Top Banner

of 20

PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

Apr 09, 2018

Download

Documents

kcochran
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    1/20

    Establishing Milk SupplyEstablishing Milk SupplyProvide Early and Continuous SupportProvide Early and Continuous Support

    to Obtain Mothers Colostrum and Milkto Obtain Mothers Colostrum and MilkFocus Area 1Focus Area 1

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    2/20

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    3/20

    Establishing and Maintaining anEstablishing and Maintaining an

    Abundant Milk SupplyAbundant Milk Supply PumpPumpdependent women atdependent women atrisk for delayed lactogenesisrisk for delayed lactogenesisand inadequate milk volumeand inadequate milk volume

    Recent studies of lactationRecent studies of lactationinterventions in pumpinterventions in pumpdependent women report milkdependent women report milkvolumes similar to thosevolumes similar to thoseobserved in mothers of fullobserved in mothers of fullterm breastfeeding infantsterm breastfeeding infants

    Running out of milk is at leastRunning out of milk is at least

    partially iatrogenicpartially iatrogenic Implementation of evidenceImplementation of evidence--

    based best practices maybased best practices mayreduce insufficient milk volumereduce insufficient milk volume

    Cregan MD et al: Acta Obstet Gynecol Scand81. (9): 870-877.2002Morton J. J Perinatol29. (11): 757-764.2009Meier PP. Breastfeed Med3. (3): 141-150.2008

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    4/20

    Establishing and Maintaining anEstablishing and Maintaining an

    Abundant Milk SupplyAbundant Milk Supply Begins in pregnancy withBegins in pregnancy withbreast anatomic andbreast anatomic andphysiologic changesphysiologic changes

    Around 20 weeks gestationAround 20 weeks gestationmammary glands aremammary glands aresufficiently developed tosufficiently developed tosecrete a small amount ofsecrete a small amount ofcolostrum (Lactogenesis I)colostrum (Lactogenesis I)

    Milk secretion suppressed byMilk secretion suppressed byhigh circulating levels ofhigh circulating levels of

    progesterone.progesterone. After the delivery progesteroneAfter the delivery progesterone

    levels decline rapidlylevels decline rapidly

    Lactogenesis II, the onset ofLactogenesis II, the onset ofcopious milk secretion occurscopious milk secretion occurs

    Lawrence RA. Breastfeeding: a guide for the medical profession, 2010Neville MC et al. Pediatr Clin North Am 48. (1): 35-52.2001

    Meier PP et al. Breastfeed Med3. (3): 141-150.2008

    Morton J et al. J Perinatol29. (11): 757-764.2009

    Female breast from infancy to lactation with corresponding

    cross section and duct structure

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    5/20

    Establishing and Maintaining anEstablishing and Maintaining an

    Abundant Milk SupplyAbundant Milk Supply Lactogenesis IILactogenesis II -- milk synthesis andmilk synthesis andsecretion regulated by combination ofsecretion regulated by combination ofautocrine and endocrine processesautocrine and endocrine processes Regular and effective milk removal viaRegular and effective milk removal via

    the feedback inhibitor of lactation (FLM)the feedback inhibitor of lactation (FLM)mechanismmechanism

    Transition from endocrine to autocrineTransition from endocrine to autocrine

    mechanisms of control andmechanisms of control andestablishment of adequate milkestablishment of adequate milkvolumes (600volumes (600--625 ml/day) occurs625 ml/day) occursseamlessly in mothers of term infantsseamlessly in mothers of term infantsbecause the infant removes availablebecause the infant removes availablemilk and the milk is replacedmilk and the milk is replaced

    Transition from lactogenesis II to a milkTransition from lactogenesis II to a milkoutput that is sufficient for exclusiveoutput that is sufficient for exclusivebreastfeeding is short, but criticalbreastfeeding is short, but critical

    Transition periodTransition period -- when most breastwhen most breastpumppumpdependent mothers experiencedependent mothers experiencemilk volume problemsmilk volume problems

    Require rapid identification andRequire rapid identification andresolutionresolution

    Knight C.H et al. RevReprod3. (2): 104-112.1998Neville M.C., Morton J. J Nutr131. (11): 3005S-3008S.2001

    (Redrawn from Neville MC: Determinants of milk volume andcomposition.In Jensen RG, editor: Handbook of Milk Composition, San Diego, 1995,

    AcademicPress.)

