The Sixth European ABM Conference in Lisbon Portugal—A Win for Organizers and Attendees Alike!

I returned from a trip to Europe over a week ago tonight, my first stop Lisbon Portugal. I celebrated one of those “big” birthdays in Lisbon, you know, the ones that end in a “0” or a “5” with 230 of my closest friends and colleagues in Breastfeeding Medicine from 23 nations around the globe.  Honestly!!  Well, they were not all there just to celebrate my birthday, although some did stay an extra day just to celebrate the day with us!!

What began this marvelous journey was an invitation from conference organizers Elien Rouw, MD, FABM (Germany), Monica Pina MD, ABM (Portugal), and Reet Raukas MD, ABM (Estonia) to speak at the 6^th European Academy of Breastfeeding Medicine Conference, held on June 17-18, 2016 in Lisbon, Portugal.  Dr. Rouw has been behind these regional international conferences from the start, and is the mastermind in organizing them, along with local physicians and other like-minded organizations at various times in the countries in which they have been held.  The success she and her co-coordinators have had is a tribute to their hard work, their desire to bring quality physician education in breastfeeding medicine and related subjects to Academy of Breastfeeding Medicine (ABM) members and other physicians and health care members outside the United States, and their tireless efforts to make these conferences affordable, with little support outside their own “blood, sweat and tears”.  This is in actuality a matter of equity and disparities in our field.  Many US physicians cannot afford to travel to Europe or Asia or Australia yet we expect our non-US colleagues to travel to the US yearly to the Annual conference, which is expensive for many of us even if we live in the US.  So do Dr. Rouw and her European colleagues accomplish their goals?  They most certainly do!!!  If one watches and grabs an airfare when they are at their lowest, even from the US this conference is very affordable, and the bonus is, no matter where you come from, you are treated to a beautiful European city, its gracious hospitality and phenomenal cuisine!

This success has built over the past 10 years. Former conferences have been organized in Germany (2007), Austria (2008), Poland (2010), Italy (2012) and Romania (2013).  The 6^th Conference in Lisbon was organized in collaboration with SOS Amamentação Portugal and with support of the city council of Lisbon —the largest thus far, and buzzing with activity!!

The speakers and some attendees from outside Portugal stayed in a wonderful hotel that was noted as not far from the site of the conference. The morning of the 17^th a bus was arranged to pick all of us up who were staying at the hotel an hour before the conference started to transport us the short distance to the conference venue, Auditório Polo ArturRavara ESEL, a relatively new site of the nursing school in Lisbon.  After a late arrival, we drove around for quite a while.  Turns out our (native Portuguese) bus driver was lost, because he got the wrong address!  So, we started the first day a bit late. Was this a problem?  Not at all!  Everyone rose to the occasion and soon the conference had begun in a beautiful and comfortable venue and we were all immersed in breastfeeding medicine!

Mastitis Protocol Updated

In case you missed it, the Academy of Breastfeeding Medicine Protocol #4, “Mastitis“, by Dr. Lisa Amir, was published in Issue #5 (May/June) of Breastfeeding Medicine.  The good news (or the bad news, depending on how you look at it) is that not much has changed since the previous version was published in 2008.  There are slightly expanded discussions of methicillin-resistant staph aureus and secondary candidal infections, and a brief explanation of fluid mobilization for symptomatic treatment of a swollen breast.  The style has been changed to include fewer paragraphs and more bulleted lists, which makes for easier reading and reference.  And of course the references have been updated.  It is of the high caliber we expect these clinical protocols to be, and relates the state of the art as it exists for the diagnosis and management of Mastitis today.  If you haven’t had a chance to take a look at it, check it out in Breastfeeding Medicine Volume 9, Number 5, 2014 pages 239-243, or go to the Academy of Breastfeeding Medicine website, and check under the Protocols and Statements tab.

Kathleen Marinelli MD, IBCLC, FABM is a neonatologist a Board member of the Academy of Breastfeeding Medicine, and Chair of the United States Breastfeeding Committee.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Newly Published! ABM Clinical Protocol #1: Guidelines for Blood Glucose Monitoring and Treatment of Hypoglycemia in Term and Late-Preterm Neonates, Revised 2014

It is with great excitement that I announce that the long awaited publication of the 2014 Revision of the Academy of Breastfeeding Medicine Protocol #1 Hypoglycemia in Breastfeeding Medicine Volume 9, Number 4, 2014! The previous version was released in 2006. The authors, Nancy Wight MD, IBCLC, FABM and Kathleen Marinelli MD, IBCLC, FABM remain the same.

