Tag Archives | Maryanne Perrin

“World Day of Human Milk Donation” – An International Effort!

By Maryanne Perrin, MBA

I spoke with Dr. Danielle Aparecida da Silva of Brazil’s Oswaldo Cruz Foundation (equivalent to the Food and Drug Administration in the USA) to learn more about the upcoming “World Day of Human Milk Donation” which will be celebrated on May 19, 2013.  Aparecida da Silva is in charge of processing and quality control for the national reference center which supports milk banks throughout Iberoamerica and Africa.

A Day to Promote Milk Donations

DonateMilk(Brazil)PosterSince 2004, Brazil’s Human Milk Bank network (Bancos de Leite Humano or BLH-BR) has held an annual “National Day of Human Milk Donation” to promote the importance of giving milk.  This campaign involves selecting a “godmother of donation” who is usually an actress, singer, or other public figure (a few years ago it was volleyball players on the Olympic team) to bring awareness regarding the importance of donating milk to save the lives of thousands of premature babies. In 2010, Brazil began discussions with their partner countries in the Iberoamerican Program of Human Milk Banks (IberBLH) about hosting a “World Day of Human Milk Donation” which is celebrated on May 19 by Brazil and 23 other countries. This date was chosen because it is the date of the signing of the “First Letter of Brasilia,” a document to form international cooperation in milk banking. On May 19, the IberBLH member countries will promote the idea that when you donate milk, you donate life.  This year’s theme is “Give Milk, Life Thanks” and the campaign will use radio, television, posters, and community events to raise awareness of the import role that milk donors play.

About Brazil’s Milk Bank Network

brazil

Dr. Danielle Aparecida da Silva

In the 1980s, Brazil created breastfeeding promotion policies that focused on two objectives: providing breastfeeding support to mothers, children, and families and managing the human milk banks to ensure a quality product.  The combination of breastfeeding support and donor milk banking is based on the notion of human milk as a functional food that is important for decreasing neonatal morbidity.  In 2012 Brazil’s breastfeeding promotion center provided breastfeeding support to almost 1.6 million women, collected approximately 160,000 liters of donor milk throughout their 212 milk banks, and supported 167,000 premature infants. In 2007, Brazil was instrumental in forming the IberoAmerican Program of Human Milk Banks for the exchange of knowledge and technology related to breastfeeding and milk banking with other countries.

The Importance of Donor Milk on a Global Level

According to the World Health Organization over 1,000,000 babies die every year from complications associated with prematurity, and it is the leading cause of death for infants under 4 weeks old.  What kind of global impact could we have by making donor milk available to fragile infants worldwide who don’t have access to their mother’s milk?  The cooperation of the Iberoamerican network in creating awareness about the need for milk donors is an important first step. Imagine if 50 countries participated in the 2014 “World Day of Human Milk Donations” and 75 countries the following year? Congratulations to Brazil and their Iberoamerican partner countries for highlighting donor milk as an important piece in the overall strategy to improve global infant health!  

What efforts are going on in your country to raise awareness about donor milk banking?

MaryannePerrin3-2Maryanne Perrin loves all things related to food: growing it, cooking it, eating it, and now studying about it at the molecular and cellular level.  She has a BS in Industrial Engineering from Purdue University and an MBA from the University of North Carolina, Chapel Hill, and enjoyed a variety of career paths (information technology, management consulting, stay-at-home-mom, entrepreneur) before returning to school to obtain a PhD in Nutrition Science. She was quickly captivated by the amazing story of human milk and is focusing her research on understanding the nutritive and immunoprotective value of donor milk beyond one year postpartum.  When she’s not studying or helping ILCA with social media, she likes playing in the woods with her husband, three kids, and the family dog.  

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The Milk Machine: Learning More about How Breastmilk Protects the Gut

Maryanne Perrin, MBA, and ILCA volunteer

Research over the last several decades has highlighted WHAT makes human milk so amazing — it’s associated with reduced risk of infections, asthma, obesity, diabetes, leukemia, and necrotizing enterocolitis (NEC), just to name a few. Determining HOW human milk delivers these benefits (referred to as “the mechanisms”) is less fully understood, though researchers around the world are working on these questions. A study published last month in the journal Pediatric Research gave some interesting insights on a potential human milk mechanism that is involved in protecting against NEC.

