The position paper Camera systems for live streaming in the neonatal intensive care unit (NICU) is now available in English, Spanish, and Hungarian. It is based on the results of a project roundtable with well-known clinical experts from hospitals in Germany and Austria, organised by EFCNI.
Interview with Prof Luc J.I. Zimmermann
Prof. Zimmermann, in adults, how does a typical course of infection with RSV look like and how frequent is it?
RSV infections are very common, and, just like the influenza virus, RSV appears during flu season, in the coldest and wettest months of the year. In healthy adults, an RSV infection shows only mild symptoms similar to the common cold, like a running nose or a sore throat, and normally does not need to be treated. However, in other patient groups like preterm babies, an RSV infection can actually become rather threatening.
Why are preterm babies more at risk for serious complications from RSV infections?
The lungs are one of the last organs to develop as a baby is growing inside the womb. This means that when a baby is born preterm, even if it is only a few weeks too early, the lungs are not fully developed. Secondly, full-term babies get antibodies from their mothers during pregnancy, which help to fight RSV and other viruses, but when babies are born too early, they do not get enough of these antibodies before birth.
How is the virus transmitted to another person and how can we avoid infections?
To prevent an infection should be indeed our first priority. As for all viruses, RSV is also transmitted by droplets from one person to another, e.g. if an infected person sneezes and another person inhales the droplets, or if a person touches a surface that was recently touched by an infected person. Just remember the general and well-known hygiene rules against infections: Wash your hands frequently and thoroughly, do not share objects with others, avoid crowds, do not shake hands, and, if possible, stay home when you have cold-like symptoms.
It is often said that washing hands is the single most powerful measure of all to prevent infections, so can you please explain what needs to be observed when washing hands, especially when there is a baby at risk?
Washing hands with soap and water is the best way to reduce the number of germs on them. We recommend wetting the hands first, then lathering the hands with sufficient soap and scrubbing also the back of your hands, between your fingers, and under your nails. Rinse well and dry your hands with a clean towel or air-dry them.
So far, there is no vaccine available against an RSV infection. Can you tell us something about the current status regarding the development of a potential vaccine?
First of all, it is great news that it is increasingly recognized that RSV is not only a danger to our most vulnerable patients, but that it also represents a massive health burden on a global scale. It is correct, there is no vaccine available yet, but currently a number of different approaches and vaccine candidates are being tested so hopefully an effective vaccine will be on the market at some point soon.
Currently the only available medication is palivizumab, can you tell us what it is?
Palivizumab is not a vaccine, but a preventive medication based on monoclonal antibodies. It is applied by a series of injections that need to be given monthly, but only during the flu season. Palivizumab can help to prevent an infection but can also mitigate illness caused by an RSV infection.
In what cases should palivizumab be considered?
Palivizumamb should be considered if your baby is born too early, suffers from chronic lung disease, congenital heart disease or immunodeficiency disease. Guidelines on precise indications are currently not the same in every country and they are recently revised in many of them. It would be useful to streamline these guidelines in Europe.
Special thanks to Prof. Luc Zimmermann for his support and advice.
The topic “Respiratory syncytial virus (RSV)” is kindly supported by AbbVie.
Expressing first milk before birth and feeding it to a newborn is called colostrum banking. Dr Vökt from the Women’s Hospital in Grabs, Switzerland, gave us an interview explaining in which cases colostrum banking is indicated and what the benefits are.
Interview with Dr Cora Vökt
What exactly is colostrum banking and how does it work in practice?
Colostrum is a special term for the milk that is produced by the maternal mammary gland during the first days after childbirth and contains all the vital nutrients and immune substances that newborn babies need. Since colostrum is produced already in the second half of pregnancy as part of lactogenesis stage 1, many women can express this first milk from the lactiferious gland by massaging their breast. The prenatal colostrum expression and storing, also referred to as colostrum banking, is a method to obtain milk for your own baby and support breastfeeding in the first 24 hours or possibly in the first days of life.
For which patient groups do you recommend colostrum banking?
