Robust evidence exists that a mother's own milk is critical to reduce the risk of specific morbidities in premature babies. Providing one's milk for one's premature baby has also been seen as the "one thing that only a mother can do."

This recent study by Rossman, Kratovil, Greene, Engstrom & Meier is part of a larger longitudinal, multi-methods study that combined quantitative measures with a qualitative maternal interview to determine the association among maternal psychological distress, maternal visitation, provision of breast milk, parenting behaviors, and developmental-behavioral outcomes for very low birth weight (VLBW) infants. A convenience sample of women meeting the following criteria was recruited: mother of a VLBW infant hospitalized in an NICU and expected to survive; maternal age ≥ 18years; able to speak English; and without a previous infant hospitalized in a NICU. During the digitally recorded, approximately one hour interviews, the mothers were asked only one specific question related to providing milk: "You've been providing milk for your baby since he/she has been born. Could you please describe what that means to you?"

A total of 23 mothers VLBW infants participated in the study. The mothers stated they had "faith in the healing properties of their milk" and though the "most important thing they could do for their infants was to provide milk". Mothers equated providing milk with "giving life to their infants" and hoped their milk would "mitigate" complications of prematurity. The mothers stated that providing milk for their infants also helped the maternal healing process and facilitated bonding and connecting with their infant.

Role of Fathers on Breastfeeding: Initiation, Exclusivity, Continuation

It has been postulated that informal sources of support, particularly by the male partner, have more influence on breastfeeding behaviors than formal support from health care providers. A recent study by Kristen M. Mitchell-Box, DrPH at the University of Alaska Anchorage and Dr. Kathryn L. Braun, DrPH at the University of Hawaii Honolulu appearing in the Journal of Human Lactation (http://jhl.sagepub.com/content/29/4/473) examined the impact of male-partner-focused interventions on breastfeeding initiation, exclusivity, and continuation.


Enhancing social support of the breastfeeding woman is one of the main strategies identified by WHO and UNICEWF for increasing breastfeeding rates. A comprehensive review about fathers and breastfeeding (Bar-Yam and Darby, 1997) concluded that fathers are an important influence on breastfeeding initiation and continuation. Other research suggests that many male partners prefer breastfeeding and believe it is the most natural and healthy choice for mothers and baby (Rempel & Rempel, 2011). There is also evidence form the literature that suggests many men do not feel that the method of feeding is their decision and they feel left out of the mother-baby relationship (Avery & Magnus, 2011).

The authors performed a systematic review of published articles identified in PubMed, PsychInfo, CINAHL, and the Cochrane Database of Systematic Reviews. Included articles were from English language, peer-reviewed scientific journals. Of the 535 articles originally identified, only 6 articles reporting on 4 unique male-partner breastfeeding interventions that were tested using a rigorous design - 2 by randomized controlled trial and 2 by quasi-experimental design met criteria for inclusion.

Intervention components included Education: (1) breastfeeding health benefits for mother, baby and family; (2) why male partners are an important and necessary part of the infant feeding decision-making process; and (3) strategies they could use to support breastfeeding. Open Discussion: promotion of open discussion with the educator so the father could ask questions and get help with challenges. Educational Materials: including written materials and videos demonstrating breastfeeding, baby care, and how men can support new mothers by taking active roles in household chores and child care. Incentives: were provided to attend the breastfeeding educational programs, to meet certain breastfeeding goals, or to provide follow-up data. Follow-up Support: Participating mothers received follow-up visits or calls for data collection in all studies.

The authors concluded that despite recommendations to target male partners in breastfeeding education only ten interventions targeting the partner and only 4 were rigorously tested in the literature. They also concluded that interventions were effective in increasing breastfeeding initiation, exclusivity and continuation but more effort is needed to understand how these services should be delivered (e.g., by professionals or peer dads) and supplemented (e.g., follow-up contacts or incentives) to improve outcomes.

To learn more about Prolacta's human milk products, please go to www.prolacta.com.