    Milk volumes during first week postpartum

    0

    100

    200

    300

    400

    500

    600

    700

    1 2 3 4 5 6 7

    Days postpartum

    Ml/kg

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    6/20

    Establishing and Maintaining anEstablishing and Maintaining an

    Abundant Milk SupplyAbundant Milk Supply Requires frequent and completeRequires frequent and completebreast emptying with an effectivebreast emptying with an effectivebreast pumpbreast pump

    Barriers include:Barriers include: Ineffective breast pumpIneffective breast pump

    Infrequent pump useInfrequent pump use Ending a pumping session before all ofEnding a pumping session before all of

    the available milk is removedthe available milk is removed Improperly fitting breast shieldsImproperly fitting breast shields Pregnancy related illnessPregnancy related illness Anxiety regarding infant healthAnxiety regarding infant health Lack of privacyLack of privacy Travel to the hospitalTravel to the hospital

    Difficulty with time managementDifficulty with time management Return to workReturn to work Intense stress, fatigue, and pain whichIntense stress, fatigue, and pain which

    downdown--regulate prolactin via theregulate prolactin via thedopaminergic prolactin inhibiting factordopaminergic prolactin inhibiting factorand blocks oxytocin and milk ejectionand blocks oxytocin and milk ejectionreflexreflex

    Sisk P et al. J Hum Lact. 2010;26:368-375Meier P et al. Neoreviews.2007;8:e467-e477

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    7/20

    In Hospital PreventionIn Hospital Prevention

    Maternal visits toMaternal visits toinclude touch andinclude touch andskinskin--toto--skin holdingskin holding

    as soon as possibleas soon as possibleBreast pumpingBreast pumping

    immediately afterimmediately aftereach skineach skin--to skinto skininteractioninteraction

    Becker GE et al. Cochrane Database of SystematicReviews 2008, Issue 4. Art. No.: CD006170. DOI: 10.1002/14651858.CD006170.pub2

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    8/20

    In Hospital PreventionIn Hospital Prevention

    Hospital grade electric pump with doubleHospital grade electric pump with doublepumping kit for hospital and at homepumping kit for hospital and at homeuseuse Obtain more milk in less timeObtain more milk in less time

    Demonstration of correct labeling,Demonstration of correct labeling,handling, storage, and transport ofhandling, storage, and transport ofmilk storage containersmilk storage containers

    Cleaning suppliesCleaning supplies Agent recommended by manufacturerAgent recommended by manufacturer

    and approved by infection preventionand approved by infection preventiondepartment, i.e. Castile soap packets indepartment, i.e. Castile soap packets inhospitalhospital

    Any dish detergent for use at homeAny dish detergent for use at home Plastic basinPlastic basin Scrub brushScrub brush

    Storage in hospitalStorage in hospital -- Water pitcher with iceWater pitcher with icein mothers room until milk can bein mothers room until milk can betaken to the NICUtaken to the NICU

    Teach relaxation and breast massageTeach relaxation and breast massage

    Becker GE et al. Cochrane Database of SystematicReviews 2008, Issue 4. Art. No.: CD006170. DOI: 10.1002/14651858.CD006170.pub2.

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    9/20

    In Hospital PreventionIn Hospital Prevention

    CustomCustom--fitted breastfitted breastshields (sizes 24, 27, 30,shields (sizes 24, 27, 30,36 mm)36 mm)

    Storage containersStorage containers Food grade plasticFood grade plastic

    BPA freeBPA free

    Variable sizesVariable sizes

    PrePre--printed labels wprinted labels wspace for date and timespace for date and time

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    10/20

    In Hospital PreventionIn Hospital Prevention

    Pumping and milkPumping and milkvolume logvolume log

    Rush Mothers Milk Club

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    11/20

    Combining Hand Techniques inCombining Hand Techniques in

    Addition to PumpingAddition to Pumping Hand expression ofHand expression of

    colostrum first 3 days incolostrum first 3 days inaddition to using theaddition to using theelectric pumpelectric pump

