Kittie Frantz, RN, CPNP-PC

Kittie Frantz is a Pediatric Nurse Practitioner with over 45 years of work developing breastfeeding programs. Still clinically active, she is a full-time Clinical Instructor in Pediatrics for USC Keck School of Medicine as well as the Coordinator of Lactation Education for Los Angeles County USC Medical Center in Los Angeles California. She has lectured for over 30 years at universities and medical conferences in many countries including Lactation Educator & Lactation Consultant courses. Her skills with Laid Back and Baby Led Breastfeeding in the hospital were key in developing Baby Friendly Staff Training.

Early post-partum impact of baby-led and laid-back breastfeeding

Many have read the works of Dr Christina Smillie and midwife Suzanne Colson, heard them speak or received the films of these amazing works. Baby-led breastfeeding and laid-back breastfeeding was stunning and made a lot of sense. But….how many actually put it into practice?

Many in lactation continued on with breastfeeding pillows and “deep latch” techniques and didn’t realize the potential of letting the baby use his own primitive reflexes to achieve the perfect asymmetrical latch. Hear how one hospital adopted these concepts and realized a tremendous reduction in the incidence of maternal sore nipples, engorgement plus comfortable mothers letting baby feed longer to satiety!

Raylene Phillips, MD, IBCLC, FABM, FAAP

Dr Raylene Phillips attended medical school at University of California, Davis. She completed her pediatric and neonatology training at Loma Linda University Children’s Hospital in Loma Linda, CA where she is an attending neonatologist. She is also Director of Nursery & Neonatology at Loma Linda University Medical Center-Murrieta. Dr Phillips is an International Board Certified Lactation Consultant, a Fellow of the Academy of Breastfeeding Medicine, and is the current President of the National Perinatal Association. Her primary areas of interest are mother-baby attachment, breastfeeding education and support, and Family-Centered Neuroprotective Care of babies in the NICU.

Supporting exclusive breastfeeding in the early postpartum period

We will first take a look at why exclusive breastfeeding matters for babies and for mothers. We will then discuss common challenges during the first week after birth and evidence-based ways we can support exclusive breastfeeding while safeguarding at-risk babies. Topics will include hypoglycemia, hyperbilirubinemia, early weight loss, supplementation, maternal concerns and breastfeeding myths.

Lisa Marasco, MA, IBCLC, FILCA

Lisa Marasco has been working with breastfeeding mothers for over 25 years and has been an Internationally Board Certified Lactation Consultant since 1993. She holds a Master’s degree in Human Development with specialization in Lactation Consulting and was designated a Fellow of ILCA in 2009. Lisa is co-author of The Breastfeeding Mother’s Guide to Making More Milk, a contributing author to the Core Curriculum for Lactation Consultants, and a new Cochrane Collaborative author. She is employed by WIC of Santa Barbara County, California, USA while she continues to research, write, speak, and maintain a small private practice. In addition, Lisa is an Associate Area Professional Liaison for La Leche League of South California/Nevada, and serves on the Breastfeeding Coalition of Santa Barbara County.

The hormones of lactation: too much, too little?

We all understand that there are hormones important to lactation, but when it comes to understanding the clinical picture of a breastfeeding problem, we usually hit a wall. This presentation takes a closer look at prolactin, oxytocin, thyroid, androgen and insulin hormones and their relative impact on reproduction and lactation from the perspective of “too much” and “too little”, ending with a discussion on the when, how, and what’s of hormone testing.

Nancy Mohrbacher, IBCLC, FILCA

Nancy Mohrbacher was born and raised in the Chicago area, where she lives with her husband Michael. She is a lactation consultant, a La Leche League Leader, and a Breastfeeding USA counselor who has been helping nursing mothers for more than 30 years. She has written many breastfeeding books for parents and professionals, including:

• Breastfeeding Answers Made Simple
• Breastfeeding Made Simple (with Kathleen Kendall-Tackett)
• Working and Breastfeeding Made Simple
• Breastfeeding Solutions: Quick Tips for the Most Common Nursing Challenges
• And its companion Breastfeeding Solutions app for Android and iPhone.

Nancy currently contracts with hospitals to improve breastfeeding practices, writes for many publications, and speaks at events around the world. Nancy was in the first group of 16 to be honored for her contributions to the field of breastfeeding with the designation FILCA, Fellow of the International Lactation Consultant Association.