A prenatal colostrum expression and storing can be considered in all women that are at risk to have a difficult start into breastfeeding. This can be necessary for example if babies have a congenital disease (e.g. a cleft lip and palate) which makes it hard for them to drink sufficiently, or because an effective early nutrition is medically indicated due to an increased risk for hypoglycaemia.
Maternal gestational diabetes is the most common indication for early bottle feeding and blood glucose monitoring amongst normally developed newborns. Most commonly birth clinics will, in compliance to the neonatal recommendations, give formula or maltodextrin in addition to breastfeeding, which can compromise the initiation of breastfeeding or even prevent exclusive breastfeeding later on. Through colostrum banking it is possible in many cases to freeze and store maternal colostrum to give it to the baby directly after birth in addition to normal breastfeeding.
In many instances, prenatally learned breast massage will make colostrum secretion after birth more effective and promote the initiation of breastfeeding.
If newborns are very sleepy and don’t want to be breastfed in their first 1-2 hours of life, it will be easier to express some colostrum and put a few droplets in the mouth of the baby to stimulate breastfeeding. Sometimes it is also possible to express a sufficient amount of fresh colostrum after birth and give it to the baby right away without having to use milk that was expressed and frozen before birth. Fresh colostrum is usually preferred.
What is the benefit of colostrum banking from a medical point of view?
Colostrum banking helps to have an easier start into breastfeeding in general and to ensure exclusive breastfeeding right from day one. In normal-size and mature newborns who are at risk of hypoglycaemia, colostrum banking can help to reduce or even avoid the addition of formula without increasing the risk of hypoglycaemia.
How do hospitals in Switzerland introduce colostrum banking to pregnant women?
At several Swiss hospitals pregnant women with gestational diabetes are informed about the possibility of individual, antenatal colostrum expression to get early milk for their own child. If they’re interested, they will be instructed by trained specialists.
What is your experience with colostrum banking since its introduction at the Grabs Women’s Hospital?
Since early 2018, we are informing pregnant women with dietary or insulin-dependent gestational diabetes about the possibility of prenatal colostrum expression in the late pregnancy. If interested, they get qualified counselling and instructions from one of our lactation consultants. So far we have received a lot of positive feedback from the women. The counselling seems to make the initiation of breastfeeding easier, engorgement often happens earlier and is perceived more pleasant, and less or (in the majority) no formula has to be added (without increasing the risk of hypoglycaemia), all of which is greatly appreciated by the women.
Are there any additional specific rules or recommendations that should be observed in colostrum banking, also in comparison to regular human milk banks?
For individualized colostrum banking, where pregnant women extract their colostrum by breast massage a few weeks prior to the calculated date of birth, a qualified and professional advice from a specialist with adequate training is needed. It is also necessary to obtain a signed consent form from the expecting mothers, and they also need to be instructed in the correct technique of breast massaging and how to ensure an hygienic environment for expression and storage. Of course, prior to using colostrum banking, it has to be ruled out that there are any contraindications for breastfeeding.
Special thanks to
Dr Cora Vökt, International Board Certified Lactation Consultant, Specialist in Gynaecology and Obstetrics with focus on fetomaternal medicine, Senior Consultant at the Women’s Hospital Grabs, Switzerland
Lighthouse project hospital hygiene: How to implement hygiene measures in a hospital – and foster compliance
The WHO campaign Clean Your Hands aims to improve awareness of the importance of hand hygiene in health care and to actually promote change and reduce the number of infections in hospitals worldwide. To find out how this campaign was implemented in a local hospital, we interviewed Dr Axel von der Wense, Head of the Neonatal and Intensive Care unit at the Altonaer Children’s Hospital.
An interview with Dr Axel von der Wense, Altona Children’s Hospital, Hamburg, Germany
The Altonaer Children’s Hospital is one of the leading hospitals in infection prevention and hand hygiene, how and when did you introduce and implement state-of-the-art hygiene guidelines and become one of the German flagship hospitals in hygiene?