    Hands on pumpingHands on pumpingduring pumping sessionsduring pumping sessions

    Increase milk removalIncrease milk removal

    Milk volumes whichMilk volumes whichincrease over time andincrease over time andexceed those of mothersexceed those of mothersof full term infantsof full term infants

    Morton J et al. J Perinatol29. (11): 757-764.2009http://newborns.stanford.edu/Breastfeeding/HandExpression.htmlJones E et al. Arch Dis Child 2001; 85: F91F95

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    12/20

    Symphony Preemie+ PatternSymphony Preemie+ Pattern

    Initiation with pumping patternInitiation with pumping patternsimilar to nursing infantsimilar to nursing infantcompared to standard pumpingcompared to standard pumpingpattern producespattern produces more milk inmore milk inless timeless time::

    36% more mothers achieved36% more mothers achievedthe minimum milk outputthe minimum milk outputtarget oftarget of >>350 mL/day350 mL/day

    By day 6 NICU mothersBy day 6 NICU mothersproduced as much as mothersproduced as much as mothersof exclusively breastfeedingof exclusively breastfeedingterm infantsterm infants

    More than twice the number ofMore than twice the number ofmothers achieved milk outputmothers achieved milk outputtarget of 500 mL/daytarget of 500 mL/day

    124 fewer minutes of pumping124 fewer minutes of pumpingduring the first 14 daysduring the first 14 days

    Medela communications, 2010

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    13/20

    Preparing for Mothers HospitalPreparing for Mothers Hospital

    DischargeDischarge InformationInformation Physiology of lactogenesisPhysiology of lactogenesis Milk volume targets for first 2Milk volume targets for first 2

    postnatal weekspostnatal weeks >>350 ml/day350 ml/day 500500--1000ml/day as a cushion1000ml/day as a cushion

    Discussion of identified maternalDiscussion of identified maternalrisk factors for lactation, includingrisk factors for lactation, includingdelayed lactogenesis IIdelayed lactogenesis II

    Assistance procuring an electricAssistance procuring an electricpumppump

    Pump loan programPump loan program WICWIC

    Breast milk storage guidelinesBreast milk storage guidelines Cooler for transporting milkCooler for transporting milk Sharing of lactation specialistSharing of lactation specialist

    contact numberscontact numbers

    North American Human Milk Banking Association http://www.hmbana.org/index/pubsNorth American Human Milk Banking Association http://www.hmbana.org/index/pubs

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    14/20

    Critical First 2 weeksCritical First 2 weeks

    Prolactin levels are high but drop after 2 weeksProlactin levels are high but drop after 2 weeks transition to autocrine controltransition to autocrine control

    Milk targets:Milk targets: >>350 ml/day, 500350 ml/day, 500--1000ml/day as1000ml/day ascushioncushion

    Establish routine of frequent pumping resultingEstablish routine of frequent pumping resultingin milk removalin milk removal Effective breast pumpEffective breast pump Breast massage and compressionBreast massage and compression

    Relaxation techniquesRelaxation techniques Milk ejection reflexMilk ejection reflex Adequate sleepAdequate sleep

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    15/20

    After Mothers Hospital DischargeAfter Mothers Hospital Discharge

    ProvideProvide Consistent message regarding importance ofConsistent message regarding importance of

    mothers milk as medicinemothers milk as medicine Daily review of mothers records of pumpingDaily review of mothers records of pumping

    and volume expressedand volume expressed Referral to lactation expertReferral to lactation expert 24 hours visitation24 hours visitation

    NonNon--nutritive sucking at the breastnutritive sucking at the breast Appropriate chairs and privacy screens forAppropriate chairs and privacy screens for

    skin to skin and breastfeeding opportunitiesskin to skin and breastfeeding opportunities Close monitoringClose monitoring

    Type of pump obtainedType of pump obtained Engorgement, plugged ducts, mastitisEngorgement, plugged ducts, mastitis Pumping routinePumping routine Milk volumesMilk volumes

    Observations of mother using pump in theObservations of mother using pump in theNICU to detect problems, i.e. illNICU to detect problems, i.e. ill--fitting breastfitting breastflanges and incomplete milk emptyingflanges and incomplete milk emptying

    Intervention as neededIntervention as needed

    Sisk P et al. J Hum Lact. 2010;26;368-375

    Meier P et al. Neoreviews.2007;8:e467-e477Nyqvist K. Acta Paediatr, 97, 776-781.