Concerns about low milk production

This presentation provides a primer on assessing milk adequacy during the first week of life, the need for supplements, and when supplements are needed, recommended feeding volumes and methods. Also includes reasons mothers use formula supplements unnecessarily, up-to-date, evidence-based strategies for optimizing milk production in mothers exclusively pumping, and the latest thinking on the use of galactogogues.

Joy Anderson, AM, IBCLC

Joy Anderson has been an International Board Certified Lactation Consultant since 1991 and an active volunteer Australian Breastfeeding Association (ABA) counsellor since 1987. For about 12 years, she worked part-time as a lactation consultant in private practice as well as devoting much time to ABA. In 2008, she qualified as an Accredited Practising Dietitian from Curtin University of Technology, Western Australia. In 2013, Joy was recognised in the Australian Honours List, and awarded Member of the Order of Australia for her service to the community through work for the Australian Breastfeeding Association.

Joy has special interests in all aspects of infant feeding and food intolerances in general, and in particular adverse food reactions in breastfed babies. Joy is in the process of publishing a book on this particular interest, and retiring from a part-time private practice in Perth, Western Australia. In this role, she has been unique, being the only dietitian and IBCLC in private practice in Australia focusing on adverse food reactions in breastfed infants, and has consulted with clients via phone and Skype from all parts of the country. Joy has a website at dieteticsandlactation.com.au.

Adverse food reactions in the breastfed infant

Many mothers notice that foods they eat can affect their breastfed babies, resulting in colic, reflux, poor sleep and difficulty settling, as well as physical symptoms such as rashes/eczema; green, mucousy stools; or constipation. This presentation briefly covers the types of foods transferred from the maternal diet to breastmilk that can be implicated in causing these problems in babies. The aim of the presentation is to raise awareness that foods in the maternal diet can affect babies, and some directions to start investigating the mother’s diet where this is suspected.

Susan Tawia, PhD

Dr Susan Tawia holds a PhD in Reproductive Physiology, a Diploma in Breastfeeding Management and a Diploma in Education and, before joining the Australian Breastfeeding Association, worked as a research scientist and science teacher.

In 2008, Susan was appointed a Scientific Information Officer with ABA, and in that role she provided up-to-date scientific information to breastfeeding mothers, ABA counsellors and community educators, health professionals and other stakeholders. Susan also writes review articles for ABA’s peer-reviewed journal, Breastfeeding Review.

In 2013, Susan was appointed the ABA Manager of Breastfeeding Information and Research and while continuing to write articles and ensuring that ABA provides evidence-based information, she has also been identifying research opportunities within ABA and promoting research collaborations between ABA and university-based researchers.

Breastfeeding, brain development, IQ and educational attainment

The most recent evidence for an effect of infant feeding on cognitive development will be reviewed, but it will go beyond IQ, beyond just a number, and will look at the normal brain development that happens when infants are breastfed and what developmental, educational and social consequences occur when infants are artificially fed.

Anastasia Karathanasi, MD, IBCLC

Dr Anastasia Karathanasi is a Greek pediatrician and neonatologist who works in private practice. She has made her doctorate in children’s sleep disorders. She is an IBCLC since 2007 and supports mothers and children to breastfeed. She also is the IBLCE coordinator for Greece and Cyprus. She is vice president and an active member of Galaxias-the Greek breastfeeding association. She is an advanced Paediatric Life Supporter (APLS) and a volunteer with refugees in Greece. But mostly she is a mother of three wonderful breastfed children and now is pregnant with her fourth.

Refugees in Greece

Nowadays, there are many refugees in Greece. People are looking for better lives, for better future for their children. Most of them are families who are in a very hard position. The situation and the time is hard for Greek people too. But, there is hospitality and altruism in Greek people’s soul where they forget themselves and give everything to those who shout for help. They don’t hold prejudiced views towards race, gender, social status or religion.

The Greek Breastfeeding Association Galaxias and LLL Greece are making a great effort to support breastfeeding and protect refugee children’s lives. They are organized and voluntarily give their knowledge to promote breastfeeding. In that way, they can ensure unique health benefits for babies, protect mom’s health, save money and help people survive.

Jodine Chase

Jodine Chase is a public relations and communications consultant specializing in issues and crisis management news analysis. Jodine is a long-time breastfeeding advocate who, as a volunteer, works for many breastfeeding related causes including advocating for the re-establishment of milk banks and amending policies and legislation to protect breastfeeding rights. Jodine serves on the board of her local breastfeeding advocacy group, for the Best for Babes Foundation, and volunteers with ILCA, INFACT Canada, and Friends of the WHO Code. She’s involved in many breastfeeding related events including the Miracle Milk Stroll and the Breastfeeding Challenge.

