Speaking of Human Milk

NICU dietitian Patti Perks and CICU dietitian Megan Horsley:Discuss published criteria for defining malnutrition in pediatric and neonatal populationsIdentify variables that impact nutrition and growthDiscuss the application and challenges of malnutrition criteriaIdentify potential outcomes of diagnosing malnutrition

In this episode:Neonatalogist Dr Evelyn D Rider talks about the benefits of early fortification with human milk–based fortifiers in babies born weighing

In this episode:Neonatal nurse Amy Paradis discusses the strategies used in her NICU to prevent late-onset sepsis and the evidence regarding the use of an Exclusive Human Milk Diet on reducing the incidence of and evaluations for late-onset sepsis.Show notes:Hair AB, Peluso AM, Hawthorne KM, et al. Beyond necrotizing enterocolitis prevention: improving outcomes with an exclusive human milk-based diet [published correction appears in Breastfeed Med. 2017;12 (10 ):663]. Breastfeed Med. 2016;11(2):70-74. doi:10.1089/bfm.2015.0134Delaney Manthe E, Perks PH, Swanson JR. Team-based implementation of an exclusive human milk diet. Adv Neonatal Care. 2019;19(6):460-467. doi:10.1097/ANC.0000000000000676Abrams SA, Schanler RJ, Lee ML, Rechtman DJ. Greater mortality and morbidity in extremely preterm infants fed a diet containing cow milk protein products. Breastfeed Med. 2014;9(6):281-285. doi:10.1089/bfm.2014.0024

In this episode:National health equity thought leader Jenné Johns discusses how health inequities and implicit bias in the healthcare system impact moms of color and preterm birth rates. She also shares how her own experience in the neonatal intensive care unit (NICU) motivated her to launch a virtual training academy focused on delivering health and racial equity educational programs for healthcare professionals who support the perinatal and neonatal community. Show notes:Once Upon a Preemie AcademyOrder Jenne's book Once Upon a PreemieContact Jenne to bring Implicit Bias training to your organization: info@onceuponapreemieacademy.com

Neonatal nurse Kim Carmignani discusses the evidence regarding the use of an Exclusive Human Milk Diet on reducing the risk of bronchopulmonary dysplasia (BPD) among preterm infants. References:1. Hair AB, Peluso AM, Hawthorne KM, et al. Beyond necrotizing enterocolitis prevention: improving outcomes with an exclusive human milk-based diet. Breastfeed Med. 2016;11(2):70-74. doi:10.1089/bfm.2015.0134. Published correction appears in Breastfeed Med. 2017;12(10):663. doi:10.1089/bfm.2015.0134.correx 2. Manthe ED, Perks PH, Swanson JR. Team-based implementation of an exclusive human milk diet. Adv Neonat Care. 2019;19(6):460-467. doi:10.1097/ANC.00000000000006763. Hair AB, Bergner EM, Lee ML, et al. Premature infants 750-1250 g birth weight supplemented with a novel human milk-derived cream are discharged sooner. Breastfeed Med. 2016;11(3):133-137. doi:10.1089/bfm.2015.01664. Lapcharoensap W, Bennett MV, Xu X, Lee HC, Dukhovny D. Hospitalization costs associated with bronchopulmonary dysplasia in the first year of life. J Perinatol. 2020;40(1):130-137. doi:10.1038/ s41372-019-0548-x 5. Assad M, Elliott MJ, Abraham JH. Decreased cost and improved feeding tolerance in VLBW infants fed an exclusive human milk diet. J Perinatol. 2016;36(3):216‐220. doi:10.1038/jp.2015.168