First of all, we were one of the first neonatal hospitals that participated in Neo-KISS, a German surveillance system for nosocomial infections in preterm babies. Although we had quite low infection rates, we wanted to improve further and started with the National Action Plan for Clean Hands early on. We also increased the number of hygiene specialists in our department and offered a lot of training to our nurses and paediatricians.
While hygiene is very crucial in all hospitals and care facilities, what makes it so extremely important in newborn care?
Newborn and especially premature infants have a very immature immune system. That makes them extremely prone for infections even with bacteria that would not be dangerous for anyone else. Infections are still a major contributor for morbidity and mortality in sick newborn infants.
What were the main steps in the implementation of the hygiene standards, and how was it actually organized?
The most important issue is to be aware of hygiene mistakes. If you think “Oh, our department is already perfect in hygiene standards”, then you will never get better. It is not enough to commit to standards of disinfection and prevention, instead you really have to verify every day if the standards are being observed in everyday routines in the clinical setting. For that you need independent observers who see how the staff works and give direct feedback.
What kind of practical training did your staff receive? What part of the training, in your view, is the most important part?
Hand disinfection can be nicely visualized using a so-called Black box, a teaching tool uses fluorescent light. The Black box can show how well you washed your hands and which parts of your hands might not be completely disinfected with alcohol solution. This is only one example. The most important part is the observation of daily hygiene routines during the normal workflow.
How do you ensure that, after returning to the daily routines, doctors and nurses continue to follow the hygiene standards at your hospital?
As I said before, you cannot only train hygiene procedures by lectures or written standards. Many of our hygiene mistakes happen unintentionally, and you will only find out about it if you encourage if someone speaks up about it and you can openly talk about it.
Do you have some data showing the success of introducing the hygiene standards at your hospital? Did it actually reduce the no. of infections?
The German Neo-KISS system can measure nosocomial infection rates for very premature infants and offers results for every hospital compared to others. We started in 2006 and although we had rates below the mean values of other departments, we were able to further improve our infection rates over the next years.
In your view, what could be done by policy makers to support hospitals and healthcare staff in their fight against infections?
First of all there should be strict recommendations on how many hygiene specialists should work at a hospital, especially in high risk wards like neonatal intensive care units. Secondly, politicians can support the issue and ensure that there really is enough nursing staff for the number of patients treated in the unit. There has been progress in Germany over the last years defining the minimum number of nurses per ward, but this must be further improved in the future.
Special thanks to
Axel von der Wense, Head of the Dept. of Neonatology and Paediatric Intensive Care at the Altona Children’s Hospital, Hamburg, Germany
Wir freuen uns, unsere neue Eltern-Broschüre “Muttermilch für Frühgeborene – Nahrung für Körper und Seele” vorzustellen! Hier finden Mamas von Frühgeborenen sowie deren Partner und Familienangehörige nicht nur zahlreiche praktische Tipps rund ums Stillen, sondern auch interessante Fakten über Muttermilch, wie diese zur gesunden Entwicklung ihres frühgeborenen Babys beiträgt und Vieles mehr. Mit dieser Broschüre wollen wir Mütter ermutigen, ihr Frühgeborenes mit Muttermilch (oder gespendeter Frauenmilch) zu ernähren, wir möchten zudem Hilfestellung bieten, sei es bei Fragen zu Stillpositionen, wie die Milchproduktion gefördert werden kann und was bei der Entwicklung von Frühgeborenen zu beachten ist. Natürlich bietet “Muttermilch für Frühgeborene“ auch Mamas von termingeborenen Babys viele wertvolle Ratschläge für eine erfolgreiche, schöne Stillerfahrung. Wir danken den Autoren und Editoren sowie den unterstützenden Fachgesellschaften für die Zusammenarbeit bei dieser Broschüre. Wir bedanken uns außerdem bei Medela für die Unterstützung. Die Broschüre kann hier kostenlos von unserer Website heruntergeladen werden und ist auf Anfrage auch gedruckt erhältlich. Bei Interesse kontaktieren Sie uns bitte über info[at]efcni.org. Eine digitale englischsprachige Ausgabe wird zum Jahresende erhältlich sein.