Photo by derPlau via Flickr Creative Commons

Photo by derPlau via Flickr Creative Commons

First, a little background information: Most of the fat in our diet is found in the form of triglycerides, a “suitcase” that carries three (thus the “tri”) fatty acids bound to a glycerol backbone. To absorb these fats, our bodies first break off the fatty acids, producing free fatty acids (FFAs), which are packaged into micelles and absorbed via the intestinal epithelial cells, and then repackaged into triglycerides for transport to other tissues.

Researchers at the University of California, San Diego wondered whether there was a difference in the toxicity of digested human milk (HM) compared to infant formula (IF), so they used an in-vitro model to study what happened to various cells when exposed to digested HM and IF. This involved mixing HM and IF in test tubes with various enzymes to simulate the digestive process, and then exposing three different cell types to the digested content: human neutrophil cells (a white blood cell that is involved in the early response to infections); cow heart endothelial cells, and rat intestinal epithelial cells.

What did they find?

Digested infant formula had significantly higher levels of FFAs than digested human milk (more triglycerides were cleaved) and it also had significantly higher death rates of neutrophils during a two hour exposure (ranging from 47 – 99% depending on the formula brand compared to a 6% death rate during exposure to digested human milk). Results were similar for the death of cow heart cells and rat intestinal cells. The likely mechanism for the cell death is the elevated level of FFAs which act as detergents and rupture cell membranes. When FFA levels were reduced by inhibiting the enzyme that cleaves triglycerides, cell death was also reduced.

Infant formula is designed to have a similar fat content to human milk, so what could cause the elevated FFAs levels that contribute to necrosis? The authors speculated on several things including the way triglycerides are delivered in human milk (they are in larger globules than in infant formula, potentially making them less digestible by lipase enzymes), the possibility that human milk deactivates enzymes that digest fat (or infant formula activates them), and the different structure of the triglycerides (human milk puts the long chain fatty acids in the #2 position on a triglyceride, making them less digestible, while in infant formula, the long chain fatty acids are primarily located at position #1 or #3 on the glycerol backbone, which is preferentially cleaved by digestion enzymes).

The mechanism described in this study is not pathogen driven, but instead driven by a cytotoxic environment that leads to premature cell death. Other potential NEC mechanisms were reported in the last year that involved bacteria; one study done in a rat model showed that the oligosaccharides in human milk bind pathogens that cause NEC, while another study showed that bacteria that grew on human milk formed a potentially protective biofilm. All of these studies were done in a test tube or in animal models, which means more research is needed to determine whether these mechanisms also operate in humans.

Collectively these studies suggest that human milk potentially has a variety of “tools in its toolbox” for protecting the immature and developing infant. Does this surprise you?!

MaryannePerrin3-2Maryanne Perrin loves all things related to food: growing it, cooking it, eating it, and now studying about it at the molecular and cellular level.  She has a BS in Industrial Engineering from Purdue University and an MBA from the University of North Carolina, Chapel Hill, and enjoyed a variety of career paths (information technology, management consulting, stay-at-home-mom, entrepreneur) before returning to school to obtain a PhD in Nutrition Science. She was quickly captivated by the amazing story of human milk and is focusing her research on understanding the nutritive and immunoprotective value of donor milk beyond one year postpartum.  When she’s not studying or helping ILCA with social media, she likes playing in the woods with her husband, three kids, and the family dog.  

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Can A Cow Jump Over the Moon (or Produce Human Milk)?

By Maryanne Perrin, MBA

Photo by law_keven via Flickr Creative Commons

“Hey diddle diddle,
The cat and the fiddle,
The cow jumped over the moon.”

How many of us have lulled little ones to sleep with the lines from this old English nursery rhyme? Today’s news headlines claim cows are performing another impressive trick –producing human milk – thanks to the wonders of genetic engineering. And while cow tricks are amusing in nursery rhymes, in the field of infant nutrition they deserve a lot more scrutiny. So let’s take a closer look at the claims of human-milk-producing cows.

What’s Been Engineered Into Cows’ Milk

In recent years, scientists in China have genetically modified cows to produce human lysozymes, an antimicrobial protein (1) that disrupts the cell wall of gram-positive bacteria. They’ve also created a cow that produces human lactoferrin, another important antimicrobial protein (1) that destabilizes the cell wall of both gram-positive and gram-negative bacteria. A 2011 study out of The Netherlands found that the lysozyme content of human milk was 3,000 times greater than that of bovine milk, and that the lactoferrin content was 75 times greater (2). Clearly the greater concentrations of these antibacterial proteins in human milk are important for infants, given the immature nature of their gastrointestinal tract. But does adding a genetically engineered human protein to cow milk provide the same immunological benefits to humans (many more studies will be needed to establish safety and efficacy) and are there other important human milk compounds missing from engineered cows’ milk?