The commercialization of human milk

Non-profit human milk banks in North America dispensed over 4 million ounces of human milk in 2015 for infants in need. That sounds like a lot of milk, and it is an increase of 10 fold since the turn of the century. But in the same year, two competing US companies say they processed a similar amount of milk for commercial human milk products. One says they bought 1 million ounces at $1/oz that year. And a third company that offers a web-based brokerage for private buyers and sellers claims to have 10,000 ads offering 45 million ounces of milk at any given time. A Utah-based company is paying women in Cambodia for their milk and reselling it in the US. Infant formula companies are looking to extract human milk components to enhance their products, and the for-profit trend is expanding beyond the US’s borders into Canada, Australia, and beyond. Learn more about this human milk marketplace – what are the products being sold, and how to do they compare to traditional human donor milk? What are the options for families that wish to donate or sell milk, and for those in need?

Jennie Bever Babendure, PhD, IBCLCM

Dr Jennie Bever Babendure is a Biologist and International Board Certified Lactation Consultant. She is Co-owner of The Arizona Breastfeeding Center, a freestanding breastfeeding practice in Tempe, Arizona. She also has an academic appointment in the College of Nursing and Health Innovation at Arizona State University, where she studies the interplay between social and biological issues in human lactation. Dr Bever Babendure is on the board of the Central Arizona Lactation Consultant Association.

Dr Bever Babendure received her Bachelor’s degree in Biochemistry from Arizona State University, and PhD in Biology from the University of California, San Diego. She completed UC San Diego’s Lactation Consultant Training Program and earned her IBCLC certification in 2009. She has served as an administrator of the Friends of the WHO Code Facebook group since 2011, when she co-led a social media campaign to encourage the Pan American Health Organization to cease their acceptance of funding from Nestle. Dr Bever Babendure and her husband have four beautiful children who do their best to teach her more about motherhood, lactation, and humility every day.

Formula marketing in the information age: a moving target

As more US hospitals commit to cease th,e practice of doling out “gift bags” containing infant formula and marketing materials to every new mother and baby, infant formula companies have moved to market their products in increasingly sophisticated ways. In particular, they are targeting mothers prenatally, when research shows they are most likely to make decisions about infant feeding. In order to get a more complete picture of the infant formula marketing efforts aimed at new mothers, we collected and categorized all print and email infant formula marketing received by one US mother during her pregnancy and first few months postpartum. We found that heavy “gift bags” containing multiple brands of formula and coupons were being given out in obstetrics offices, and large sample cans of formula were mysteriously showing up on mothers’ doorsteps, often just before they gave birth. In addition to the hundreds of print ads and coupons sent by mail and seen in baby magazines, we also found a large amount of this marketing taking place online, where content is “pushed” toward consumers via email, search engines and even social media. Through this study and our work with the “Friends of the WHO Code” on Facebook, we have begun to develop a clearer picture of the cultural environment in which US mothers are entrenched, where breastfeeding support is often expensive and difficult to find, while breastmilk substitutes arrive at your door, inbox, and Facebook page unprompted, complete with coupons and the implied endorsement of trusted healthcare providers.

Kiersten Israel-Ballard, DrPH

Dr Kiersten Israel-Ballard is a technical officer with PATH’s Maternal Newborn, Child Health and Nutrition program. Dr Israel-Ballard will serve as principal investigator for this project, overseeing all aspects of project implementation. She has over 13 years of experience in assessing and supporting methods for optimal infant and young child feeding. Her work has largely focused on the prevention of mother-to-child transmission of HIV (PMTCT), specifically in conceptualizing appropriate infant feeding methods for developing countries. She helped to create and lead a multidisciplinary team of international collaborators to design a simple breast milk pasteurization method (flash-heat) and systematically evaluate its safety, acceptability, and feasibility in field settings. In her current role, Dr Israel-Ballard leads the human milk bank initiative at PATH. This has included conducting advocacy for human milk banking as a cost-effective strategy for improving health of vulnerable infants, establishing a global technical advisory group, leading rigorous evaluations to determine impact, and developing innovative human milk banking technologies for resource-limited settings. She has also led programs to support implementation of nutrition and PMTCT programs for local governments and partners. This has included curriculum development, training for health care workers at clinic and community levels, enhancing reporting and surveillance systems, monitoring and evaluation, and supportive supervision, including novel methods for peer support. She has led advocacy efforts to guide the prioritization of nutrition in health systems. Building upon previous research experience, she also focuses on innovative approaches to improve infant health through identifying and assessing the feasibility of novel technologies. This has included assessment of a nipple shield for PMTCT, introduction of mobile phone devices for supporting home-based perinatal care by midwives, and development of a safety monitoring system for low-tech human milk banks. She has considerable international experience, working at all health levels in Kenya, South Africa, Tanzania, Zimbabwe, Rwanda, and India. She has a DrPH degree from the University of California, Berkeley, School of Public Health; an MPH with a concentration in infectious diseases from the University of California, Berkeley, School of Public Health; and a BA in molecular, cellular, and developmental biology from the University of California, Santa Cruz.

