Category Archives: News

BFHI UNICEF Neonatal Conference reviewed by Mairead O’Sullivan

Having attended several previous BFHI UNICEF Conference physically I was enthusiastic as ever to attend this virtual conference. As a neonatal nurse IBCLC this conference gives a chance to see what other specialist are doing in their areas both in the UK and abroad working to increase neonatal breastfeeding practices. Working currently in the Irish maternity healthcare system it was way of looking at what we can do as IBCLC’s in Irish neonatal services to develop our practices towards BFHI standards.

 

The Conference was easy to register for through the organisations although registration did close 5 days beforehand so limited lastminute decision to attend. It was indicated at times throughout the conference and in the closing speeches almost 1,000 participants had registered from the event which has to show a hugely positive multi professional interest in healthcare professionals in continuing to develop breastfeeding support in line with BFHI standards specifically in Neonatal Units.

 

With a jam-packed agenda for 9am until 5pm consisting for 13 various speakers there was something for everyone to focus on, for purposes of review I truly found it difficult to pick a specific speaker and could have easily written about all topics covered. I decided as I work in a unit looking to change its structure and develop its breastfeeding support focus, I took particular attention to the following 3 speakers which I will discussion briefly what is each highlighted.

 

Renée Flacking, Professor in Paediatric Nursing, Dalarna University, Sweden “Positive breastfeeding experiences and facilitating factors” This speaker was one of the earlier in the day speakers and spoke passionately about the practices in Swedish neonatal units where rooming in and family centre care is at the paramount NICU/SCBU. Babies nursed all in single rooms where both parents or one parent were encouraged to say with their new-born and be involved in the care from the time of admission to NICU. This practices really encourages BFHI and WHO standards of rooming in, encouraging bonding, skin to skin, breastmilk expression or breastfeeding from the earliest possible stage, on occasions when mum needs specialist care she maybe cared for in a different ward, but partners are then encouraged to stay with new-born. This is something to be looked at in Irish healthcare as some maternity facilities look at upgrading their neonatal units should be aiming to implement. Renée was highly informative about how practices could be developed but also highlighted the comparison to neonatal nurse shortages in the UK to Sweden where they are adequately staff to facilitate this fantastic model of care.

 

Dr Sarah Bates, Consultant Paediatrician & Neonatologist, PERIPrem Operational Clinical Lead (SW England), BAPM & CRG Representative for LNU & SCU (UK), Great Western Hospitals NHS Foundation Trust. Spoke on “Improving survival and outcomes for preterm infants through optimising early maternal breastmilk: A QI toolkit from BAPM.’   Dr Bates spoke very passionately about the work her team have done in implementing the first stage of the BAPM Quality improvement toolkit ‘optimising early maternal breastmilk for preterm infant’ whilst discussing the teams current work in the finalising the next stage of the toolkit, due for release later in 2021. She spoke about how they implemented the plan with a focus on obtaining early maternal breastmilk for preterm infants, recognising that not enough neonatal infants receive breastmilk from the start of their feeding journey. Her quote by Bo Jackson “set your goals high and don’t stop til you get there” really rings out to me the passion of her and her team. The focus on the discussion was to have Maternal Expressed Breastmilk / Colostrum available for preterm babies as soon as possible. The concept of Antenatal harvesting of colostrum was discussed at a much earlier stage than what some recommendations now quote as 36+weeks GA. Sarah’s team speaks about addressing mothers in pending inevitable preterm deliveries an encouraging the establishment of hand expression of antenatal colostrum along with early support once baby(s) are born in establish collection of colostrum and breastmilk. The current 2020 toolkit if fully downloadable and accessible for all to review and having reviewed it after the conference I could see this is in being an extremely beneficial toolkit for all neonatal units in encouraging maternal breastmilk of preterm infants starting from antenatal discussion. I could honestly have listened to Sarah for a lot longer and look forward to hearing about the next stage of the toolkit.

 

Prof Paul Clarke, Consultant Neonatologist/ Honorary Professor, Norfolk and Norwich University Hospitals NHS Foundation Trust & University of East Anglia lecture on ‘Delivery room cuddles for extremely preterm babies and parents . Although this speaker was one of the last of the day his discussion on the concept of offering Cuddles to new-born extreme preterm baby’s immediately after intubation/ stabilisation rang home a lot of thoughts with me. It was an extremely inspiring thought-provoking talk knowing that preterm babies are generally at their most stable immediately after delivery and that this could in fact be the most joyous memory that these parents may be able to have with their new-born or the only cuddle they may have for several weeks and days recognising its importance for maternal wellbeing and aiding in the recovering from the shock associated with preterm delivery. Prof Clarke highlights the idealism of having a well-trained team available in order to facilitate this initial cuddle with no focus on duration of cuddle only that baby is respiratory stable, and parents are allowed that initial chance to bond with their new-born before neonatal admission. Prof Clarke user of service user stories throughout his presentation and conclusion draws reality on the families who thank s to this concept are now benefiting hugely and along in some circumstances their preterm infant may not have lived for long that memory of the initial cuddles lives on forever. A truly inspiring speaker.