What’s Still Missing?

We’ve learned a lot over the past few decades about the make-up of human milk (and there’s still more to be discovered and understood!). Two of the most obvious areas where human milk and bovine milk differ in their nutrient make-up are in proteins and carbohydrates.

Proteins: Both the quantity and nature of proteins differ between human and bovine milk. For example, human milk has substantially less total-protein and casein-protein than cows’ milk, while it has significantly higher concentration of several proteins associated with the development of the mucosal immune system. The Netherland study showed that of the 268 proteins identified in human milk, 121 of these proteins (45%) were not found in cow milk (2).  Notable differences include the high concentration of immunoglobulin A, a human milk protein customized to bind pathogens found in the mother’s (and thus the baby’s) environment, and CD14, a protein involved in detecting gram-negative bacteria and activating the innate immune system.

Carbohydrates: Human milk has a higher concentration and more diverse portfolio of oligosaccharides, (a short chain of sugar molecules) than cow milk (3). Human Milk Oligosaccharides (HMOs) pass through an infant’s gut undigested, and serve as a prebiotic for the development of a healthy gut microflora. They also appear to act as a very shape specific “lock and key” to bind pathogens. While much research remains to be done in this field, recent studies have shown HMOs to be protective against NEC in an animal model, and to be associated with a reduced transmission of HIV.

Today’s scientific advances will allow us to continue to identify health-promoting compounds in human milk and then manufacture them using various biotechnologies. But “human milk” cannot be created by bolstering cow milk with one or two important proteins, as evidenced by the hundreds of unique proteins and hundreds of unique and changing oligosaccharides in human milk (not to mention living cells and bacteria) that work collectively to support an infant’s immature immune system. Re-engineering all of that into a single cow is a mighty big challenge – probably even bigger than jumping over the moon!

Written by Maryanne Perrin, MBA, Graduate student in Nutrition Science, and ILCA volunteer

References

1. Hanson, L.A. (2005). Human milk: Its components and their immunobiologic functions. In J. Mestecky, M. Lamm et al (Eds.), Mucosal Immunology 3rd Edition ( 1795-1827). Oxford: Elsevier Academic Press.

2. Hettinga K, van Valenberg H, de Vries S, Boeren S, van Hooijdonk T, et al. (2011) The
Host Defense Proteome of Human and Bovine Milk. PLoS ONE6(4): e19433. Doi:10.1371/
journal.pone.0019433.

3. Mehra R, Kelly P. Milk oligosaccharides: Structural and technological aspects. International Dairy Journal. 2006; 16(11): 1334-1340.

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Got Twitter?

Written by Maryanne Perrin – MBA, graduate student in Nutrition Science, ILCA volunteer

Many of my friends who are die-hard Facebook users say they just don’t understand the power and appeal of Twitter. If you fall into this category, read on! We are trying to build an army of TwIBCLCs (slang for “IBCLCs who tweet”) to fill the social media airwaves with breastfeeding chatter in preparation for the 2012 ILCA Conference and World Breastfeeding Week. In this article we’ll give you five great reasons to “Get Twitter” and we’ll also cover some Twitter basics in hopes that you’ll pick up your phone (or laptop) and tweet.

Five Great Reasons to “Get Twitter”

(1) Significant improvements in breastfeeding rates will require major cultural changes and Twitter has a track record as a tool for driving change (think Arab Spring and Komen breast screening funding). The more people there are talking about a message, the closer we move towards a tipping point where breastfeeding becomes the cultural norm.

(2) TwIBCLCs can share real-time insights and sound bites from conference presentations with thousands of IBCLCs around the world who aren’t able to attend (Twitter makes it easy for people to view all messages associated with a certain subject – in this case #ilca2012). That’s a great gift to your colleagues! If you want to see what TwIBCLCs were saying at last year’s conference, click here.

(3) During the conference we’ll give away a daily prize (gift certificates, webinar certificates, and even a Conference Registration Day for 2014) for a TwIBCLC selected at random (just tag your tweets with #ilca2012 so we can find them).

(4) Don’t underestimate the power of Twitter as a networking tool! Relationships I’ve developed on Twitter have led to media interviews and even an invitation to attend a congressional briefing in Washington, DC. To help you further expand on your Twitter relationships, we’ll hold a Tweetup (“an organized gathering of people who use Twitter”) in the Exhibitors Hall on Friday, July 27, 2012 from 12:30pm until 2:00pm so you can meet your fellow TwIBCLCs face-to-face.