Strengthening human milk banking: a global perspective

This presentation outlines effective implementation strategies for increasing access to human milk, including strengthening human milk banking programs globally.

Esther Jiménez Quintana, PhD

Dr Esther Jiménez is a researcher at ProbiSearch SL, a spin-off of the Complutense University of Madrid and an Assistant professor at the Department of Nutrition, Food Science and Food Technology. Complutense University of Madrid. She holds a PhD in Science and Food Technology (2009). Her main research areas are Perinatal and human milk microbiota and Characterization of probiotic bacteria and study of their use in bacterial dysbiosis. The mainobjective of her research is to study the influence of maternal microbiota during the prenatal period (cord blood, amniotic fluid) and postnatal time (colostrum and milk) in bacterial colonization of the newborn’s gut born at term and preterm. Additionally she is interested on the use of probiotics to treat lactational mastitis and other dysbiosis.

The human milk microbiome

For a long time human milk was considered sterile; however, subsequent studies have shown that it contains a complex bacterial ecosystem. Culture-dependent and independent techniques revealed the predominance of staphylococci, streptococci, lactic acid bacteria and strict-anaerobe bacteria.

The exact mechanisms by which bacteria reach the mammary gland have been the subject of much debate over the years. Traditionally, it is believed that part of the bacteria enter the milk through contact with the mother’s skin and the suckling’s mouth. Different studies suggest that bacteria present in the maternal gut could reach the mammary gland during late pregnancy and lactation through a mechanism involving gut immune cells. Thus, modulation of maternal gut microbiota during pregnancy and lactation could have a direct effect on infant health.

The potential role of this complex ecosystem in human milk appears to have implications on the short and long term infant health, but also on the mammary health. Bacteria present in human milk can serve as probiotics for the neonate which means that they exert anti-infectious, anti-inflammatory, immunomodulatory and metabolic effects on the infant. Regarding mother’s health, mammary bacterial dysbiosis may lead to mastitis. This condition affects up to one third of the lactating mothers and represents the first medical cause for undesired weaning. Selected lactobacilli strains isolated from human milk have shown to be good candidates for use as probiotics in mastitis treatment and prevention. A relationship between mammary bacterial dysbiosis and cancer has been suggested in recent years although further studies with higher numbers of participants are needed.

Sertaç Arslanoğlu, MD

Dr Sertaç Arslanoğlu is Professor of Pediatrics (Neonatology) at İstanbul Medeniyet University (IMU) and Administrative Director of the Department of Pediatrics of the IMU Goztepe University Hospital, İstanbul, Turkey. She is a founding member and Vice President of European Milk Bank Association (EMBA) and Scientific Coordinator of the Italian Association of Human Milk Banks (AIBLUD).

She received her medical education, paediatric specialty, and neonatology subspecialty training in İzmir, Turkey- at Ege University, Behcet Uz Children’s Hospital, and Ege University, respectively. Her main field of research is neonatal nutrition, human milk, human milk fortification, human milk banking and functional foods. Between 2002 and 2012 she worked for 10 years in Milan, Italy, mainly as a neonatologist responsible for nutritional management in the NICU and as Coordinator of Nutritional Research at the Center for Infant Nutrition of Macedonio Melloni Maternity Hospital, University of Milan. She also collaborated with Turin and Modena Universities as a consultant on neonatal nutrition and research. In 2009 she was nominated as a part of the Working Group on Nutrition of the World Association of Perinatal Medicine. After 10 years of experience working in Northern Italy, in December 2011 she returned to Turkey mainly to establish human milk banking in this country. She published over 80 peer reviewed papers with 1265 citations (Web of Science).