 

Mairead O’Sullivan July 2021. 

Mairead received a bursary of €100 from ALCI to attend the online BFHI UNICEF Neonatal Conference.

ALCI All Ireland Breastfeeding Conference 2021

The Association of Lactation Consultants of Ireland (ALCI) will be hosting its annual Conference online this year, to enable members to update their knowledge and skills while staying apart to stay safe. The Conference will be live on Saturday 2nd October and is open to members and non-members alike. There is a fantastic line up of speakers including keynotes speaker Cathy Watson Genna and Dr. Jenny Thomas. Here is the ALCI Conference 2021 Timetable.

Catherine Watson Genna BS, IBCLC is an International Board Certified Lactation Consultant in private practice in New York City. Certified in 1992, Catherine is particularly interested in helping moms and babies breastfeed when they have medical challenges. She speaks to healthcare professionals around the world on assisting breastfeeding babies with anatomical, genetic or neurological problems. She is the author of Selecting and Using Breastfeeding Tools: Improving Care and Outcomes and Supporting Sucking Skills in Breastfeeding Infants 3rd edition.  Catherine served as associate editor of the journal Clinical Lactation, and researches breastfeeding biomechanics with Columbia and TelAviv Universities.

Dr. Jenny Thomas is a paediatrician and breastfeeding medicine specialist at in Franklin, Wisconsin and is a Clinical Assistant Professor of Community and Family Medicine and Paediatrics at the Medical College of Wisconsin (MCW). She received her MD from MCW in 1993, and her MPH in 2011. She has been an International Board Certified Lactation Consultant (IBCLC) since 2003. She is now serving on the American Academy of Paediatrics (AAP) Section on Breastfeeding Executive Board after spending several years as the Chief of the Chapter Breastfeeding Coordinators. She is the author of “Dr. Jen’s Guide to Breastfeeding.” She is one of only a few physicians internationally to be recognized as a Fellow of the Academy of Breastfeeding Medicine (FABM) for her expertise on breastfeeding. Dr. Thomas’ interests and research have focused on issues related to the use of social media to support breastfeeding mothers.

There will be three case studies on the day with speakers including ALCI Past President Margaret Hynes IBCLC who will address a case study of breastfeeding following a mastectomy, Patricia Marteinsson IBCLC who will address a case study of severe breastmilk overproduction, and ALCI Immediate Past President Sue Jameson IBCLC who will address cleft palate. Other presentations will include a National Update, a session on Reflux with Carol Smyth IBCLC, a session on Therapeutic Ultrasound with Kathryn Downey IBCLC and Mairead McCahill-Riley IBCLC and a session on Infant Mental Health with Marie Meagher Crowley IBCLC and Rosarii O’Donnell. During the live event, participants will be welcome to submit questions and time will be allocated at the end of each session for answers. The Conference will be recorded and made available for a further month for delegates to watch.

The Conference will include a Poster Competition and the announcement of the six winners of the Scholarship Competition. Bursaries are available for ALCI members. ALCI are proud to be offering online education to members, while staying apart to stay safe. The Conference costs € 35 for members, € 25 for members over the age of 65, € 25 for fulltime undergraduate students and € 65 for non-members (if registered before Friday 10th September). New memberships are welcome with membership lasting until January 31st 2022. Email info@alcireland.ie with any queries. Book here.

 

Here is the ALCI Conference 2021 Timetable

Why Infant Reflux Matters Reviewed by Kathryn Downey PHN IBCLC

Why Infant Reflux Matters is another concise book by Pinter and Martin in the series of why it matters. This publisher has previously presented a range of topics from fertility through to starting solids and all in between. However, this latest title delivers a wealth of information from a renowned Reflux and feeding expert Carol Smyth. Smyth imparts her own experiences as a mother coupled with the in-depth investigations she has pursued in unravelling the modern-day conundrum of infant reflux. In this enlightening read, marrying reflux symptoms together with evidence, she proposes and acknowledges the misinterpretations of normal newborn behaviours and societal expectations which differ tremendously from the needs of our exterogestates.

 

Smyth presents her topic in two parts. Part one is a series of chapters addressing the question what is Reflux. She identifies how so many normal newborn behaviours could indeed be misinterpreted or lead to a series of misinterpretations for parents. Smyth draws on her own experiences as a breastfeeding parent as well as that of her interaction, assessment and support for the many women and infant’s she has supported on their breastfeeding journey. She further explores the cultural diversities of infant care and interpretation of need that is drifting further from accepted societal perceptions of that care. She clearly acknowledges that we as mothers and parents have been persistently fed inaccurate expectations regarding our infant’s behaviour.

