Physiology of the Lactating Breast, Secretory Activation

The first two postpartum weeks represent a critical window for achievement of secretory activation and the transition to autocrine/paracrine control of lactation. In otherwise healthy dyads the breastfeeding infant adapts sucking patterns to accommodate these lactation phases and in turn provides essential stimulation for milk synthesis. For NICU mothers the pump substitutes for the infant with respect to mammary gland stimulation and milk removal. This presentation introduces a novel evidence-based 2-part instrument - My Pumping Pathway - which links pumping behaviours to those used by the human infant during the first 1-2 postpartum weeks.

Emerging evidence indicates that achievement of secretory activation and coming-to-volume, events that occur during the first two weeks postpartum, are fundamental to continued lactation. The biologic underpinnings of the transition from secretory differentiation to secretory activation and coming to volume are extraordinarily complex, and are poorly understood by many clinicians, especially with respect to integrating them into best-practices. Patterns of infant suckling and milk removal during this critical stage have been relatively well-studied and mirror the biology of the mammary gland. However, there are often ideological barriers to adapting these patterns for breast pump dependent mothers with NICU infants.

In the previous module the focus was on the components, the modes of action and the clinical benefits of NPWT. In this module we take a closer look at exactly how NPWT works.

Evidence based care, established from an understanding of the basic principles of lactation and mammary gland function is imperative to improve breastfeeding rates and subsequently the health and wellbeing of breastfeeding women, infants’, and their families. This series aims to develop an understanding of the anatomy and physiology of the lactating breast to drive timely and effective secretory activation to establish a copious milk supply through lactation best practices.

Infants with critical CHD experience extremely low rates of human milk feeding and direct breast/chestfeeding. Until recently,there has been little evidence on this,with variation in feeding practices.This session will discuss a series of recent studies examining the prevalence of human milk and breastfeeding for infants with CHD,identifying supportive and limiting factors of these feeding practices,and investigating the impact of human milk and breastfeeding on health outcomes in this population. Qualitative findings from parents of infants with CHD will further describe the process by which direct breastfeeding can be established with these infants.

This course gives medical professionals a comprehensive introduction to the topic of chest drain management. The focus of the course is on the anatomy of the chest cavity, the function of chest drainage, the introduction of different chest drainage systems and the monitoring and management of chest drainage. It will further give an introduction to Medela’s Thopaz+ digital chest drainage and monitoring system and explain the differences between underwater seal drains and Thopaz+. There will be a short quiz at the end of each section of the training. Good luck and enjoy the course.

Join our webinar for a concise exploration of colostrum's molecular science and practical applications. Learn how to optimize colostrum provision by emphasizing early breastfeeding initiation. Discover best practices for increasing skin-to-skin practices in your units and explore the implementation of oral immune therapy for critically ill infants.

This offering aims to showcase the importance of infants receiving colostrum. It looks at its components, its clinical benefits and ways to optimise babies receiving it in a variety of clinical settings. Describing how, the first milk produced by mothers, called colostrum is a thick, sticky substance with uniquely high concentrations of immune factors, biologically active proteins, and nutrients and vitamins. Focussing on how each drop of colostrum plays a critical role in nurturing the infant's developing oral and gastrointestinal microbiomes, protecting them from infections and supporting their overall health both in the short and longer term.

Colostrum has long been referred to as “liquid gold,” but what exactly makes it so special? In this webinar for healthcare providers, we will discuss the nutritional, but even more importantly, the amazing immunological and anti-infective properties of colostrum.

In this webinar we discuss maternal-neonatal risk factors where expression of human milk should be implemented in the first 3 days of life to support an optimal milk supply. Discussion on the development of a decision-making tree or algorithm designed to support members of the healthcare team when a Lactation Consultant may not be readily available.

In some vulnerable populations, such as late preterm, lack of effective breastfeeding may not be recognized, resulting in delayed or impaired milk production. This course will cover the evidence behind appropriate lactation initiation, especially in at-risk populations, and how we can best support parents to meet their lactation goals. Presenter, Rebecca Hoban MD, MPH.

This presentation highlights the newest evidence that mothers’ own milk is “personalized medicine” for NICU infants, and summarizes why donor human milk feedings do not yield the same beneficial outcomes. Given that there is no optimal substitute for mothers’ own milk, strategies to prioritize its availability in the NICU are essential. This session targets the first two weeks post-birth as a critical period that includes secretory activation and achievement of coming to volume in breast pump-dependent mothers of NICU infants, and includes evidence, best practices and the newest ongoing research in this area. Presenter, Paula Meier, Professor, PhD, RN.

On February 26, 2022, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) released a key report on the 55-billion-dollar formula industry and its negative impact on breastfeeding decisions. This webinar highlights key findings of the report and provide clinicians with tools to teach families why human milk matters. It is critical that families are presented with scientific evidence about the differences between human milk, donor milk and infant formula.

Embedded in this approach is evidence that the mammary gland undergoes essential programming during the first two weeks postpartum, which can be measured with biomarkers, and is essential to long-term mothers' own milk (MOM) provision. Clinical strategies that target the early postpartum period will be highlighted, including species-specific mammary gland stimulation, monitoring of MOM biomarkers of secretory activation and assessment of coming to volume. Additionally, the distinction between impaired secretory differentiation and delayed/impaired secretory activation in this population will be discussed, with application to NICU mothers who have multiple inflammation-based morbidities that increase the risk for lactation problems.