Launch unserer neuen Broschüre “Muttermilch für Frühgeborene” in München (v.l.n.r): Barbara Mitschdörfer (Bundesverband „Das frühgeborene Kind” e.V.), Nicole Thiele (EFCNI), Thomas Kühn (Vivantes Klinikum, Berlin-Neukölln), Natacha Jalu (Medela). © Christian Hartlmaier
The Family and Infant Neurodevelopmental Education (FINE) programme is an educational pathway in infant and family-centred developmental care for all healthcare professionals working in neonatal care. The overall goal is to improve the outcomes for babies and families in neonatal care. The curriculum includes themes such as neurodevelopment of the newborn, the relationship between parents and their baby, management of stress and pain, and observing and understanding the baby’s behaviour. The concept has spread to many parts of the world and thousands of healthcare professionals have completed at least the first level of the FINE curriculum. Due to the sustainable impact on the implementation of family-centred care, FINE is one of our lighthouse projects in the field of education and training of the multidisciplinary neonatal team.
An interview of Inga Warren and Monique Oude Reimer-van Kilsdonk
We had the opportunity to ask Inga Warren, Primary author and Co-director of FINE, and Monique Oude Reimer-van Kilsdonk, Co-director of FINE, some questions about their programme:
What was the idea behind FINE and what was the starting point?
FINE began as in-service training at St. Mary’s Hospital in London, then home to the UK’s NIDCAP Training Centre, but we soon realised the need to make good quality education accessible beyond our own unit on a scale that would not be possible for NIDCAP.
How did you put your idea into practice?
Start-up funding from parents allowed Inga time to develop training materials. Nikk Connemann (project consultant) as well as Monique and Esther van der Heijden (Co-author) in Rotterdam shared the vision of creating a universal programme that would support NIDCAP in practice and we started working together in 2012; by 2013 the FINE curriculum had taken shape and the current training pathway was formalised with Level 1: Foundations and Level 2: Practical Skills, and we began to recruit experienced and talented faculty.
When did you start to hold advanced trainings across Europe?
The first centre outside to try FINE Level 2 was the Institute of Neonatology in Belgrade, Serbia in 2014. NIDCAP training had been introduced but as in many other low-income countries a more affordable option was needed. Six nurses completed the level 2 course, translated into Serbo-Croat.
The EFCNI gave us platforms for spreading information with invitations to speak at the jENS conference in Budapest 2015 and the annual Parent Organisations meeting in 2016. With this support awareness of FINE has grown and grown. EFCNI facilitated translations into German and enabled training at both levels to start in Germany in 2016. They encouraged and supported parent organisations in Greece (2016), Cyprus (2017), Romania, and Hungary (2018) to set up FINE training. These are brave moves in countries where parents often do not have opportunities to care for their babies during neonatal care.
Enquiries are coming from more countries in the Eastern side of Europe and many other countries around the world. NIDCAP Training Centres in eight countries are now licensed to run FINE, with three more preparing. The UK – Rotterdam partnership has delivered FINE to many other countries that are not eligible for a license. The NIDCAP Federation International has endorsed the programme.
Where do you think, the most notable changes were achieved?
Staff surveys in the UK show a strong conviction that FINE improves practice. In France and Belgium, it has been so well received that it has attracted state funding. In the absence of data by which to compare before and after practice it is difficult to measure precise outcomes but we have encouraging feedback from units such as Helena Venizelou in Athens, Greece, and in Cluj in Romania where new practices such as kangaroo care were introduced rapidly, parental access was opened up and staff were enthusiastic about the dramatic changes they made in spite of previous forebodings. More centres in these countries are now asking for FINE and we are very proud to be supporting the work of parent organisations in this way. Countries with well-developed infant and family centred developmental care, such as Sweden, are reporting that FINE has revitalised interest in NIDCAP based care and we are seeing a growing number of people enquiring about further training, which will be important for developing faculty to make FINE sustainable.