Registered dietitian Stacia Pegram discusses:Evidence regarding the use of a human milk caloric fortifier for preterm infantsRole of Prolacta’s human milk caloric fortifier as a part of an Exclusive Human Milk Diet (EHMD)Strategies for maximizing nutrient delivery in an EHMDShow notes:Learn more about Prolact CR®Prolact CR® Preparation GuidelinesRogers SP, Hicks PD, Hamzo M, Veit LE, Abrams SA. Continuous feedings of fortified human milk lead to nutrient losses of fat, calcium, and phosphorous. Nutrients. 2010;2(3):230-240. doi:10.3390/nu2030240 Hair AB, Blanco CL, Moreira AG, et al. Randomized trial of human milk cream as a supplement to standard fortification of an exclusive human milk-based diet in infants 750-1250 g birth weight. J Pediatr. 2014;165(5):915-920. doi:10.1016/j.jpeds.2014.07.005Hair AB, Bergner EM, Lee ML, et al. Premature infants 750-1250 g birth weight supplemented with a novel human milk-derived cream are discharged sooner. Breastfeed Med. 2016;11:133-137. doi:10.1089/bfm.2015.0166 Tabata M, Abdelrahman K, Hair AB, Hawthorne KM, Chen Z, Abrams SA. Fortifier and cream improve fat delivery in continuous enteral infant feeding of breast milk. Nutrients. 2015;7(2):1174-1183. doi:10.3390/nu7021174Knake LA, King BC, Gollins LA, et al. Optimizing the use of human milk cream supplement in very preterm infants: growth and cost outcomes. Nutr Clin Pract. doi:10.1002/ncp.10423

In this episode:Scott Eaker describes the stringent screening process for breastmilk donors to become Prolacta donors. Prolacta’s testing and manufacturing practices provide the safest and highest quality nutritional products for neonatal care. Bio:Scott Eaker is the chief operations officer at Prolacta Bioscience, responsible for operations, quality, regulatory affairs, and supply chain. Prior to Prolacta, Eaker worked at Baxter Healthcare, overseeing the development and deployment of standardized quality systems across multiple biologic and medical device manufacturing facilities in the U.S. and Europe.

Victoria Niklas, MD discusses the function of human milk oligosaccharides (HMOs) in newborns and their benefit to preterm infant healthThe impact of freezing, thawing and pasteurization on HMOsThe potential of HMOs in future health and wellness uses

NICU Nurse Amy Paradis discusses best practices for effectively and accurately measuring growth of premature infants in the NICUShow notes:NICU Nutrition Calculator App (iphone)Peditools.org to access Fenton 2013 Growth Chart, WHO Growth Chart, and Zemel Growth ChartCalifornia Perinatal Quality Care Collaborative Grow, Babies, Grow Toolkit

Dena L. Goldberg, PhD, RDN discusses the importance of identifying malnutrition in preterm infants and neonates and its role in improving clinical outcomesWe explore the recommended indicators of malnutrition in the preterm and neonate population developed by the Academy of Nutrition and Dietetics (AND) Pediatric Nutrition Practice Group (PNPG) committeeShow notes:Becker P, Carney LN, Corkins MR, et al. Consensus statement of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition: indicators recommended for the identification and documentation of pediatric malnutrition (undernutrition). Nutr Clin Pract. 2015 Feb;30(1):147-61. doi: 10.1177/0884533614557642Goldberg DL, Becker PJ, Brigham K, et al. Identifying malnutrition in preterm and neonatal populations: recommended indicators. J Acad Nutr Diet. 2018 Sep;118(9):1571-1582. doi: 10.1016/j.jand.2017.10.00

Dr. Martin Lee discusses the earliest research on the importance of human milk in the preterm populationThe story behind the development of the first and only 100% human milk-based fortifier for micropreemiesShow notes:Sullivan S, Schanler RJ, Kim JH, et al. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. J Pediatr. 2010;156(4):562-567. doi:10.1016/j.jpeds.2009.10.040Modanlou HD, Lim MO, Hansen JW, Sickles V. Growth, biochemical status, and mineral metabolism in very-low-birth-weight infant.J Pediatr Gastroenterol Nutr. 1986 Sep-Oct;5(5):762-7. doi:10.1097/00005176-198609000-00017Cristofalo EA, Schanler RJ, Blanco CL, et al. Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants. J Pediatr. 2013;163(6):1592-1595. doi:10.1016/j.jpeds.2013.07.011Abrams SA, Schanler RJ, Lee ML, Rechtman DJ. Greater mortality and morbidity in extremely preterm infants fed a diet containing cow milk protein products. Breastfeed Med. 2014;9(6):281-285. doi:10.1089/bfm.2014.0024