There have not been any earth shattering changes in the field since the last protocol was published. Importantly in fact there has been no progress in the definition of clinically relevant “hypoglycemia.” An expert panel convened in 2008 by the U.S. National Institutes of Health concluded that there has been no substantial evidence-based progress in defining what constitutes clinically important neonatal hypoglycemia, particularly regarding how it relates to brain injury, which is what concerns us all the most. We reiterate that the literature continues to support that transient, single, brief periods of hypoglycemia are unlikely to cause permanent neurologic damage. Therefore, the monitoring of blood glucose concentrations in healthy, term, appropriately grown neonates is unnecessary and potentially harmful to parental wellbeing and the successful establishment of breastfeeding.

Help Your Clients Understand Their Rights in the Workplace

With more than half of women with infants employed, simple workplace accommodations are critical for breastfeeding success. By helping moms understand their rights as a breastfeeding employee and plan for their return to work, lactation care providers can support a successful transition so that working moms are supported to reach their personal breastfeeding goals.

The federal “Break Time for Nursing Mothers” law requires employers to provide break time and a private place for hourly paid employees to pump breast milk during the work day. The United States Breastfeeding Committee’s Online Guide: What You Need to Know About the “Break Time for Nursing Mothers” Law compiles key information to ensure every family and provider has access to accurate and understandable information on this law.

Buongiorno from the 4th ABM European Regional Meeting for Physicians in Trieste Italy!

Yesterday was the first day of the 4^th ABM European Regional Meeting for Physicians in beautiful Trieste Italy.  As this is very close to the childhood home of my grandfather, I feel like I have come home.  The city itself is a beautiful Italian city perched on the edge of the sparkling blue Adriatic Sea.  Arriving by car from Germany two days ago, the vistas from high above the city out over the sea were breath-taking.

The meeting started off with an informal “pizza party” of sorts at a lovely restaurant nearby the hotels on the canal and close to the sea Friday night.  The multinational attendance was immediately evident by the accents and languages one heard.

We began bright and early Saturday morning on a gorgeous sunny day.  There are 100 attendees from 29  countries and 6 countinents—a mini United Nations!    OK—really 5 continents, but one attendee originally was from Australia and another works part-time in Australia, so I think that counts for 6 continents!!  Elien Rouw (Germany) and Adriano Cattaneo (Italy) opened the program as the conference organizers.  The first plenary session was a fascinating look at “The mechanics of breastfeeding revised” by Michael Woolridge (UK).  The next session was a roundtable discussion, “Ensuring effective feeds: biological nurturing, learning how a baby latches on, or both?”  It was lead by presentations by Christina Smillie (US), M. Ersilia Armeni (Italy) and Kathleen Marinelli (US), and engendered lively discussion from the attendees!

In the afternoon, we focused on Baby-Friendly worldwide.  Maria Bettinelli (Italy) spoke of “Breastfeeding and continuum of care throughout the life cycle: a framework for action in the Baby Friendly Initiative.”  We learned not only of Baby-Friendly in the hospital, but of the Italian Baby-Friendly Community program.  This was followed by the second Round Table, this one on “Experiences and Challenges in countries implementing the Baby-Friendly Initiative.  Our speakers to inform this session were Martha Muresan (Romania), Irena Zakarija-Grkovic (Croatia), and Carol Williams (UK).  The last plenary presentation of the day was “Baby-Friendly Initiative: beyond information towards relational approaches with women” by Fiona Dykes (UK).  This thought-provoking discussion was followed by two platform abstract presentations—Maria Astengo (Italy)”Breastfeeding Promotion and Support in Public Health Services: Experiences of a Local Health Agency” and Beatriz Flores (Spain) Why Does Spain have so Few BFHI Hospitals?”

There were also many posters on display from all over the world on many different topics in breastfeeding.  Seeing the ideas out there and the work that is being done, and the animation of colleagues interacting over this work, was very exciting indeed!

