Marsha Walker, RN, IBCLCMarshalact@gmail.com

When your interventions do not always help increase milk

production it may be genetic! Mutation of the protein ZnT2 which transports zinc in specific

body tissues Low Zn in milk Reduced mammary gland development Functional problems

ZnT2 transports zinc by importing it into vesicles -- small organelles within the cell -- that then secrete zinc into the breast milk.

Zinc is also necessary to trigger the growth of mammary glands, mammary epithelial cells and secretion pathways.

Without functional ZnT2, zinc accumulates in the cytoplasm, becoming toxic to the cell.

#1 The Zn of insufficient milk

Sooyeon Lee, Stephen R. Hennigar, Samina Alam,

Keigo Nishida, Shannon L. Kelleher. Essential Role for Zinc Transporter 2 (ZnT2)-mediated Zinc Transport in Mammary Gland Development and Function during Lactation. Journal of Biological Chemistry, 2015; 290

Lee S, Hennigar SR, Alam S, et al. Essential Role for Zinc Transporter 2 (ZnT2)-mediated Zinc Transport in Mammary Gland Development and Function during Lactation. The Journal of Biological Chemistry. Published online April 7 2015

References

The immune response is blunted and

underdeveloped in the premature infant, but human milk supports the infant's growth, function, and effectiveness.

Thus, own mother's colostrum (OMC) administered oropharyngeally has potential todeliver oral immune therapy (C-OIT) even before enteral feedings have begun.

Colostrum interacts with lymphoid tissue in the oropharynx and gut.

#2 The magic of colostrum: oral immune therapy

Pletsch D, Ulrich C, Angelini M, Fernandes G, Lee

DS. Mothers' "liquid gold": a quality improvement initiative to support early colostrum delivery via oral immune therapy (OIT) to premature and critically ill newborns.

Rodriguez NA, Meier PP, Groer MW, Zeller JM, Engstrom JL, Fogg L. A pilot study to determine the safety and feasibility of oropharyngeal administration of own mother'scolostrum to extremely low-birth-weight infants. Adv Neonatal Care. 2010 Aug;10(4):206-12.

References

CDC Baby Friendly Hospital Initiative Research- 39,273 citations for “breastfeeding” on Pub Med Donor human milk for NICU infants More milk banks opening Legislation and policy improvements at state and federal

levels Baby Cafes Approach to breastfeeding support More diversity, equity in breastfeeding support More evidence-based

#3 Explosion of breastfeeding interest

#4 Social and electronic media for breastfeeding education and support

Engaging millennials by meeting them where they hang out!

Facebook, Twitter, Pinterest, blogs, apps, You Tube, Instagram, Brelfies

Web cams for distance consultations

Mothering message boards

Concept of entrainment the synchronization of organisms to an external

rhythmMusic therapy improves sucking in preterm infants LATCH scores are higher Sucking activity is strengthened Sucking activity is increased Improves volume of intake

#5 Musical sucking

Akca, K., & Aytekin, A. (2014). Effect of

soothing noise on sucking success of newborns. Breastfeeding Medicine, 9, 538-542.

Loewy, J., Stewart, K., Dassier, A-M., Telsey, A., & Homel, P. (2013). The effects of music therapy on vital signs, feeding, and sleep in premature infants. Pediatrics, 131, 902-918.

References

#6 The Bibi Cam

BiliCam is a smartphone-based non-invasive medical device that uses the on-device camera to monitor jaundice in newborns.

It requires a color calibration card that can be printed by the user at any of the color-calibrated printers such as FedEx Kinko’s, CVS, etc.

The technology is based on the analysis of newborns’ images collected in a standardized way on the phone.

The color data in the image are used to estimate the bilirubin level.