The benefits of human milk for preterm infants

There is no doubt that human milk (HM) is the best nutrition for appropriate growth and development of a term newborn infant. Its particular composition “nutrients with optimal bioavailability, hormonal and enzymatic components, anti-infective, trophic and growth factors, prebiotics and probiotics, biologically active molecules and cells” makes HM uniquely suited not only for term but also for preterm infants.

This presentation aims to focus mainly on the benefits deriving from the use of donor human milk in feeding preterm infants:

1. In the first part of the presentation, the audience will find the proven benefits of human milk (mainly mother’s own milk or mother’s own milk plus donor milk) for preterm infants.
2. In the second part, recent important discoveries regarding milk composition will be presented. These are some bioactive components and cells which have a substantial potential to improve health outcomes in the short and long-term.
3. The third and last part of the presentation will be dedicated to the proven beneficial effects of donor human milk on health outcomes in preterm infants.
4. The presentation will come to an end with the latest ESPGHAN recommendations and Milan Consensus Statement on this topic.

Delphine Lamireau, MD, IBCLC

Dr Delphine Lamireau is a pediatrician and International Board Certificated Lactation Consultant. She is responsible for two human milk banks belonging to the Paediatric Department of Bordeaux University Hospital, one located in Marmande, France and the other one in Bordeaux, France.

Lyophilisation of human milk

Lyophilisation is a really interesting way of conserving of human milk after pasteurization. We are the only center in the world to doing this, up to now. The advantage of this method is being able to keep the product at room temperature, for a longer time (18 months compared to 6 months for frozen products) and also the ability to facilitate the transport and storage which is especially important for the French departments and territories overseas.

Natalie Shenker, BM BCh, MSc, PhD

Dr Natalie Shenker completed her medical training in Oxford in 2003, before pursuing a career in paediatric surgery. While studying for a Masters in Developmental Biology at Imperial College London, she discovered a passion for molecular biology. With a family heavily affected by cancer, she stepped into breast cancer research, studying for a PhD in the relatively new area of epigenetics and cancer risk prediction supervised by Dr James Flanagan and Prof Bob Brown at Imperial. Natalie started a collaboration with Gillian Weaver, manager of the hospital milk bank at Imperial, to assess whether it was possible to use samples of breast milk for epigenetic research into breast cancer risk prediction. This study has led to the establishment of the BECS study by Dr Flanagan, a cohort study that aims to recruit several thousand samples of milk over the next few years that will enable a network of collaborations into a range of aspects of breastfeeding and long-term maternal health. Natalie became a trustee of the UK Association for Milk Banking in 2014, and is passionate about ensuring equitable access of sick and premature babies to donor milk.

Spotlight on infant formula: why action to tackle the harmful practices of companies is needed

Breast milk as a research resource: the untapped potential of human milk banks

by Natalie Shenker, BM BCh, MSc, PhD

In this talk, Natalie presents the latest state of research into the links between breast feeding and breast cancer, including the latest evidence for risk reduction and our understanding of how pregnancy-associated breast cancer develops. She also describes how she is innovating to ensure this research can continue through the milk bank network of the UK in times of funding uncertainty.

Gillian Weaver, BSc(Hons), RD

Gillian Weaver is an international human milk banking specialist who previously ran the longest continually operating milk bank in the world, based at Queen Charlotte’s and Chelsea Hospital in London where she worked for over a quarter of a century. Since retiring from her hospital work at the end of last year, Gillian has become involved in supporting the development of milk banks in Vietnam and India through her work for the organisation PATH and is also an advisor to the Australian Red Cross which is currently establishing a national milk bank for Australia. Gillian is also working to support the development of a national milk bank service in her native UK.

The business of milk banking: to pay or not to pay

The recruitment and screening of breastmilk donors is fundamental to the safety of donor milk. It is not possible to accept breastmilk from all breastfeeding mothers and determining which ones will provide the safest milk and be the most reliable on-going sources of donor milk requires a combination of an in depth knowledge of lactation, microbiology and health sciences as well as of human nature.

It is in the interests of milk banks to ensure that the recruitment and screening procedures, whilst being sufficiently comprehensive to assure maximum safety, do not deter the mother from donating at all, from donating for as long as is good for the her and good for the bank and also do not deter the mother from donating again in the future following a subsequent pregnancy.

For every question or test that is included in the recruitment and screening, there will be a proportion of prospective donors who will be screened out. This is true for smoking, alcohol intake, prescribed, over the counter and herbal medications, certain previous health treatments etc. If advised that she cannot donate, a mother may question the safety of her own baby breastfeeding and it is incumbent upon milk bank staff to ensure that mothers are given sufficient clear information and advice so that they are not deterred from breastfeeding for as long as they may otherwise have intended. As some mothers opt out prior to ever speaking to a member of milk bank staff, all recruitment literature should clarify the reasons why certain behaviours, medications and health conditions are not accepted by the milk bank but are safe for the mother and her own baby.