From October 2018 to the end of 2019, FINE 1 and FINE trainings are planned in the following countries (as of September 2018):
- Austria (FINE 2)
- Belgium (FINE 1+2)
- France (FINE 2)
- Germany (FINE 1+2)
- Greece (FINE 1)
- Hungary (FINE 1)
- Ireland (FINE 1+2)
- Italy FINE (1+ 2)
- Lithuania (FINE 1)
- Netherlands (FINE 1+2)
- New Zealand (FINE 1)
- Portugal (FINE 1)
- Qatar (FINE 1+2)
- Romania (FINE 1+2)
- Saudi Arabia (FINE 1+2)
- Sweden, (FINE 2)
- UK (FINE 1+2)
Special thanks to
Inga Warren, Co-director of FINE
Monique Oude Reimer-van Kilsdonk, Co-director of FINE
For the next long-term EU budget 2021-2027, the Commission is proposing €100 billion for research and innovation.
A new programme – Horizon Europe – will build on the achievements and success of the previous research and innovation programme (Horizon 2020) and keep the EU at the forefront of global research and innovation. Horizon Europe is the most ambitious research and innovation programme ever.
Commission Vice-President Jyrki Katainen, responsible for Jobs, Growth, Investment and Competitiveness, said “Investing in research and innovation is investing in Europe’s future. EU funding has allowed teams across countries and scientific disciplines to work together and make unthinkable discoveries, making Europe a world-class leader in research and innovation. With Horizon Europe, we want to build on this success and continue to make a real difference in the lives of citizens and society as a whole.”
Carlos Moedas, Commissioner for Research, Science and Innovation, added: “Horizon 2020 is one of Europe’s biggest success stories. The new Horizon Europe programme aims even higher. As part of this, we want to increase funding for the European Research Council to strengthen the EU’s global scientific leadership, and reengage citizens by setting ambitious new missions for EU research. We are also proposing a new European Innovation Council to modernise funding for ground-breaking innovation in Europe”.
While continuing to drive scientific excellence through the European Research Council (ERC) and the Marie Skłodowska-Curie fellowships and exchanges, Horizon Europe will introduce the following main new features:
A European Innovation Council (EIC) to help the EU become a frontrunner in market-creating innovation:The Commission’s proposal will establish a one-stop shop to bring the most promising high potential and breakthrough technologies from lab to market application, and help the most innovative start-ups and companies scale up their ideas. The new EIC will help identify and fund fast-moving, high-risk innovations with strong potential to create entirely new markets. It will provide direct support to innovators through two main funding instruments, one for early stages and the other for development and market deployment. It will complement the European Institute of Innovation and Technology (EIT).
New EU-wide research and innovation missions focusing on societal challenges and industrial competitiveness:Under Horizon Europe, the Commission will launch new missions with bold, ambitious goals and strong European added valueto tackle issues that affect our daily lives. Examples could range from the fight against cancer, to clean transport or plastic-free oceans. These missions will be co-designed with citizens, stakeholders, the European Parliament and Member States.
Maximising the innovation potential across the EU: Support will be doubled for Member States lagging behind in their efforts to make the most of their national research and innovation potential. Moreover, new synergies with Structural and Cohesion Funds will make it easy to coordinate and combine funding and help regions embrace innovation.
More openness: The principle of ‘open science’ will become the modus operandi of Horizon Europe, requiring open access to publications and data. This will assist market uptake and increase the innovation potential of results generated by EU funding.
A new generation of European Partnerships and increased collaboration with other EU programmes: Horizon Europewill streamline the number of partnershipsthat the EU co-programmes or co-funds with partners like industry, civil society and funding foundations, in order to increase their effectiveness and impact in achieving Europe’s policy priorities.Horizon Europe will promote effective and operational links with other future EU programmes, like Cohesion Policy, the European Defence Fund, the Digital Europe Programme and the Connecting Europe Facility, as well as with the international fusion energy project ITER.
