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Upcoming important dates, next steps for the Human Milk Well Baby Phase II Initiative...
(The HM Well Baby initiative's weekly email newsletter comes out every Wednesday.)
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...from Marty
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|  The AAP, in timely fashion and as PQCNC recommended (well, would have recommended if we were asked) released an updated policy statement on Breastfeeding and Human Milk this month.
Click here to view.
It has been six years since the prior statement was released. The updated policy is notable for its concise review of the maternal, neonatal and pediatric benefits of breastfeeding and human milk. The policy addresses care issues related to both the preterm and term infant. There is also detailed discussion regarding the incorporation of the Ten Steps into clinical practice in order to promote breastfeeding. You all should pat yourselves on the back after reading the statement. The AAP recommendations touch on all the areas that PQCNC EHM Well and NICU teams have proposed as key action plan elements.
Regarding term infants, the AAP encourages practices and hospitals to revise or discontinue disruptive hospital policies that interfere with early skin-to-skin contact, that provide water, glucose water, or commercial infant formula without a medical indication, that restrict the amount of time the infant can be with the mother, that limit feeding duration, or that provide unlimited pacifier use. The policy reviews opportunities for cultural change in the organization of the hospital services for the mother and infant dyad. These changes will require "medical and nursing culture to accept the premise that breastfeeding should begin within the first hour after birth (even for Cesarean deliveries) and that infants must be continuously accessible to the mother by rooming-in arrangements that facilitate around-the-clock, on-demand feeding for the healthy infant."
With respect to the preterm infant, the AAP notable reports that "mother's own milk, fresh or frozen, should be the primary diet, and it should be fortified appropriately for the infant born weighing less than 1.5 kg. If mother's own milk is unavailable despite significant lactation support, pasteurized donor milk should be used." We have seen this evolution in our collaborative. Infants previously supported with formula during the first week of life are increasingly being fed donor milk.
One potentially controversial element in our EHM Well definition for delivery room skin to skin contact is allowing separation of the mother and baby in order to quickly perform assessment and clinical procedures with return of the infant to the mother for a period of at least one hour. The AAP guidelines recommend "direct skin-to-skin contact with mothers immediately after delivery until the first feeding is accomplished and encouraged throughout the postpartum period." The policy statement suggests that providers "delay routine procedures (weighing, measuring, bathing, blood tests, vaccines, and eye prophylaxis) until after the first feeding is completed." Additionally it is recommended that there be a "delay in administration of intramuscular vitamin K until after the first feeding is completed but within 6 h of birth."
For those in the EHM Well initiative, this will be a discussion point on our next webinar.
Please review the new recommendations from the AAP regarding breastfeeding in light of your hospital's current practices and our initiative action plan. Likely we all will identify opportunities to improve. This month, as you are solidifying your EHM team and developing a process for data collection, also identify a critical opportunity to improve at your facility and begin the introduction of the proposed change.
PQCNC EHM Nursery has at least 25 teams participating and EHM NICU has 10. This will be an action packed 6 months. We made great progress in Phase 1. Time to put the hammer down and increase breastfeeding and human milk rates by 50% across the state!
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STUDY: BREASTFEEDING & EXPOSURE TO ANTIDEPRESSANTS
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|  Breastfeeding among women exposed to antidepressants during pregnancy was the focus of a study published online in the February edition of the Journal of Human Lactation. The study authors compared the breastfeeding outcomes of women exposed to antidepressants at the time of delivery, those who discontinued use prior to delivery, and those not exposed. Participants included 466 pregnant women who enrolled in the California Teratogen Information Service Clinical Research Program (CTIS) over 10 years. Those exposed to an antidepressant both prior to delivery and at the time of delivery were significantly less likely to initiate breastfeeding as compared to unexposed women. There appears to be a need for additional education and support for these women, in order to avoid poorer breastfeeding outcomes. To review the study click here...
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Welcome to HM Well Baby Phase II!
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|  1. If you are receiving this email you are on a team that is participating in HM Well Baby Phase II - if you think you have received this email in error please contact me. You will be receiving regular weekly emails (usually on Wednesday) that will share information and resources, keep you updated on your progress, and alert you to coming events.
2. The final version of the charter, the data collection form in both PDF and Word versions and the data dictionary have been posted to the HM Well Baby Extranet. (Please contact me if you do not have access to the Extranet as that is essential for retrieving documents and resources).
3. Remember, all teams should start data collection for Phase II as soon as possible. (Please contact me if you have questions)
4. If you are the data enterer for your team, the new data collection site online and accessible from www.pqcnc.org - select "Initiatives" from the right-hand menu, then "Milk (EHM4B)" , then "Well Baby Track", then "Well Baby Data II'. Your phase I data login and password will work for phase II as well. If you are new to the Initiative you will need to register for an account on the data site and I will then be able to give you access. (Please contact me if you have questions or have difficulty accessing the site.)
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HM Well Baby Monthly Webinar
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|  The March HM Well Baby Webinar is scheduled for Wednesday, March 28, 2:00 - 3:00 PM. Monthly Webinars are generally the fourth Wednesday of the month at 2:00 PM and last no more than an hour. The schedule for upcoming webinars is always available at the link below
to access the webinar.
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Contact
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Keith M Cochran
PQCNC Debrouillard
Keith_Cochran@unc.edu
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