Topics & Abstracts

Appropriate care of artificial airways is an important part of clinical care in the NICU. This presentation will demonstrate how to provide ongoing care to newborns with an endotracheal tube or a tracheostomy tube. Indications, and contraindications of endotracheal tube management. A variety of securing methods will be reviewed for endotracheal tubes. A review of a variety of chronic conditions that may warrant a tracheostomy tube. The procedure for securing a tracheostomy tube will be reviewed. Cleaning and maintaining a tracheostomy will be discussed. Education with the staff caring for newborns with an artificial airway will be reviewed along with parent education.

Live Presentation Schedule Jun 13, 2023

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13-06-2023 15:00 13-06-2023 16:00 35 Artificial Airway Management of the Neonate Appropriate care of artificial airways is an important part of clinical care in the NICU. This presentation will demonstrate how to provide ongoing care to newborns with an endotracheal tube or a tracheostomy tube. Indications, and contraindications of endotracheal tube management. A variety of securing methods will be reviewed for endotracheal tubes. A review of a variety of chronic conditions that may warrant a tracheostomy tube. The procedure for securing a tracheostomy tube will be reviewed. Cleaning and maintaining a tracheostomy will be discussed. Education with the staff caring for newborns with an artificial airway will be reviewed along with parent education. GOLD Neonatal Online Conference false DD/MM/YYYY

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Families whose infants die in the Neonatal Intensive Care Unit (NICU) may be asked about autopsy, organ donation, and research tissue donation. Understanding how parents experience these often difficult but important conversations is crucial information for healthcare teams. This presentation provides the results of research that looked at the perspectives of parents who had experienced neonatal loss. Make a lasting difference to the families in your care by learning more about how to approach the conversation of autopsy, organ donation, and tissue donation for research in a way that is parent centered.

Live Presentation Schedule Jun 13, 2023

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13-06-2023 17:00 13-06-2023 18:00 35 Building a Legacy: Views About Autopsy, Organ Donation, and Research Donation After Neonatal Death Families whose infants die in the Neonatal Intensive Care Unit (NICU) may be asked about autopsy, organ donation, and research tissue donation. Understanding how parents experience these often difficult but important conversations is crucial information for healthcare teams. This presentation provides the results of research that looked at the perspectives of parents who had experienced neonatal loss. Make a lasting difference to the families in your care by learning more about how to approach the conversation of autopsy, organ donation, and tissue donation for research in a way that is parent centered. GOLD Neonatal Online Conference false DD/MM/YYYY

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While providing breastmilk for all infants, especially neonates is considered Gold Standard for feeding, providing breastmilk in the NICU can present with a multitude of challenges. Whether the facility is short staffed, the family dynamics prevent parents from being present, or milk supply issues abound, breastfeeding and providing breastmilk can create many difficulties for NICU infants and their families. During this presentation, we will discuss building successful breastfeeding programs in the NICU, multiple challenges that parents face in milk production, neonatal state and it's impacts on breastmilk implementation, as well as NICU politics and their correlation with a successful breastmilk agenda.

Live Presentation Schedule Jun 5, 2023

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05-06-2023 15:00 05-06-2023 16:00 35 Building a Successful Breastfeeding Program in the NICU: Challenges and Practical Solutions While providing breastmilk for all infants, especially neonates is considered Gold Standard for feeding, providing breastmilk in the NICU can present with a multitude of challenges. Whether the facility is short staffed, the family dynamics prevent parents from being present, or milk supply issues abound, breastfeeding and providing breastmilk can create many difficulties for NICU infants and their families. During this presentation, we will discuss building successful breastfeeding programs in the NICU, multiple challenges that parents face in milk production, neonatal state and it's impacts on breastmilk implementation, as well as NICU politics and their correlation with a successful breastmilk agenda. GOLD Neonatal Online Conference false DD/MM/YYYY

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Developing secure bonds of attachment is a major developmental task for all human babies, a process that is considered to be foundational for future mental health and even physical wellbeing. The mechanism for doing so is called “nurturing,” and a growing body of evidence supports the impact of nurturing on physiologic stability, co-regulation and growth, as well as brain development and ongoing physical and emotional health. The first bond of attachment is between mother and baby and begins before birth. Separation of mothers and babies always causes stress and interrupts the bonding and attachment process. When temporary separation is necessary in the NICU, there are ways we can support mothers and babies to help minimize the detrimental effects of separation and to promote healing. This presentation will describe the neuroscience behind parent-infant bonding and attachment and the neurobiology of skin-to-skin contact as a modality for nurturing babies. We will describe ways to communicate with NICU babies in a manner that enhances bonding and attachment and promotes the development of trust as well as enhances brain and language development. We will discuss ways to support babies, mothers, families, and staff in promoting bonding and attachment in the NICU.