At the end of the day, we all met by the waterfront and took a bus tour of part of the city.  We had the opportunity to see the main Piazza, Roman ruins, different beautiful parts of the city, the Church of San  Giusto with its beautiful paintings of the breastfeeding Madonna, not to mention the added bonus of the vistas of the sea and the city from that height.  Then the buses took us to a seaside restaurant for a traditional Italian multicourse dinner, with nothing but good food, great Italian wine and time to network and talk with colleagues and new friends.  It was a lovely somewhat magical evening for all.

On Day 2, we began with a presentation that got the audience as worried as the speaker—”The inter-relationships between pregnancy, obesity and breastfeeding” by Kathleen Marinelli (US).  The figures are staggering and very frightening.  This was followed by a fascinating Roundtable: “Continuing breastfeeding and the timing and introduction of complementary foods” by Adriano Cattaneo (Italy), Carol Williams (UK) and Maria Teresa Hernandez-Aguilar (Spain).  We may sound different to one another, dress differently, but we certainly all face the same issues.  Pat Hoddinott (UK) gave a stimulating discussion of her research on “Family perspectives on breastfeeding—what would make a difference?”  This was followed by the last presentation of the conference, “The social impact of breastfeeding” by Anne Marie Oudesluys-Murphy (Netherlands).

The sessions were wonderful, informative, and lively at discussion time.  Breaks and lunch—well, let’s talk food first.  Can’t top freshly made espresso or cappuccino instead of just an urn of old cooling coffee in my book!  And trying to be “good” I had to avoid the Italian pastries (sigh).  Prosciutto, cheese, bread, pasta and couscous salads for lunch…doesn’t get much better—except that it was all served on a sunny rooftop terrace overlooking the city.  How to make it better—many physicians with many accents all talking with one another.  And I kept hearing snatches of conversation with words like “collaboration”, “share our research protocol”, “compare how we do it with how you are doing it”, “interested in looking at this with me”?   Isn’t this what ABM is all about??  Our Mission Statement:”The Academy of Breastfeeding Medicine is a worldwide organization of physicians dedicated to the promotion, protection and support of breastfeeding and human lactation.  Its mission is to unite into one association members of the various medical specialties with this common purpose.”  Our Vision Statement: ABM is an independent self-sustaining multi-specialty international physician-to-physician organization that promotes breastfeeding education, knowledge, attitudes and skills for physicians, worldwide.  These discussions certainly support out Mission and our Vision!  I learned we share many of the same issues, and we can certainly learn innovation from one another.  This IS an international meeting in the best sense of the world.  Elien is to be praised for her hard work and persistence in starting and continuing these meetings.  I for one, am very impressed and am looking forward to future meetings with great expectation!  A number of members have offered to host the next meeting in their countries after attending this meeting.  Our Strategic plan has us holding the annual meeting outside North America by 2015.  I would posit that with the attendance the European meetings have drawn, and the success they have attained, we could be considering holding the 2015 meeting in Europe.  Elien—what do you think??!!

Kathleen Marinelli MD, IBCLC, FABM is a neonatologist a Board member of the Academy of Breastfeeding Medicine, and Chair of the ABM Protocol Committee.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Newest ABM Protocol Released from the International Meeting in Miami Today: Allergic Proctocolitis in the Exclusively Breastfed Infant

We are here in sunny Miami at the 16th Annual International Meeting of the Academy of Breastfeeding Medicine–our “Sweet Sixteenth” birthday party!  What better way for me, a member of the Board of Directors and the Chair of the Protocol Committee to celebrate the accomplishments of our organization than to see the e-pub release today, live from the meeting, of our newest clinical protocol, #24: Allergic Proctocolitis in the Exclusively Breastfed Infant?

Highlights from Third Annual Summit on Breastfeeding: First Food–The Essential Role of Breastfeeding

Riding home on the train from Washington DC Thursday night, I was utterly physically exhausted as my mind tumbled over everything I had heard during the past two days.  I was returning from the Third Annual Summit on Breastfeeding.  For those of you who aren’t familiar with this Summit, I am going to unapologetically copy from the announcement of this Summit, as they said it better than I can!