(5) Finally, you’ll master the art of brevity by making your point in 140-characters or less and earn groovy-points with your kids, colleagues and clients for embracing a new technology.

Getting Started with Twitter

Okay, you’ve just created a Twitter account. Now what? Like anything in life, you’ll get as much out of Twitter as you put into it. Here are some tips for getting started.

  • Make sure to complete your full profile, which includes a 140 character description of yourself, a photo, and a link to your website, so people can learn a bit about you and your interests. (It’s hard to feel connected to an image-less, description-less Tweeter.)
  • Find people to “follow” by searching on terms that interest you (e.g. breastfeeding, IBCLC). Once you follow someone, their tweets will show up in your newsfeed. Don’t forget to follow ILCA (we’re at @ILCA1985)!
  • Join in conversations, share news, or retweet valuable information others have shared. You only have 140 characters so consider using a URL shortening service like bit.ly, tinyurl, or goo.gl to create a shortcut for longer URLs.
  • Consider using hashtags (e.g. #breastfeeding) in your tweets for specific keywords that you are interested in. This allows others to find you and begin a conversation based on common interests. The hashtag for the 2012 ILCA Conference is #ilca2012.
  • Want more information? Twitter 101 provides basic information about Twitter and links to additional resources.

Are you a TwIBCLC? We’d love to hear comments on how you’ve used and benefited from Twitter.

By Maryanne Perrin – MBA, graduate student in Nutrition Science, ILCA volunteer

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Using Text Messaging to Support Breastfeeding in WIC

Written by Maryanne Perrin, MBA, Graduate student in Nutrition Science, and ILCA volunteer

Recently, we talked to a private practice IBCLC and several of her clients about using mobile* phone based text messaging to support breastfeeding.  We’re continuing the exploration of this innovative topic by talking to IBCLCs within the Women, Infants and Children (WIC) program about how they use text messaging to help low-income mothers succeed with breastfeeding. (NOTE: WIC provides nutritional support to over 50% of infants born each year in theUnited   States which means that this federally funded program has a unique opportunity to play a significant role in promoting and supporting breastfeeding.)

The American Red Cross WIC office inSan Diego,California and the Shasta County WIC office in Redding,California both recently began using text messaging within their Breastfeeding Peer Counselor (PC) programs. Jennifer Nolan, Peer Counselor Supervisor and IBCLC (American Red Cross), and Sara Stone, Lead Peer Counselor and IBCLC (ShastaCounty), shared their stories with us…

Getting Started

Shasta County WIC PCs

Both WIC offices received federal grant funding which they used to purchase mobile phones for their Peer counselors (PCs).  American Red Cross has 3 people on the peer counseling team and Shasta County has 8.  When a new mother enrolls in the peer counselor service, each office asks the mother about her communication preferences and no one ever initiates text messaging without first receiving the mother’s approval (depending on an individual’s phone plan, they could potentially incur additional expenses for receiving unwanted text messages).

ShastaCounty also had to request a modification to the contacts database so that “text messaging” was an option for tracking contacts. (Note: they only count the text message as a contact if they get a reply from the mother; unreturned texts are not counted.)  Once the database modifications were made, they became available to other California WIC agencies as well, allowing them to track text messaging use.

A lesson learned in Shasta County was the importance of having an effective phone for text messaging.  Initially they got very basic phones for their PCs, but soon upgraded to phones with full keyboards so that the PCs could be efficient in sending texts.

How Text Messaging Is Used

Both Jennifer and Sara stressed that text messaging is never a starting point for building a relationship with a client, but instead a complementary communication method they use after first establishing face-to-face or phone contact. “We get better participation in our program by using a communication mode that is most comfortable for mothers,” says Jennifer.  Sara echoed this sentiment, describing text messaging as a cultural shift that allows WIC PCs to stay better connected with their clients.  Examples of the types of messages exchanged between PC and mother include:

  • Prenatal contacts that involve inviting the mother to classes or scheduling/confirming appointments
  • Sharing tips about baby’s development and checking in during pregnancy to help build rapport
  • Receiving texts from mother while she is in the hospital to learn about baby’s arrival
  • Asking and answering simple breastfeeding questions or scheduling calls to follow-up on more complicated breastfeeding issues
  • Checking in on postpartum status and sending encourage messages

Why Use Text Messaging?