Persistent disparities exist in both breastfeeding initiation and continuation. Not all families can access breastfeeding information, resources, technology, and support equally. Structural racism and implicit bias exist in healthcare, which can impact the family’s decision-making processes for human milk and breastfeeding. Dr. Spatz first published her ten-step model 20 years ago with published outcome data worldwide. The first step of this model is “informed decision-making.” This presentation will discuss research and strategies to ensure all families can make informed feeding choices.

This module will introduce the basics of what is a wound, the differences between acute and chronic wounds along with the stages of wound healing.

Hands-free in-bra pumping is popular amongst women who seek flexibility and/or efficiency of milk removal. However, this new modality of expression involves design feature considerations that may have the potential to impact performance compared to traditional systems. To-date this modality has not been tested so we have developed new protocols to explore hands-free in-bra pumping and used these to investigate the impact on the efficacy of a hands-free in-bra double pumping system, including effectiveness, milk ejection characteristics, nipple changes and comfort ratings. We will present data on the increased flexibility of maternal mobility, perceptions, and confidence of the pumping experience.

In earlier modules, reference was made to Negative Pressure Wound Therapy (NPWT). In this module, NPWT is the central focus.

The delivery of the best practices for human milk nutrition in the NICU is an ongoing challenging commitment. Nutrition has lots of variability in practice as there is less evidence to help guide practice than in other areas. Nevertheless standardizing best practices is better care and we can learn from quality improvement science to accelerate our efforts to build in these best practices. This webinar will discuss the pragmatic quality improvement framework that can be used in your unit to incorporate the best practices in human milk delivery, nutrition and infant feeding to ensure the best outcomes for your babies.

Following secretory activation, the lactating breast enters the build phase of lactation. You will learn how daily milk production rapidly increases through a dynamic of supply and demand, with a full milk supply being established between 2 and 4 weeks post-partum. The module with also cover best practices to support building and establishing a copious milk supply. These include frequent and effective milk removal, how oxytocin plays a key role in milk transportation and factors that inhibit and support milk ejection. Relevance to practice for both breastfeeding and pump-dependent mothers will be described.

Evidence based care, established from an understanding of the basic principles of lactation and mammary gland function is imperative to improve breastfeeding rates and subsequently the health and wellbeing of breastfeeding women, infants’, and their families. This module is part of the anatomy and physiology of the lactating breast series and aims to understand the physiological breast changes from neonate to the end of pregnancy, focusing on breast growth during pregnancy known as secretory differentiation.

This module will describe how infection occurs, how it can be diagnosed, and how it is managed.

Learn about the latest recommendations, research, and best practices with regards to human milk handling within the healthcare setting and consider ideas to implement within your hospital to improve patient safety.

UNICEF and the WHO advocate initiation of breastfeeding within one hour of birth and frequently thereafter. Scientific studies exploring the early hours and days post birth identify that onset of secretory activation may differ in women with risk factors. In this course, you will learn about risk factors that impact lactation outcomes in at-risk women and infants. The second module further translates the evidence into the clinical setting to optimise exclusive breastfeeding at hospital discharge and beyond.

The nutrition of breast milk in newborns and particularly in premature infants has an impact on the lifelong health of the child. This webinar by Professor Matthias Keller, will first address barriers to breast milk feeding in a neonatal intensive care unit. Subsequently, the concept of clinical care pathways as a management tool will be introduced, highlighting their significance for change management, as well as for incorporating evidence into clinical practice and quality management in a healthcare facility. Of particular importance is the identification of project managers and process owners who will be responsible for patient care pathways.

All babies deserve access to the best nutrition possible. For very low birthweight babies, breast milk is not just the best nutritional source, it is a medical necessity. However, not all mothers are able to breastfeed. Human Milk Banks provide a valuable service to ensure that the most vulnerable infants have access to human milk to help them develop, heal and thrive when mother’s own milk is not available or not enough to feed her baby.

In this final module we explore the physics behind negative pressure wound therapy. Some of the key questions we will explore include how negative pressure is created and delivered to the wound bed, and how changes in pressure lead to fluid removal. Finally, we explore several of the clever adaptations that have been made to negative pressure wound therapy systems to enhance their function.

Several factors not routinely identified in pregnancy,are associated with reduced exclusivity and duration of breastfeeding. Identification of pregnant women at risk of low milk production creates a window for education and intervention. This screening in combination with point-of-care milk testing that can detect delayed secretory activation,breast inflammation or infection,and low milk production,directly informs lactation care that may optimize breastfeeding outcomes. Advances in practice are urgent due to the increasing prevalence of pregnancy complications found to be associated with low milk production. It is critical that research is carried out to develop interventions to improve lactation outcomes.

Using equity as a lens in the quality improvement process is vitally important to ensure standardized processes and equitable outcomes for all neonates. Join Rose Horton for a conversation on nurses' roles in mitigating disparities in the NICU.

This module will cover the aetiology of most wounds and their management.

In this module you will learn about best practice in the assessment and documentation of wounds.