“The First Annual Summit, held in June 2009, marked the 25th anniversary of the Surgeon General’s Workshop on Breastfeeding and Human Lactation, a milestone event led by C. Everett Koop, MD in 1984. Dr. Koop also delivered opening remarks at this 21st century follow-up.

The Second Summit in June 2010 addressed the unmet health needs of underserved mothers and their vulnerable children associated with low rates of breastfeeding, working proactively toward reducing barriers to breastfeeding. The goal was to bring high-level visibility in order to generate timely and judicious policy recommendations for a national breastfeeding agenda under the new health reform plan.

The Third Annual Summit on Breastfeeding was just held June 29-30, 2011 to make sure that we continue our best efforts to guarantee support for First Food: The Essential Role of Breastfeeding.  The Summit again took place in Washington to ensure maximum visibility in the public policy arena.

With continued support from the Kellogg Foundation, key leaders in health and public policy, including high-level representatives from key federal agencies as well as hands-on grass roots administrators from important programs throughout the country and leaders from academic institutions, industry, nonprofits, and public agencies were invited.”

The significant accomplishments of the First Summit and the Second Summit are documented in special supplements of Breastfeeding Medicine.  The Third Summit will be published in detail in an upcoming issue of Breastfeeding Medicine—so be on the look-out for Volume 6 Issue 5 in October.

Announcing our Newest Protocol: ABM Clinical Protocol #10: Breastfeeding the Late Preterm Infant (34 0/7 to 36 6/7 Weeks Gestation) (First Revision June 2011)

I am pleased to announce our newest protocol has been published in Breastfeeding Medicine: ABM Clinical Protocol #10: Breastfeeding the Late Preterm Infant (34 0/7 to 36 6/7 Weeks Gestation) (First Revision June 2011).  This is a revision of the previously entitled ABM Clinical Protocol #10: ‘‘Breastfeeding the Near-Term Infant (35 to 37 Weeks Gestation)”.  As this protocol starts out explaining:

“At the time this protocol was first written ‘‘near-term’’ infant was commonly used to describe infants born in the few weeks before the 37th week of gestation. In July 2005 a panel of experts assembled by National Institute of Child Health and Human Development designated infants born between 34 0/7 to 36 6/7 weeks of gestation as late preterm to emphasize the fact they are really ‘‘preterm’’ and not ‘‘almost term’’ and establish a uniform designation for this group of infants.  This definition, however, includes infants born 1 week more premature (34 0/7–34 6/7 weeks) than the previous Academy of Breastfeeding Medicine protocol for the ‘‘near term infant’’ that encompassed infants born at 35 0/7 weeks to 36 6/7 weeks. In addition, infants born at 37 0/7–37 6/7 weeks may be at risk for breastfeeding problems and associated risks, and, therefore, the following guidelines may be applicable to these infants as well”.   Breastfeeding Medicine 2001; 6(3):151-156.

This protocol is the perfect example of what we as the Protocol Committee hope can happen as we update and revise our Clinical Protocols on a 5 year basis.  Unless the evidence has changed dramatically, the plan is to attempt to update the references and the data in such a way as to follow the general outline of the original protocol.  The reasoning is that those of you who are used to using a particular protocol will think everything is changed if you see a completely differenct document, when maybe only one or two things have actually been changed.  If the format remains generally the same, you will be able to easily see what has been updated and what has changed since the last version, and easily be able to update your own practice.  Sometimes this is not possible if either practice really has changed extensively, or author styles and interpretation of the data are so different that there is just no way around it.  But this protocol is an excellent example of how some of the evidence has changed, starting with the basic definition of the population, and there are many more references available ( 13 cited in 2004 versus 52 in 2011) but the basic outline has been followed, enhanced, and expanded to make an even better protocol than the original was.

As the ABM Protocol Chair, I speak for my Committee and for the ABM Board of Directors when I say we are very proud of these Clinical Protocols and our Statements, all of which can be found on our website.  The Clinical Protocols are also accepted and published by the National Guidelines Clearinghouse, sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health & Human Services, which has very stringent requirements for acceptance to their website.

So please check out this newest protocol, and keep your eye open for our next one, the brand new Clinical Protocol #24: Allergic Proctocolitis in the Exclusively Breastfed Infant!