Live Presentation Schedule May 30, 2023

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30-05-2023 16:00 30-05-2023 17:15 35 Building Strong Bonds: The Neurobiology of Parent-Infant Attachment in the NICU Developing secure bonds of attachment is a major developmental task for all human babies, a process that is considered to be foundational for future mental health and even physical wellbeing. The mechanism for doing so is called “nurturing,” and a growing body of evidence supports the impact of nurturing on physiologic stability, co-regulation and growth, as well as brain development and ongoing physical and emotional health. The first bond of attachment is between mother and baby and begins before birth. Separation of mothers and babies always causes stress and interrupts the bonding and attachment process. When temporary separation is necessary in the NICU, there are ways we can support mothers and babies to help minimize the detrimental effects of separation and to promote healing. This presentation will describe the neuroscience behind parent-infant bonding and attachment and the neurobiology of skin-to-skin contact as a modality for nurturing babies. We will describe ways to communicate with NICU babies in a manner that enhances bonding and attachment and promotes the development of trust as well as enhances brain and language development. We will discuss ways to support babies, mothers, families, and staff in promoting bonding and attachment in the NICU. GOLD Neonatal Online Conference false DD/MM/YYYY

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Healthcare professionals play an important role in promoting the safety of neonates during motor vehicle travel. Properly securing neonates in age- and size- appropriate car seats reduces the risk of serious injury or death from a motor vehicle crash, yet research and field data show most infants and children are incorrectly secured in their car seats. Additionally, screening fragile infants for positioning and tolerance in their car seat reduces the risk of cardiorespiratory compromise. However, research demonstrates that although the American Academy of Pediatrics continues to recommend that at-risk infants be monitored for tolerance in an appropriate car seat or car bed, knowledge, policies, and practices vary widely between healthcare institutions. In light of these concerns, this presentation will review the rationale behind the recommendation to complete a Car Seat Tolerance Screening (CSTS) and discuss common misconceptions about the process and results. Additionally, the steps to set up and conduct a CSTS will be discussed, including a focus on proper harnessing and positioning of the neonate. Finally, the scope of practice of the provider, the bedside nurse, and the hospital’s Child Passenger Safety Technician will be explored.

Live Presentation Schedule Jun 12, 2023

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12-06-2023 19:00 12-06-2023 20:00 35 Demystifying the Car Seat Tolerance Screening Healthcare professionals play an important role in promoting the safety of neonates during motor vehicle travel. Properly securing neonates in age- and size- appropriate car seats reduces the risk of serious injury or death from a motor vehicle crash, yet research and field data show most infants and children are incorrectly secured in their car seats. Additionally, screening fragile infants for positioning and tolerance in their car seat reduces the risk of cardiorespiratory compromise. However, research demonstrates that although the American Academy of Pediatrics continues to recommend that at-risk infants be monitored for tolerance in an appropriate car seat or car bed, knowledge, policies, and practices vary widely between healthcare institutions. In light of these concerns, this presentation will review the rationale behind the recommendation to complete a Car Seat Tolerance Screening (CSTS) and discuss common misconceptions about the process and results. Additionally, the steps to set up and conduct a CSTS will be discussed, including a focus on proper harnessing and positioning of the neonate. Finally, the scope of practice of the provider, the bedside nurse, and the hospital’s Child Passenger Safety Technician will be explored. GOLD Neonatal Online Conference false DD/MM/YYYY

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Many premature infants spend months within neonatal intensive care units (NICUs). During their NICU admission, typical preventive care ideally should also be addressed. The Centers for Disease Control and Prevention (CDC) recommends that infants and children be vaccinated at the recommended schedule regardless of premature birth. In this presentation, we will review the different immunizations given in the first six months of life that are most relevant to patients in the NICU. Additionally, we will compare distinctive immunogenic and tolerability aspects for the term and preterm population. There is also tremendous growth in new vaccines and viral prophylaxis options coming to market soon. This presentation will also address these new agents and how they are pertinent to the NICU population. So don’t miss your shot to further your immunization knowledge.

