Applying New Learnings on Human Milk Composition to Clinical Practice in the NICU

This education is about:

• Recent updates to neonatal nutrition guidelines
• Variability of human milk composition
• Evidence on donor milk in preterm infants
• Human milk fortification strategies
• Applying knowledge of human milk variability in clinical practice
• Engaging the multidisciplinary team to optimize neonatal nutrition

Why it matters:

Human milk is optimal for preterm infants due to its ability to offer protection against potentially life-threatening complications such as necrotizing enterocolitis. However, the concentration of many nutrients in human milk—whether mother’s own milk or donor milk—falls short of meeting those required to support growth and development. To achieve growth targets for preterm infants, macro- and micronutrient supplementation is a critical component of an adequate nutrition care plan.

• Profile

  Michaela Berroya, RNC, MSN Ed

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  Michaela Berroya, RNC, MSN Ed., is a nurse clinician at New York-Presbyterian Hospital in New York City. She also serves as an adjunct pediatric clinical instructor at the New York University Rory Meyers College of Nursing, also in New York City. She received her master of science in nursing/nursing education degree from the University of Phoenix, Arizona.

  Ms. Berroya is a charge nurse in a 60-bed, level IV neonatal intensive care unit (NICU), one of the busiest and most highly regarded in the country. Her responsibilities involve overseeing the nursing care for critically ill infants and for educating and orienting new staff to the unit. She serves on the hospital’s Developmental Care Committee representing the needs of the NICU team, its patients and their families, and on several other committees.

  Recognizing the special concerns of parents whose infants spend time in the NICU, the hospital offers multidisciplinary developmental monitoring and nutritional support for the first three years of life—six years in the case of high-risk infants—through periodic follow-up milestone visits and evaluations.

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  Michaela Berroya, RNC, MSN Ed

  Nurse Clinician
  Neonatal Intensive Care Unit
  NewYork-Presbyterian Hospital
  New York, New York

• Profile

  Jennifer Fowler, MS, RDN, LDN

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  Jennifer Fowler is a clinical pediatric dietitian at Vidant Medical Center, James and Connie Maynard Children’s Hospital in Greenville, North Carolina. She received her master’s degree in nutrition and dietetics at Arizona State University.

  Ms. Fowler provides patient care for a 50-bed, level IV neonatal intensive care unit (NICU) and a 21-bed step-down special care nursery. Her responsibilities include conducting nutritional assessments and providing education and support for the families of her young patients. Among the educational instruction that Ms. Fowler provides for other members of the NICU team is training in the use of the Timeless Mother’s Own Milk System (MOMS), a barcode scanning system designed to eliminate misidentification and mismatching of breast milk in the nursery.

  Ms. Fowler has a special interest in feeding protocols and she has contributed articles on the topic for a number of medical journals. At the 2019 ASPEN Nutrition Science and Practice Conference she received Poster of Distinction recognition for “Decrease in Central Line Utilization with Improved Growth in VLBWW Newborns Following Feeding Roadmap Implementation.” The complete manuscript for her presentation was subsequently published in the Journal of Parenteral and Enteral Nutrition.

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  Jennifer Fowler, MS, RDN, LDN

  Clinical Pediatric Dietitian
  Vidant Medical Center, James and Connie Maynard Children’s Hospital
  Greenville, North Carolina

• Profile

  Fernando R. Moya, MD

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  Fernando R. Moya, MD, is director of the Division of Wilmington Pediatric Subspecialties in the Department of Pediatrics, and professor of pediatrics at the University of North Carolina School of Medicine, in Chapel Hill, North Carolina. Board certified in pediatrics and neonatal-perinatal medicine, Dr. Moya is also medical director of the Pediatric Subspecialty Clinic at Novant Health—New Hanover Regional Medical Center in Wilmington, North Carolina. 

  Dr. Moya has been involved in clinical and translational research throughout his career. As a principal or coinvestigator on more than a dozen clinical trials, Dr. Moya’s research focused on preterm infant nutrition and respiratory care, among other topics. Dr. Moya has disseminated his research and expertise in more than 80 peer-reviewed publications and 200 articles, presentations, and book chapters.

  He has lectured on the topic of preterm infant health in more than 25 countries throughout the world. He is a reviewer for numerous prestigious medical journals, including the American Journal of Obstetrics and Gynecology, European Journal of Pediatrics, The Journal of Maternal-Fetal Medicine, Pediatric Research, Genetics in Medicine, and Journal of Perinatology.

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  Fernando R. Moya, MD

  Professor of Pediatrics
  University of North Carolina School of Medicine
  Director, Division of Wilmington Pediatric Subspecialties
  Wilmington, North Carolina

• Profile

  Brian K. Stansfield, MD

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  Brian K. Stansfield, MD, is vice chair for research and an associate professor in the Department of Pediatrics at Augusta University in Georgia. He completed his residency in pediatrics at Children’s Hospital of Georgia, followed by a fellowship in neonatal-perinatal medicine and a postdoctoral pediatric research fellowship at Indiana University.

  Dr. Stansfield’s research on early life growth is robust and includes factors affecting human milk composition, human milk fortification, and the effects of prematurity and other neonatal factors on adult diseases. Dr. Stansfield has published more than 100 journal articles, abstracts and book chapters on these and other topics related to neonatology, pediatrics, and biochemistry.

  At Augusta University, Dr. Stansfield’s academic responsibilities encompass curriculum development in neonatal physiology, research study design, and professional development. He serves as a section editor on the editorial board of Pediatric Research, as a reviewer for the Journal of Perinatology and Cellular and Molecular Life Sciences, and an ad hoc reviewer for numerous other medical journals.

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  Brian K. Stansfield, MD

  Associate Professor and Vice Chair of Research
  Department of Pediatrics
  Member, Vascular Biology Center
  Medical College of Georgia
  Augusta University
  Augusta, Georgia