BiliCam: Using Mobile Phones to Monitor Newborn JaundiceLilian de Greef, Mayank Goel, Min Joon Seo, Eric Larson, James W. Stout, James A. Taylor, Shwetak N. PatelThe 2014 ACM International Joint Conference on Pervasive and Ubiquitous Computing (UbiComp 2014)

Increased milk volume seen in mothers using acupressure The acupoints used were GB20 (in a depression between

the upper portion of the sternocleidomastoid muscle and the trapezius on the same level with GV16), acupoint LI4 (on the dorsum of the hand, between 1st and 2nd metacarpal bones), and acupoint SI1 (1 cun posterior to the corner of the nail on the upper side of the little finger).

The mothers were educated to press the acupoints in both sides of the body three times a day, each time for 2-5 min, and for 12 sequential days.

The level of pressure was so as to pail the nail of the pressing thumb

#7 Press here for better breastfeeding

Esfahani MS, Berenji-Sooghe S, Valiani M,

Ehsanpour S. Effect of acupressure on milk volume of breastfeeding mothers referring to selected health care centers in Tehran. Iranian Journal of Nursing and Midwifery Research. 2015;20(1):7-11.

References

# 8 Here’s a new idea!3D printer for custom fit flange?

Better fit by customizing the flange to the breast?

As 3D printing processes improve, maybe we can take advantage of new technology to help avoid problems and increase efficiency

Modular pumps and pump parts

Adapter for open systems from 3D printer

http://www.openbreastpump.org/ 3D printable pump partsUse of silicone

diaphragms on "open system" pumps could potentially help combat milk contamination

Still in the testing phase

Athena breast pump prototype

This smartphone-controlled device communicates with pump hardware via Bluetooth and is compatible with many collection systems.

It will allow the smartphone controlled pump to change the rhythm of its pumping action.

Plus, there's an intuitive

Using a warm breast shield with an electric breast

pump was comfortable and improved the efficiency of milk removal. Resulted in a shorter time to remove 80% of available

milk Higher percent of available milk removed compared

with an ambient temperature breast shield

#9 Warm those shields

Kent JC1, Geddes DT, Hepworth AR, Hartmann PE.Effect of warm breastshields on breast milk pumping. J Hum Lact. 2011 Nov;27(4):331-8.

Reference

Patients with atopic eczema complain of sleep

disturbancesMelatonin is involved in sleep Laughter increases breastmilk melatonin levelsAllergic responses of infants to latex and house dust

mites were reduced by feeding with breast milk after laughter of mothers

Maybe a laughing mother at night breastfeedingswill also help babies sleep!

#10 Laughter, melatonin, eczema, & sleep

Cohen Engler A, Hadash A, Shehadeh N, Pillar G.Breastfeeding may improve nocturnal sleep and reduce infantile colic: potential role of breast milk melatonin. European Journal Pediatrics 2012 Apr;171(4):729-32.

Reference

It's not the breastmilk that has a vitamin D deficiency, it's the dietary vitamin

D recommendation for the lactating mother!

The common notion that low concentrations of vitamin D in human milk is a defect in design has prompted the recommendation for vitamin D supplementation for breastfeeding infants starting within days after birth.

This misconception was revealed in a study that supplemented the lactating mother with 6400 IU of vitamin D per day. The problem is not in the composition of human milk but in the dietary vitamin D recommendation for the lactating mother. The current recommendation of 400 IU per day for the lactating woman is insufficient to maintain blood concentrations of the parent vitamin D compound. This results in minimal vitamin D transfer into breastmilk. The resulting deficiency in the breastfed infant, especially darker-pigmented infants, can be significant.

With appropriate vitamin D intake, the lactating mother can fully transfer to her milk the vitamin D required to sustain optimal vitamin D nutrition in the nursing infant with no additional supplementation required for the infant.

BONUS:Delivering the “D”

Hollis BW, Wagner CL, Howard CR, et al. Maternal

versus infant vitamin D supplementation during lactation: a randomized controlled trial. Pediatrics 2015; 136:625-634.

Reference