Women who have insufficient glandular tissue (IGT) may struggle with their milk supply, despite good breastfeeding management. Some of these babies can present with dehydration in the neonatal period, hypernatremia or even death, and it is uncommon for mothers to receive support with breastfeeding to achieve goals that benefit the dyad. It is of great importance to help with an accurate and prompt diagnosis that benefits both mother and baby and supports the choice to continue breastfeeding with breast/ chest supplementation if needed.
IBLCE Content Outline: 1.25 L Cerp (I, II, III, IV, V, VI, VII)
Immunoglobulin A (IgA) is secreted into breast milk and is critical to both protecting against enteric pathogens and shaping the infant intestinal microbiota. The efficacy of breast milk-derived maternal IgA (BrmIgA) is dependent upon its specificity however, variability in the binding ability to the infant intestinal bacteria is not known. We demonstrated that a relative reduction in IgA binding to inflammatory intestinal bacteria in preterm infants is associated with an increased likelihood of developing Necrotizing Enterocolitis (NEC), so binding of intestinal bacteria in infants may be important in some settings. Using a flow cytometric array, we analyzed the ability of BrmIgA against bacteria common to the infant microbiota and discovered substantial variability between all donors. Conversely, longitudinal analysis showed that the anti-bacterial reactivity of breast milk-derived antibodies was relatively stable through time, even between sequential infants, indicating that mammary gland IgA responses are durable. Together, our study demonstrates that the anti-bacterial BrmIgA reactivity displays inter-individual heterogeneity but intra-individual stability. These findings have important implications for how breast milk shapes the development of the preterm infant microbiota and protects against NEC.
IBLCE Content Outline: 1 L Cerp (I, II, III)
Congenital heart disease (CHD) is the most common birth defect. Cardiac and respiratory inefficiency complicate feeding for a significant minority of infants. Breastfeeding is generally easier for these infants than other feeding methods, especially if modifications are made to accommodate their reduced stamina and ability to manage flow. This presentation reviews the most common cardiac and respiratory issues in newborns and infants, along with research-based strategies to preserve breastfeeding and educate parents about their baby’s special feeding needs.
1.5 L Cerp (IBLCE Content Outline: I, II, III, IV, VI, VII)
Breastfeeding offers metabolic benefits for both mother and child, particularly in the context of maternal metabolic conditions such as diabetes, obesity and polycystic ovary syndrome (PCOS). However, lactating parents with insulin-resistant conditions experience more difficulties in establishing and sustaining lactation. In this presentation, we will review the basic pathophysiology of diabetes and PCOS, discuss the impact of these conditions on breastfeeding outcomes, outline the likely underlying mechanisms for lactation difficulties in women with metabolic disease, and describe clinical management considerations.
IBLCE Content Outline: 1 L CERP (I, II, III, VII)
In this presentation, Ginna will take a look back at history, and then review the current literature on nipple soreness in breastfeeding mothers. She will explore various approaches to preventing/managing pain, look at some new modalities not yet widely in use, and finish with some unique case studies.
IBLCE Content Outline: 1.5 L CERP (I, III, IV, VI, VII)
I. Development and Nutrition
III. Pathology
IV. Pharmacology and Toxicology
VI. Techniques
VII. Clinical Skills
Ginna Wall
Ginna ran the lactation program at the University of Washington Medical Center in Seattle Washington for 35 years. She led the way to Baby-Friendly Hospital certification in 2009 and recertification in 2019. Before that she was an acute care inpatient pediatric nurse, a camp nurse, a childbirth educator, and a doula. She enjoys teaching healthcare workers about all the things she learned along the way.
Catherine Watson Genna
Catherine Watson Genna is an IBCLC in private practice in New York City since 1992. She loves to teach, locally mentoring clinical interns and traveling to educate healthcare professionals around the world on assisting breastfeeding babies with anatomical, genetic or neurological problems. Catherine collaborates with Columbia University and Tel Aviv University Departments of Biomedical Engineering on research projects investigating the biomechanics of the lactating nipple and various aspects of sucking and swallowing in breastfeeding infants. She is the author of Selecting and Using Breastfeeding Tools: Improving Care and Outcomes and Supporting Sucking Skills in Breastfeeding Infants as well as professional journal articles and chapters in the Core Curriculum for Lactation Consultant Practice and Breastfeeding and Human Lactation.
Mariana Colmenares Castano
Dr Colmenares specialises in paediatrics and breastfeeding medicine. She has a special interest in tongue-tie assessment and division, and has had the opportunity to work with many challenging cases. She is a founding member of the Mexican organization of IBCLC’s, Asociacion de Consultores Certificados en Lactancia Materna de Mexico, ACCLAM and is also secretary of the Academy of Breastfeeding Medicine. She coordinates a 280 hour online breastfeeding course for health-care professionals.
Tim Hand
Dr Hand is associate professor of pediatrics and immunology and the director of the Gnotobiotic Animal core facility at the University of Pittsburgh. Currently, he directs the Immunity to Bacterial Colonization Lab at UPMC Children’s Hospital. He has published over 35 research articles and scholarly reviews and was named the inaugural ‘Emerging Leader’ by the Society for Mucosal Immunology in 2022.
Kate Rassie
Dr Kate Rassie is a consultant endocrinologist at Monash Health and at Jean Hailes for Women’s Health, Melbourne. She is also a final-year PhD candidate at Monash Centre for Health Research and Implementation, Monash University. Her doctoral thesis focuses on the relationships between maternal metabolic health and breastfeeding, with a focus on insulin-resistant conditions such as PCOS and diabetes. Clinically, she works in diabetes, obesity and metabolism; and across all aspects of female hormonal health and reproductive endocrinology (including menopause, PCOS, hypothalamic amenorrhoea, menstrual mood disorders, bone health, weight management, and thyroid disease).
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