View more (European Commission)
A guest article by Dr Rangmar Goelz and Dr Karen Kreutzer from the University Children’s Hospital Tübingen
Last year, the neonatal ward in the University Clinic Tübingen/Germany started, as one of the first clinics in Germany, to train emergency situations with the help of a baby simulator doll. As this in one of our lighthouse projects in the area “Education and training”, we spoke to Dr Rangmar Goelz and Dr Karen Kreutzer and asked them how the simulation trainings have been implemented into their training schedules and if the trainings have proven to be successful.
The University Children’s Hospital Tübingen is one of the first clinics in Germany that is using a baby simulator doll for training purposes. How did that come about?
We already started training our staff in a simulation laboratory 12 years ago. This laboratory was initially used for trainings in anaesthesiology, but it was soon used in paediatrics as well.
At the beginning we only had a doll weighing 4–5 kg. This of course was too big, but it was good enough to practice various emergency scenarios. During these trainings even the biggest sceptics in our team were able to experience how real it feels and how the blood pressure increases in such a simulated emergency situation. So right from the beginning we were completely convinced about the concept of simulation trainings in general.
For how long are you using the simulator doll Paul and why did you make the decision to integrate it into your trainings?
We heard about the simulator doll Paul at a congress and we immediately contacted the manufacturer. Paul was the missing piece to make the simulation even more realistic and adapt it even better to our every-day work at the hospital. So we were very happy when we finally received our own Paul. As the costs for the doll are quite high, we appreciated the financial support we received from the local newspaper “Schwäbisches Tagblatt”, the foundations Dachtel hilft kranken Kindern and Lichtblick e.V. , and our own parent initiative for ill children of the University Children’s Hospital Tübingen.
How do you integrate Paul into your simulation trainings in your hospital?
In the beginning we practiced mostly in our simulation laboratory because we also had to first become familiar with the doll. It is quite surprising how similar it is with a real preterm baby and how small and fragile it is. We practiced using the doll in different scenaries covering first stabilisation measures and the typical associated ermergency situations. Recently we started training with Paul outside of the laboratory directly in the neonatal ward, as Paul has another great feature: he functions wirelessly via radio control, therefore we can hold our training sessions in the actual places of action which makes it even more realistic.
How would you like to further develop the simulation trainings?
As I said, we are currently training for stabilisation scenarios that are typical for the emergency cases in the neonatal ward. But our goal is to do trainings directly in intensive care, but for this we need free beds in intensive care, which is at the moment very difficult.
What are the challenges you are facing?
One of the biggest challenges is to allocate the time that you need for the training units. The simulation trainings can only be conducted in a team, with the participation of nurses, the ward doctor, one or two senior doctors, and the training staff. This means that the trainings need to be scheduled very far ahead, and so far the trainings are not included in the general staff planning and need to be added on top. In Germany the number of nurses allocated to the care of preterm babies with very low birth weight was increased, so we now have more nursing staff. Unfortunately this not the case yet with doctors.
What changes and improvements were you able to achieve so far by practising with Paul?
The training conditions are becoming more and more realistic. So far we did not make a review of our experiences in the classical sense to show what the benefits of our baby simulation training really are. This would also exceed our administrative capacities. But maybe I could illustrate how we are benefitting from it by telling you about a situation the other day in our ward: In was in the middle of the night, and besides taking care of normal patients, we had a severe emergency situation and an emergency C-section of a very preterm baby. It was very late, everyone was stressed out and we had many other patients, but everything went perfectly smooth. This was a very satisfying and comforting experience for the whole team, which can be especially important even when all efforts fail and we cannot help the child in the end.