San Diego WIC office

Text messaging is portable (mobile phones are typically with mothers at home, at work, and in the hospital) and also non-invasive (won’t wake a sleeping baby or interrupt someone during an important meeting at work).  One WIC mother, upon receiving a call from her PC, whispered into the phone, “I’m at work, can you please text me?”

Jennifer says that the majority of their clients use text messaging, and she thinks it has the potential to prolong breastfeeding because it keeps mothers engaged and gets them the information they need (a critical mass of WIC data should allow future analysis of this).  ForShastaCounty, “It’s taken off like wildfire,” says Sara.  Text messaging has grown from 7% of their non face-to-face contacts (phone, email or text) in July 2011, to almost 25% as of February 2012.  Sara’s words of advice to other WIC agencies – “Just jump in and do it!”

Are you using text messaging or alternative technologies in creative ways to promote and support breastfeeding within WIC or other settings (e.g. third-world countries)?  If so, we’d love to hear your story!

* Other terms used around the world including cell phone, cellular phone, and hand phone.

By Maryanne Perrin

MBA, Graduate student in Nutrition Science, and ILCA volunteer

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Supporting Breastfeeding with New Technologies

A few months ago a story out of Australia caught my attention.  A research study conducted at Queensland University of Technology showed that new mothers who received cell-phone based text-messaging support (also referred to as SMS, which stands for Short Message Service) were four times less likely to stop breastfeeding than those who did not.  This collision of technology with nature’s perfect infant nutrition piqued my interest and I wanted to learn more (self disclosure – I’m a bit of a technophile).  While details of the study have not yet been published, I was able to talk with an IBCLC who uses SMS, as well as hear the perspectives of several nursing mothers.  This post is intended to share this story and also generate a conversation about what other practitioners have experienced using text-messaging to support breastfeeding moms.  Please join in the discussion!

An IBCLC’s Perspective

Robin Kaplan, IBCLC and founder of San Diego Breastfeeding Center, LLC, offers mothers the option to communicate with her via SMS after she conducts an initial in-home consultation.  She estimates that about 25% of her follow-up communication is through text-messaging, with some clients using it for 100% of their contacts.  The nature of Robin’s texts are primarily responding to questions from new mothers (moms can include a photo with the question to help in diagnosing some problems), as well as checking in with mothers to see how they are doing.  One of the benefits of text messaging is that it isn’t interruptive, like a phone call may be, and it can be managed from a time perspective (versus not knowing how long a phone call might last).  This seems to be important for new mothers, as Robin gets more responses from texting than she does from phone calls.  Texting is also conducive to the round-the-clock hours that nursing mothers keep.  “They can leave me information any time they want,” says Robin.  From a business perspective, she sees texting as time and cost-effective.  “It makes a lot of sense!”

Mothers’ Perspectives

“When you have a sleeping baby, or you’re just too tired to get into a long conversation, texting is so convenient,” said texting mother, Tracy.  “Robin was able to get straight to the point and offer quick responses to my questions, which were very helpful… Though some might think it’s impersonal, texting is still a conversation and a readily available one at that, I really appreciated the instant gratification.”

Adoptive mother, Danielle, said text-messaging support was a huge help in establishing her breastfeeding practice.  “The reason texting worked for me is that my consultant, Robin, was always quick to reply…  This [breastfeeding an adopted infant] is a new frontier and being able to text when your baby is asleep in your arms is so helpful…  For me, texting as opposed to verbalizing sometimes kept me a bit calmer. I always know I can call if I need to. The ability to have both options, however, was great.”

According to Erin, “Because newborns require so much attention around the clock, texting was the easiest form of communicating with Robin.  It allowed me to send her a quick message, an update or ask a question without regard to the hour or any of the long winded social niceties that a telephone conversation would require. By the same token, Robin was able to check in on my progress, offer much needed practical advice and soothe my worries with most welcome words of support.”

On the Bleeding Edge

How does text-messaging fit into healthcare privacy laws that might impact lactation consulting care?  This will vary country by country, and many governments are still trying to figure this out.  Robin said she is moving towards printing and then deleting text messaging conversations and adding them to patient records.  She deletes photos immediately.  Having a password lock on your phone is another measure of security.  It’s always important to get a mother’s consent before you begin sending text messages.

What has your experience been with adding text-messaging support to your lactation practice?  We’d love to hear your stories!

By Maryanne Perrin MBA, graduate student in Nutrition Science, and ILCA volunteer

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