 

Smyth delves into Exploring symptoms grouping these into categories covering Feeding Behaviours, Unsettled Behaviours and Medical Issues. Working through these categories Smyth reverts to the imperative and paramount need for a complete feeding assessment with a specialist to truly identify the cause of the symptoms before attributing these to GORD (Gastro Oesophageal Reflux Disease). She further explains concisely what reflux and GORD are and the positives and negatives of the available treatments.

 

She further discusses co-regulation and dysregulation to show us clearly how the infant system actually works. And herein, she offers us all, as practitioners and parents an opportunity to understand how we can switch from merely surviving to thriving during the fourth trimester.

 

This is a very concise and informative book, quick to read and practical to use. It has a logical progression and obvious evidence base. As an IBCLC I would most definitely recommend this book to Health Care Professionals caring for young babies as well as to parents who are struggling with reflux symptoms and looking for answers. A most unputdownable read.

Liz Greene “Breastfeeding the Late Pre-Term Infant (LPTI)” Reviewed by Jenni Ashcroft

Breastfeeding the Late Pre-Term Infant (LPTI) was a presentation at the 2021 ALCI Spring Study Day by Liz Greene RGN, RM, RNT, IBCLC

 

Liz opened by acknowledging that we are seeing more of these late preterm infants (LPTI) due to a rise in the incidence of multiple birth pregnancies and resulting earlier gestation births, which in turn leads to a higher prevalence of feeding difficulties and increase in additional support required.

 

The LPTI is classified as 34+0 -36+6 week gestation, with moderate preterm infants (MPTI) being classified as 32+0 – 33+6 week gestation. Normal weight at 34+0 weeks (female and male respectively) >1.6-1.7kg and at 36+6 (female and male respectively) >2.2kg -2.3kg. This highlights the range of weight, maturation and significant development that is missed during this three-week period in utero.

 

British association of perinatal medicine (BAPNM) acknowledge that LPTI have specific needs that require more attention, and have established a working group for health care professionals; “Management of moderate preterm infants framework for practice” first draft is being prepared.

 

Alongside earlier gestation birth it is important to also acknowledge whether the LPTI was growth restricted in utero. Low birth weight is classified as <2.5kg – if body weight was <2nd centile for gestation the baby is smaller than average – resulting in less body fat and energy reserves which will impact upon oral feeding abilities. For this reason, despite maternal breast milk for LPTI infants being higher in protein and more tailored to increased requirements of the LPTI compared to the term infant, fortification of breast milk is often indicated particularly if growth restriction in utero or if growth has faltered since birth, static weight gain, concerns with length or head circumference etc. Donor milk is valuable for this cohort of infants but important to recognise nutritional limitations, and therefore these infants may require specific preterm infant formula to help meet increased nutritional requirements.

 

Liz highlighted the increasing role of Neonatal dietitians within this setting to improve the care and outcomes these infants and their families are experiencing and the balancing act that is required between volume targets, fluid requirements and growth targets, and establishing oral feeding successfully.

 

Anyone who is helping the mother to feed her late preterm infant should think about what has baby’s story been so far so that care can be individually tailored to infants’ needs – admission criteria for NNU vary between units. We know the LPTI is at increased risk of:

  • Respiratory Distress Syndrome -reduced surfactant
  • Hypothermia -reduced body weight and body fat
  • Hypoglycaemia
  • Jaundice
  • Poor feeding -natural consequence is that baby has less energy available to feed vs challenges
  • Suspected sepsis
  • Increased risk of readmission following discharge

Ignition of BF usually encouraged from 32 weeks, bottle-feeding often from 33-34 weeks gestation. Individual assessment of oral feeding readiness is crucial -importance cannot be overlooked or underestimated particularly if goal of parent is to breastfeed.

 

Benefits of having a tool to undertake individual assessment

  • Safe transition to oral feeding is key by assessing pace of baby’s developmental readiness
  • Reduce problematic feeding issues in the future
  • Working beyond the hospital stay and safeguarding future feeding
  • Minimise feeding issues
  • Focuses on readiness and ability of PTI

PIOFRAS (preterm infant oral feeding readiness assessment scale) and PIBBS (Preterm infant breastfeeding behaviour scale) focused on as specifically look at infant readiness rather than assessing feeding once already established with the aim to not start at pace beyond infant’s ability.