View more (article by Dr Jens-Christian Schwindt, founder of the baby simulator doll Paul)
View more (website University Clinic Tübingen)
The simulator doll Paul is being used for trainings in the following clinics around the globe:
Women’s Guild Simulation Center for Advanced Clinical Skills Cedars Sinai Medical Center, Los Angeles, CA
The University of Tennessee Health Science Center, Memphis, TN
Old Dominion University, School of Nursing, Norfolk, VA
Children´s Hospital of Philadelphia, Philadelphia, PA
Johns Hopkins All Children’s Hospital, St Petersburg, FL
Johns Hopkins Medicine Simulation Center, Baltimore, MD
US Army Hospital Landstuhl/LRMC
Medical University Schleswig Holstein, Luebeck
Medical University Tuebingen
Municipal Hospital Dresden
Hospital Ernst von Bergmann, Potsdam
Children’s Hospital Passau
Medical University Vienna
General Hospital Klagenfurt
Medical University Salzburg
Medical University Sankt Poelten
Victoria Hospital Kirkcaldy
Acibadem University’s Centre of Advanced Simulation Education (CASE), Istanbul
Recep Tayyip Erdoğan Üniversitesi, Istanbul
Men can play an important role when it comes to breastfeeding. Within our monthly topic of “Nutrition”, we wanted to get to the bottom of this issue and talked to a well-known expert in this field, Professor Michael Abou-Dakn, Head of Department at the Clinic for Gynaecology and Obstetrics at the St. Joseph’s Hospital Berlin Tempelhof, Germany.
To what extent do men influence women’s decision to breastfeed their child and the frequency and duration of breastfeeding?
International research and our own studies have shown that both the decisions whether women are going to breastfeed or not, as well as the duration of breastfeeding are very decisively influenced by men (fathers). This is particularly true for educationally deprived strata of society, where the influence of men is even more pronounced. What’s interesting is that the partners’ attitude, negative or positive, is frequently taken over by the women themselves.
We were also able to show that expectant fathers who are only briefly informed about the advantages of breastfeeding in a course and who receive essential information on breastfeeding support, are much more supportive later on when problems arise.
Can you observe any regional differences in this regard (e.g. within Europe) and if so, which?
The studies come from different countries and show similar effects. In particular, the influence of education on the initiation and duration of breastfeeding has been proven in many studies. Unfortunately, this also applies to the motivation of women.
According to current research findings, what are fathers’ reservations about breastfeeding based on?
For the most part it is the unawareness of the negative consequences of not breastfeeding. It’s a common believe that industrial substitute products are equal to natural breast milk, which is not the case. This is simply a misjudgement, because pregnancy itself changes the volume of the breast, and breastfeeding doesn’t have a significant influence. Abroad, the financial situation is often brought to the fore. Fortunately, this is less common in Germany due to existing maternity guidelines.
How has men’s behaviour changed over time and where is it heading (e.g. since the 1950s compared to today)?
The attitude towards the uniqueness of breast milk has changed in recent years for both men and women. Overall we haven’t achieved such a significant change with our breastfeeding promotion if you take in account our goal of encouraging as many women as possible to (exclusively) breastfeed their children, even after the first 6 months. Even after the minimum of an exclusive breastfeeding period of up to 5 months recommended in Germany, no significant changes can be observed in recent decades.
Merely the attitude and the initiation of breastfeeding have improved considerably. However, most men today are more intensely involved and included in health related issues and early child care, compared to the 50s. This is probably due to the changed roles of both parents. The introduction of parental leave for fathers was also very helpful here. Because of Scandinavian research we know, that this leads to fathers feeling more deeply involved into parenting, and from own research I can affirm you, that men have an increasing interest in health related aspects during pregnancy and postpartum period. This can be used for corresponding educational work, which is already done by the German network for young families (Netzwerk Junge Familie), the European Foundation for the Care of Newborn Infants (EFCNI), and the German Federal Center for Health Education (BZgA).
To what extent can fathers encourage their partner to breastfeed and positively support her breastfeeding behaviour?
As so often, it is primarily about a positive emotional support of the partner. Pressure, no matter in which direction, is always stressful and often leads to a difficult start to breastfeeding. I am convinced that every woman can breastfeed and every child wants to be breastfed, but often the beginning is not easy and can contribute to failure. Partners who lovingly and empathetically accompany their wife are particularly helpful. This also means that women are relieved in everyday life. We were also able to show that men who are informed about breastfeeding problems and who have got to know and understood suggestions for solutions, as well as midwives or experts in breastfeeding, are helpful counsellors who can motivate their women to continue breastfeeding even in the case of initial irritations.