Kathleen Marinelli MD, IBCLC, FABM is a neonatologist a Board member of the Academy of Breastfeeding Medicine, and Chair of the ABM Protocol Committee.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

ABM Protocol and Statement Updates!

Today I wear my dual hats as ABM Protocol Chair and ABM Blogger.  It came to the attention of the Protocol Committee that there were typos/errors in a couple of our ABM protocols after publication.  Two protocols have been corrected in the on-line copies for Breastfeeding Medicine previously, and have now been updated on the ABM website as of today. 

Here are the corrections that have been made:

1.  Protocol #3—Supplementation—Volume 4, Number 3:

  Table 3, page 178  under “Time” the second line was originally printed 24-28 hours; correction is 24-48 hours.

2.  Protocol #7—Model Hospital Policy—Volume 5, Number 4:

  Page 176 and in the listing of the Ten Steps.  Step #6: only the US version require that hospitals purchase their formula.  The original published text stated: 

   6.  Give newborn infants no food or drink other than breast milk, unless medically indicated. (A hospital must pay fair market price for all formula and infant feeding supplies that it uses and cannot accept free or heavily discounted formula and supplies.)

Now it correctly and in keeping with the original, international Ten Steps says:

  6. Give newborn infants no food or drink other than breast milk, unless medically indicated.

I will let you know if any future changes occur in published protocols or statements. 

And by the way, the just published issue of Breastfeeding Medicine contains ABM’s second Statement, Educational Objectives and Skills for the Physician with Respect to Breastfeeding.  Check it out in the latest Journal (Breastfeeding Medicine. April 2011, 6(2): 99-105).  Our first ABM Statement, Position on Breastfeeding (Breastfeeding Medicine 2008;3(4):267-270), can be found under the “About Us” tab on our web page right now.  As we now have two statements, and several more on the way, we are setting up a “Statements” section on our Protocol page to make them easy to find all in one place.  Please be a little patient with us!  Our newest statement will be on our website soon!

Kathleen Marinelli MD, IBCLC, FABM is a neonatologist a Board member of the Academy of Breastfeeding Medicine, and Chair of the ABM Protocol Committee.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Breastfeeding in the Face of Natural Disaster and Nuclear Reactor Core Damage

It has been well over a week now that we the citizens of the world have been watching the seemingly unending horror unfold in Japan.  First they endured an earthquake of historic proportions, followed rapidly by a tsunami of untold destruction.   These unexpected natural disasters are frightening, devastating, and so very poignant and sad to comprehend. One cannot live in this age of instantaneous video reporting and see those images of death and destruction and not be affected at some deeply primal and emotional level.  Initially, the concerns for after effects in other nations around the Pacific were also frightening, but came nowhere near the complete devastation in Japan.  Totally coincidentally, I have been working on the United States Breastfeeding Committee Position Statement on Infant/Young Child Feeding in Emergencies. The images on the television brought the horrors of Hurricanes Katrina and Rita here in the US vividly back to my mind, and the words I have been typing into my computer drafting the Position Statement seem so inadequate in the face of the reality I see on the television screen.   It leaves me feeling impotent to really help, armed only with a computer and words.

And then, as if it could not have gotten any worse, one day later, an explosion occurred at the damaged Fukushima 1 nuclear power plant initiating a radiation leak, making this a catastrophe of unprecedented proportion.  By 6 days after the explosion, Japan’s nuclear safety agency raised the severity rating of the country’s nuclear crisis from Level 4 to Level 5 on a seven-level international scale, putting it on par with the Three Mile Island accident in Pennsylvania, USA in 1979.  For comparison, the Chernobyl accident of 1986, which killed at least 31 people with radiation sickness, raised long-term cancer rates, and spewed radiation for hundreds of kilometers, was ranked a Level 7.

So why am I writing this on a blog for ABM?  Besides the humanity that connects us all globally, and the immediate questions that arose in the medical and lactation communities concerning humanitarian efforts and safe infant and child feeding practices on the heels of the earthquake and tsunami, (on which there is much already written) the radiation leaks have led to many questions and some incorrect information related to breastfeeding that it is important to address, for now and should we ever need to deal with this again.