 

PIOFRAS

  • Gestation of baby looked
  • Non-nutritive suck used as starting point for feeding readiness and baby behavioural state -oral and body positions, reflexes etc.
  • Movement of tongue -cupping, movement and sucking strength
  • Babies alertness also looked at
  • Stress signs during non-nutritive sucking -saliva accumulating, nasal nares trembling, colour changes or apnoea, tone changes, hiccupping, crying, refusal etc.
  • Visual or felt observation on finger
  • This tool was envisaged to be undertaken by oral therapists – limitations of staffing and skill set available

 

PIBBS

  • Completed by the mother
  • Advantage -similar to previous tool -rooting, suck, swallow, alertness, time baby actively sucking/swallowing, but also how mother feels baby is feeding

 

How can we support optimal feeding for mother and the late preterm baby?

Well documented that nasogastric tube feeding (NGT) and orogastric tube feeding (OGT) and bottle feeding standard practice with this cohort of infants.

  1. Breastfeed/Hand express (HE) within 1 hour of birth
  • The reason for birth between 34+0 -36+6 gestation may have required operative or assisted birth, oxytocin release could be inhibited by stress related to birth
  • If either mother and/or baby requires medical and midwife/nursing care at birth, support mother to HE and collect colostrum as soon as possible
  • Offering pictures of baby to aid HE of colostrum
  1. Kangaroo care (KC) -want to facilitate as much as possible but realistic challenges i.e., space on NNU, maternal comfort, seating available -recliner i.e., laid back BF, if available they enhance the care available. Restricted growth infants can be difficult to hold. Gentle swaddle/cushions can be important to facilitate
  2. Regular BF/expression and double electric pumping of breast milk -PTI may not have adequate strength suck to stimulate milk removal -therefore breast pump crucial if milk not being removed. Importance of keeping mother updated on infant’s progress if separated and providing photos to support with lactogenesis II

 

Keeping LPTI and mother together (“rooming in”/transitional care) increases:

  • STS/KC
  • BF initiation
  • Lactogenesis II
  • Use of cup/tube feeding as alternate to bottle teats
  • Likelihood of BF continuation

Not all units have transitional care services, not a “place” but tailored support to these mothers and babies, increased workload to staff needs to be recognised

 

Readiness for feeding Signs baby is not ready for feeding
Rhythmic sucking noted during non-nutritive sucking Baby is sleepy – eyes are closed
Baby putting fingers in and around mouth Irregular or spaced-out sucks
Baby is awake and alert Disorganised suck-swallow-breathing
Rooting behaviours Messy feeder
Flexed arms and legs, midline positioning Extended posture and poor tone
Refusal to suck-swallow or complete a feed
Colour change, apnoea

 

 

If we push oral feeding too much -negative future feeding behaviours are likely

 

Cup feeding:

  • Can be commenced from 32 weeks onward
  • Baby is using lips, tongue, jaw, which will help to develop, suck skills
  • Can be messy -that is the norm
  • Increased BF continuation
  • Reduces bottle teat usage
  • Unsure if this increases length of stay in hospital
  • Cup feeding is infant driven -babies can lap milk earlier

 

“At breast” supplementer:

  • Evidence of its success >37+0 weeks gestation
  • Further research is need for LPTI
  • Pre-requisites – readiness to feed, maintain a good latch, organised sucking and swallowing
  • Known challenges – fiddly, cost of tubes, tube blockage or dislodged

 

Finger feeding:

  • Suitable from 32+0 weeks onward
  • Useful if baby has sucking/latching difficulties
  • Breastmilk or alternative in a container level to baby or lower
  • Tube taped to index finger

 

Elevated side lying:

  • Acknowledges developmental stage of baby
  • Recommended in NNU and transitional care settings
  • Mimics cross cradle BF hold and paced feeding therefore easing the transition back to breastfeeding

 

“Prompts” that can lead to negative feeding behaviours

  • Suddenly waking baby and commencing an oral feed
  • Rubbing/moving baby’s jaw to suck-swallow
  • Increasing the milk flow
  • Chin and cheek support
  • “Jiggling” the teat to encourage sucking/swallowing
  • Tilting back baby’s head and neck during suck-swallowing

 

What are the key messages for supporting a mother to breastfeed her LPTI:

– Facilitate STS as often as possible

– HE and use of double electric breast pump in early days/weeks

– Individualised advice and support for mother based on observation of baby’s readiness for oral feeding

– Avoid/minimise separation of mother and baby

– Transitional care

– Tube and cup feeding increase likelihood of BF continuation

 

Jenni Ashcroft April 2021.

Jenni received a bursary of €100 from ALCI to attend the online ALCI Spring Study Day 2021.

New Guidelines for IBCLC Certifying and Recertifying from 2020 and beyond

by Lorraine O’Hagan IBCLC.

 

Here is a spreadsheet of the clinical practice calculator  from the IBLCE site. It is a good example how to document hours.
Here is a presentation made by Lorraine O’Hagan IBCLC at the 2021 ALCI Spring Study Day.
Here is the link to the Recertifying information on the IBLCE website.