Special thanks to
Professor Michael Abou-Dakn
Head of Department at the Clinic for Gynaecology and Obstetrics
St. Joseph’s Hospital Berlin Tempelhof
A guest article by Professor Jean-Charles Picaud, President of European Milk Bank Association (EMBA)
Health benefits of breastfeeding are well-known in healthy term infants. These benefits are even greater in preterm infants as human milk (HM) feeding reduces the risk of complications associated with prematurity, such as digestive intolerance, necrotising enterocolitis, sepsis, retinopathy of prematurity (ROP) and bronchopulmonary dysplasia. As these benefits specifically present in preterm infants are dose-dependent, babies should receive as much HM as possible. It can be mother’s own milk when available. If not or partially available, donor HM is recommended by the World Health Organization (WHO) as the best alternative. Finally, when both are not available, these infants should be fed with a specific formula covering nutritional needs. Benefits of HM feeding are probably related both to HM properties and to the avoidance of formula.
Donor HM is obtained from HM banks which collect, treat and deliver milk from mothers who have a surplus of milk and accept to donate. Donors are carefully screened through a medical interview and serological testing. Milk collection is then performed under strict hygiene conditions explained to the donors that accept to carry out this altruistic act. Human milk banks require a significant number of donors, which is easier when breastfeeding rates in the general population are high. It is crucial to explain to all lactating mothers how much their milk could support health and development of preterm infants. Information campaigns about prematurity and it consequences, together with information about how to help these babies by donating milk are essential, because mothers delivering healthy term infants are not always aware about the potential impact of their involvement in milk donation.
Another key point is the density of the HM banks network. The number of HM banks sharply increased worldwide during the past 15 years. There are presently 226 active HM banks in 25 European countries (plus Switzerland, Russia, and Serbia). This field is developing quickly in Europe and chances of having a milk bank not too far away and the possibility to collect milk of donors, are increasing.
Donated HM is stored and transported carefully while maintaining the cold chain. Holder pasteurisation (62.5°C during 30 min) is commonly used to apply heat treatment. It offers the best compromise between microbiological safety and a preservation of HM quality. The concentration of most components is preserved or moderately reduced after the holder pasteurisation. Some components are reduced, but, more importantly, only a few enzymes and cells are destroyed. Finally, pasteurised HM keeps its main properties and is efficient to reduce short-term and long-term morbidity.
Human milk banks are running according to national guidelines, which tend to harmonise the illustrated processes. The European Milk Bank Association (EMBA) will publish Guidelines for the implementation of HM bank and Guidelines for treat treatment of donor HM to support this harmonisation of practices before the end of 2018. Furthermore, EMBA will publish recommendations to fortify donated HM, which is essential to support postnatal growth of preterm infants. A good postnatal growth has been associated with improved further cognitive development.
HM banks are engaged in actions to improve the supply of donated HM to hospitalised preterm infants. They are the main beneficiaries as there is a large body of evidence about health benefits of HM feeding in this population of high risk patients. There are other indications such as digestive malabsorption syndrome, post-operative nutrition of gastroschisis, immunologic deficiencies, etc. If supplies of banked HM are sufficient, some countries proposed that donor milk may be dispensed by prescription for situations such as adoption or surrogacy, illness in the mother requiring temporary interruption of breastfeeding, health risk to the infant from the milk of the biological mother or death of the mother.
In some countries, some HM banks propose donated milk to mothers of healthy term infants with absent or insufficient lactation. This societal demand emerged recently and the main interest could be to avoid milk sharing or selling which can be deleterious for health of recipients. This indication should be carefully discussed and not accepted before all the needs of ill newborns are covered. Until that happens in Europe, the objective of European milk banks is to supply donor HM to all preterm infants who need it to get a HM feeding (mother’s own milk andor donor HM) during hospitalisation.
Professor Jean-Charles Picaud
President of European Milk Bank Association (EMBA)
President of French Human Milk Bank Association (ADLF)
Head of Department of Neonatal Intensive Care
Croix rousse hospital
103 Grande rue de la croix rousse
69004 Lyon, France