There is a need for the understanding by all milk bank staff of the science behind determining whose breastmilk can be safely accepted but the above considerations also contribute to what may be considered the art of screening donors.

Anne Grøvslien

Anne Grøvslien was involved in the process starting a milk bank in 1995 at Oslo University Hospital. Anne has run the milk bank and has been involved in writing a guideline administrated by the Norwegian Directorate of Health. Anne is a National qualified lactation consultant and she works with mothers at the NICU.

She is involved in the voluntary humanitarian organization” Ammehjelpen”. It is a network of women who are working for a breastfeeding friendly society through mother-to-mother support for breastfeeding. Since 2002 she has been the leader of the Norwegian Milk Bank Organization.

The last years she has been involved in a programme in India where she has been involved in setting up milk banks.

From the frozen North to the heat of India: how Oslo University helped in setting up milk banks

The first milk bank in Norway was opened in 1941. Today there are 12 milk banks. 90 % of the Norwegian babies are born in a baby friendly hospital. The breastfeeding rates shows that 80% are still breastfeeding at 6 months and nearly 50% still breastfeed at 12 months. When so many mothers breastfeed their child there are also many potential donors. This gives us a unique opportunity to feed almost all our preterm babies with either mothers own milk or banked donor milk. All the milk banks are located at hospitals and the milk is being used as medical treatment and not for public health care. The milk is mostly being used raw, without any heat treatment. All the milk for the bank is tested for bacteria content. How do we manage to offer a safe product? And are the benefits large enough to allow this procedure to continue?

The India project: A neonatology exchange programme organized by the International Collaboration Unit at Oslo University Hospital. This project aims to improve the care of underprivileged newborns, in line with international standards. This exchange programme aims to reduce neonatal morbidity and mortality by improving basic neonatal care. Focus areas are basic neonatal nursing care such as Kangaroo Mother Care (KMC), nutrition, breastfeeding and human milk bank and hygiene. The project also intends to increase multicultural understanding within health care.

Aliaa Ibrahim, MSc

Aliaa Ibrahim was born and lived in Alexandria-Egypt. She is a specialist in food and science technology and holds a master degree in international Health. During the Masters she had the opportunity to train in the Croix Rousse hospital; the training was in the neonatology unit and human milk bank. She participated in EMBA and ADLF conferences earlier this year.

Is milk kinship an obstacle to the introduction of a human milk bank in Muslim countries?

Human milk is specifically beneficial for premature infants. When own mother’s milk is not available it is recommended by WHO the use of human milk from a human milk bank. However, there are cultural and religious barriers that prevent the establishment of human milk banks in the Muslim countries due to the concept of milk kinship. We aimed to evaluate the possibility of establishing human milk banks in Egypt.

Jean-Charles Picaud, MD, PhD

Jean-Charles Picaud is full Professor of Pediatrics since 2001. He trained at the School of Medicine in Lyon, France (Claude Bernard University Lyon 1). He is head of department of Neonatal and Pediatric intensive care unit in at Croix Rousse Hospital in Lyon, France. He spent one year for research work in Liege University (Belgium), with professors Jacques Senterre and Jacques Rigo. He worked on the validation of dual-energy x-ray absorptiometry for body composition assessment in neonates and on evaluation of nutrient’s utilization using nutrient’s balances. Then he developed his clinical research in the field of neonatal and infant Nutrition, and particularly optimization of parenteral and enteral nutrition for very preterm infants. He works of the evolution of gut flora in extremely preterm infants, its impact on the health of very low birth weight infants and the effects of probiotics supplementation. He published also studies about nutrition of full-term neonates and infants, notably the impact of low protein intake on further risk on infant obesity. A major field of research is human milk for preterm infants: measurement of its composition, optimization of the fortification, best way to pasteurize human milk to preserve its quality. He is the head of the regional human milk bank Rhone-Alpes-Auvergne region (80.000 births a year). He is the President of European Milk Bank Association (EMBA) and French Human Milk Bank Association (ADLF). He is member of the council of the French Neonatal Society, working in the committee on Nutrition of the French Neonatal Society.