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    16/20

    Skin to Skin HoldingSkin to Skin Holding

    Kangaroo Mother CareKangaroo Mother Care Developed as alternative toDeveloped as alternative toinsufficient/inadequateinsufficient/inadequateincubators in Bogota (1979);incubators in Bogota (1979);shown to reduce morbidity andshown to reduce morbidity andmortalitymortality

    Effective for thermal control,Effective for thermal control,

    breastfeeding and bonding in allbreastfeeding and bonding in allnewborn infantsnewborn infants Promotes oxytocin release forPromotes oxytocin release for

    mother and babymother and baby Facilitates bonding andFacilitates bonding and

    contributes to the humanizationcontributes to the humanizationof neonatal careof neonatal care

    Mothers feel more competentMothers feel more competentand confident in mothering roleand confident in mothering role

    More satisfied with the hospitalMore satisfied with the hospitalexperienceexperience

    Milk volumes correlate withMilk volumes correlate withskinskin--toto--skin holdingskin holding Furman L et al. Pediatrics 2002;109:e57

    Lau C et al. J Perinatol 2007;27:399-408

    Nyquist K. Acta Paediatrica 2010;99:820-826

    Renfrew et al. Health TechnologyAssessment. 2009;13 No. 40

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    17/20

    Breastfeeding Peer CounselorsBreastfeeding Peer Counselors

    (BCP)(BCP) PeerPeer -- similar characteristics and sharedsimilar characteristics and shared

    experienceexperience

    Effective intervention for increasingEffective intervention for increasingbreastfeeding initiation and duration inbreastfeeding initiation and duration inWIC populationWIC population

    MotherMother--toto--mother supportmother support

    2 hospitals in US have teamed BCP with2 hospitals in US have teamed BCP withNICU health care professionalsNICU health care professionals

    Bronner Y et al. J Hum Lact. 2001 May;17(2):135-9. Review

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    18/20

    Breastfeeding Peer CounselorsBreastfeeding Peer Counselors

    (BCP) in the NICU(BCP) in the NICU Women with a BCP were twice as likely toWomen with a BCP were twice as likely to

    provide any amount of breast milk compared toprovide any amount of breast milk compared towomen without a peer counselor (odds ratio,women without a peer counselor (odds ratio,

    2.81 [95% confidence interval, 1.112.

    81 [95% confidence interval, 1.11--7.14];7.14];PP=.01)=.01)

    In interviews mothers reported thatIn interviews mothers reported that Contact with BCP was preferred to professionalsContact with BCP was preferred to professionals

    BCP connected with them because of their sharedBCP connected with them because of their sharedexperience and provided emotional supportexperience and provided emotional support

    BCP helped them take it all in, find hope and feelBCP helped them take it all in, find hope and feelempoweredempowered

    Rossman B et al. J Hum Lact. 2010;DOI: 10.1177/0890334410390046Merewood A. Arch Pediatr Adolesc Med. 2006;160:681-685

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    19/20

  • 8/8/2019 PQCNC Human Milk NCCC Track LS 1 Establishing Milk Supply

    20/20

    ConclusionConclusion

    Hospital grade breast pumpHospital grade breast pump

    Hand expression, relaxationHand expression, relaxationtechniques, hands ontechniques, hands onpumpingpumping

    Collection and storageCollection and storagesuppliessupplies

    Anticipatory guidanceAnticipatory guidance -- milkmilkvolume targetsvolume targets

    Close surveillance andClose surveillance andinterventionintervention

    SkinSkin--toto--skin holdingskin holding Breastfeeding peer supportBreastfeeding peer support