A historical perspective of human milk banking in France

There is a tradition of human milk banks in France for the last 70 years and there are now 36 human milk banks that collect, treat and distribute about 70,000 liters of human milk each year. Human milk is considered as a health product and regulating authorities are similar than those covering organ grafts. The aim of the present organization is to provide most preterm infants with pasteurized donor human milk when mother’s milk is not available.

Sophie Rubio-Gurung, MD

Dr Sophie Rubio-Gurung is a pediatrician in Lyon University Hospital (France). Since 2008, after 20 years of clinical practice in Neonatal Intensive Care Units and Maternity Units, she has been Pediatric Coordinator of the AURORE Perinatal Network including 27 Maternity hospital, 13 of them with a NICU. She developed different training programs to improve security and quality of perinatal care. One of these programs is dedicated to NICU professionals to improve Breastfeeding of the preterm babies.

Regional program «Milk Flower» to improve breastfeeding in preterm neonates

In order to improve breastfeeding for preterm babies, together with Dr Rachel Buffin, from the Regional Milk Bank, we developed an e-learning program that received financial support from the regional Health Agency with the aim to teach all the NICU professionals in the Rhone Alpes Region.

Rachel Buffin, MD

Dr Rachel Buffin is a pediatrician doctor neonatologist since 2000. She works in the neonatal intensive care unit of Croix Rousse University Hospital Center (Hospices Civils de Lyon, France) known for its interest in fortification of human milk and growth of infants born extremely prematurely. She is the physician in charge of the regional Rhône Alpes Auvergne Human Milk Bank in Lyon since 2008 and has worked on Holder pasteurization since 2011. She graduated with the French interuniversity diploma of human lactation in 2013. She is an active member of the French Milk Bank Association and a member of European Milk Bank Association and is participating in the European working group on pasteurization. She was co-organizer of the 3rd international congress of EMBA last October 2015 in Lyon. She is co-founder of an e-learning programme promoting breastfeeding in very low birth weight infants which has trained 1,000+ people in 1 year.

Qualification of human milk pasteurisers

The qualification consists, for an equipment, to demonstrate that it functions properly and gives the expected results provided you have standards. It is an important point for French milkbank guidelines. Pasteurization method is actually worldwide, holder pasteurization, low temperature long time 62.5°C for 30 minutes. This method does not come from “Mr Holder” but from the name of the containers of the pasteurizer named “HOLDERS” at the beginning of the century. At this time, the critical points of this technique, were already well described: Temperature, Time of heating, within certain limits and preservation of biochemical principles.

The literature over time shows the important impact of high temperature and time of heating on the loss of biochemical principle of human milk. Controlling pasteurizers by a method of qualification, allows the control of the temperature and time of heating, homogeneity, and thus the device setting. It can show the difference between different type of pasteurizers.

Better setting in pasteurizers should improve the quality of pasteurization and preservation of immunocompetency of breast milk pending the arrival of new technologies.The French breastmilk association (ADLF) provided this year recommendations for pasteurizer qualification.

Gillian Weaver, BSc(Hons), RD

Gillian Weaver is an international human milk banking specialist who previously ran the longest continually operating milk bank in the world, based at Queen Charlotte’s and Chelsea Hospital in London where she worked for over a quarter of a century. Since retiring from her hospital work at the end of last year, Gillian has become involved in supporting the development of milk banks in Vietnam and India through her work for the organisation PATH and is also an advisor to the Australian Red Cross which is currently establishing a national milk bank for Australia. Gillian is also working to support the development of a national milk bank service in her native UK.

The art of screening breastmilk donors

This presentation provides a primer on assessing milk adequacy during the first week of life, the need for supplements, and when supplements are needed, recommended feeding volumes and methods. Also includes reasons mothers use formula supplements unnecessarily, up-to-date, evidence-based strategies for optimizing milk production in mothers exclusively pumping, and the latest thinking on the use of galactogogues.

Jean-Charles Picaud, MD, PhD

Jean-Charles Picaud is full Professor of Pediatrics since 2001. He trained at the School of Medicine in Lyon, France (Claude Bernard University Lyon 1). He is head of department of Neonatal and Pediatric intensive care unit in at Croix Rousse Hospital in Lyon, France. He spent one year for research work in Liege University (Belgium), with professors Jacques Senterre and Jacques Rigo. He worked on the validation of dual-energy x-ray absorptiometry for body composition assessment in neonates and on evaluation of nutrient’s utilization using nutrient’s balances. Then he developed his clinical research in the field of neonatal and infant Nutrition, and particularly optimization of parenteral and enteral nutrition for very preterm infants. He works of the evolution of gut flora in extremely preterm infants, its impact on the health of very low birth weight infants and the effects of probiotics supplementation. He published also studies about nutrition of full-term neonates and infants, notably the impact of low protein intake on further risk on infant obesity. A major field of research is human milk for preterm infants: measurement of its composition, optimization of the fortification, best way to pasteurize human milk to preserve its quality. He is the head of the regional human milk bank Rhone-Alpes-Auvergne region (80.000 births a year). He is the President of European Milk Bank Association (EMBA) and French Human Milk Bank Association (ADLF). He is member of the council of the French Neonatal Society, working in the committee on Nutrition of the French Neonatal Society.

Human milk fortifier – where do we go from here

Human milk from mothers who delivered preterm has a higher nutrient content during the first weeks of lactation. That difference is not sufficient to cover nutrients’ needs of preterm infants. Therefore, fortification of human milk is requested to obtain sufficient postnatal growth. Standardized fortification has been used for the past 20 years but is not sufficient for some preterm infants. Individualized, personalized fortification is now possible as new products are available.

Chiara Peila, MD

Dr Chiara Peila holds a degree in Medicine and Surgery obtained in October 2007 at the University of Turin, Italy with the discussion of the experimental thesis “Effects of Holder pasteurization in human milk” with a final mark of 110/110 and publication recommended.

She was awarded the “Gabriella Maffei” grant in 2009 (national level) for the best experimental thesis in neonatology. And she obtained a Pediatrics specialization degree in July 2014 from the University of Turin. Experimental thesis titled “Effects of holder pasteurization, assessment of the protein profile and glycosaminoglycan” – Supervisor: Prof Enrico Bertino. Vote 70/70, cum laude and publication recommended.

Dr Peila obtained a Master in Neonatal Neurology and Follow up, in May 2014, University of Modena, Italy. Clinical practice at SCDU Neonatology (University of Turin) directed by Prof E Bertino, as intern in the Neonatal Intensive Care Unit, Physiology and Neonatal pathology, from 2009 to date. Her research activity is in the field of pediatrics-neonatology, in particular concerning nutrition and growth of preterm or very-low-weight newborns.

THigh-Temperature Short-Time (HTST) treatment of human milk

Currently, Holder pasteurization (62.5°C for 30 minutes) is the most studied pasteurization method and is recommended for the heat treatment of donor human milk (DM) by the main international guidelines. The Holder method allows a good compromise between microbiological safety and the nutritional and biological quality of the milk. As a matter of fact, this method eliminates the pathogens but inactivates some biologically active, immunologic and anti-infective factors of human milk as well.

New methods to improve the biological quality and safety of DM are under investigation. The High-Temperature Short-Time pasteurization (HTST pasteurization, 72°C for 5–15 seconds) ensures better results in term of microbiological safety and maintenance of nutritional and biological quality if compared to the Holder pasteurization. On the other hand, this method requires significant technological investments and currently is available only at industrial level. A new method to perform HTST pasteurization for low quantity of human milk has been recently patented by our group.

Marita de Waard, MD

Dr Marita de Waard was born and raised in the Netherlands. She graduated from Medical School in March 2012 and worked as a resident at the Pediatric ward of a secondary referral hospital afterwards. In October 2012 she started a PhD course at the VU University Medical Center and Dutch Human Milk Bank in Amsterdam, the Netherlands. The PhD course focuses on various aspects of human (donor) milk, with as main study a randomized clinical trial towards the effects of human donor milk in very low birth weight infants (the Early Nutrition Study). The study was running in six hospitals in the Netherlands, from October 2012 until August 2014. The results of the study, which are also part of her online presentation, have recently been published in JAMA Pediatrics.

Variability and efficacy of human (donor) milk

Infections and necrotizing enterocolitis (NEC), major causes of mortality and morbidity in preterm infants, are reduced in infants fed own mother’s milk when compared to formula. These beneficial health effects of own mother’s milk may be related to immune proteins in the milk. When own mother’s milk is not available, human donor milk is considered a good alternative, albeit expensive. However, effects of pasteurized donor milk from birth onwards in preterm infants have never been investigated. The aims of the current study was:
1. To determine whether a completely human milk based diet during the first 10 days of life reduces the combined incidence of serious infection, NEC, and mortality as compared to formula feeding and
2. To compare the immune proteome of breast milk from term and preterm mothers, since a majority of milk donated to the Dutch Human Milk Bank comes from term mothers, and to determine the effect of pasteurization.