Live Presentation Schedule Jun 12, 2023

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12-06-2023 17:00 12-06-2023 18:00 35 Don’t Miss Your Shot to Learn about Immunizations in the NICU Many premature infants spend months within neonatal intensive care units (NICUs). During their NICU admission, typical preventive care ideally should also be addressed. The Centers for Disease Control and Prevention (CDC) recommends that infants and children be vaccinated at the recommended schedule regardless of premature birth. In this presentation, we will review the different immunizations given in the first six months of life that are most relevant to patients in the NICU. Additionally, we will compare distinctive immunogenic and tolerability aspects for the term and preterm population. There is also tremendous growth in new vaccines and viral prophylaxis options coming to market soon. This presentation will also address these new agents and how they are pertinent to the NICU population. So don’t miss your shot to further your immunization knowledge. GOLD Neonatal Online Conference false DD/MM/YYYY

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Sleep related deaths are the number one cause of infant deaths in the United States, with neonates that have been in a NICU being at a higher risk. In order to combat this problem, the American Academy of Pediatrics (AAP) in the early 1990's began publishing recommendations on how to prevent sleep related deaths in healthy term infants. This effort has led to a decrease in infant sleep related deaths, but confusion remains on when a premature or convalescing neonate be transitioned to a safe sleep environment in the NICU. This presentation will review the different types of sleep related deaths in infants, most current theory of cause of SIDS, review the myths of safe sleep and give guidance to the NICU nurse on how to implement safe sleep in their unit.

Live Presentation Schedule Jun 5, 2023

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05-06-2023 17:00 05-06-2023 18:00 35 Implementing Safe Sleep for Babies in the NICU Sleep related deaths are the number one cause of infant deaths in the United States, with neonates that have been in a NICU being at a higher risk. In order to combat this problem, the American Academy of Pediatrics (AAP) in the early 1990's began publishing recommendations on how to prevent sleep related deaths in healthy term infants. This effort has led to a decrease in infant sleep related deaths, but confusion remains on when a premature or convalescing neonate be transitioned to a safe sleep environment in the NICU. This presentation will review the different types of sleep related deaths in infants, most current theory of cause of SIDS, review the myths of safe sleep and give guidance to the NICU nurse on how to implement safe sleep in their unit. GOLD Neonatal Online Conference false DD/MM/YYYY

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The provision of adequate nutrition for premature infants is crucial for their growth and development. Mothers' own milk and donor milk are two options for providing nutrition to these infants. This presentation will compare and contrast the two options, focusing on their nutritional composition, the potential benefits to the infant, and the practical considerations for families and healthcare providers. Mothers' own milk is the ideal source of nutrition for premature infants, as it is specifically designed for their needs and provides all the necessary nutrients, hormones, and antibodies that the infant requires for growth and development. Additionally, mothers' own milk has been shown to reduce the risk of infections and improve outcomes for premature infants. Donor milk, on the other hand, is a valuable alternative when mothers' own milk is not available. Donor milk is screened for contaminants and pasteurized to reduce the risk of infection, but it may not contain the same composition of nutrients and protective factors as mothers' own milk. In this presentation, the use of mothers' own milk and donor milk will be discussed, and practical recommendations for families and healthcare providers will be provided to ensure that premature infants receive the best possible nutrition.

Live Presentation Schedule Jun 6, 2023

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06-06-2023 17:00 06-06-2023 18:00 35 Mother's Own Milk Versus Donor Human Milk in the NICU: Practical Recommendations for Individualized Care The provision of adequate nutrition for premature infants is crucial for their growth and development. Mothers' own milk and donor milk are two options for providing nutrition to these infants. This presentation will compare and contrast the two options, focusing on their nutritional composition, the potential benefits to the infant, and the practical considerations for families and healthcare providers. Mothers' own milk is the ideal source of nutrition for premature infants, as it is specifically designed for their needs and provides all the necessary nutrients, hormones, and antibodies that the infant requires for growth and development. Additionally, mothers' own milk has been shown to reduce the risk of infections and improve outcomes for premature infants. Donor milk, on the other hand, is a valuable alternative when mothers' own milk is not available. Donor milk is screened for contaminants and pasteurized to reduce the risk of infection, but it may not contain the same composition of nutrients and protective factors as mothers' own milk. In this presentation, the use of mothers' own milk and donor milk will be discussed, and practical recommendations for families and healthcare providers will be provided to ensure that premature infants receive the best possible nutrition. GOLD Neonatal Online Conference false DD/MM/YYYY

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Current recommendations for the growth of preterm infants are that they should try and achieve the same pattern of growth they would they were still in-utero. This growth should be both the right quantity, but also the right quality in terms of body composition and the relative proportions of fat and lean tissue. This requires higher amounts of nutrition that can be difficult to deliver, meaning that preterm infants are at risk of poor growth and body composition that favours fat accretion over lean mass. This is important, as nutrition, growth and body composition in early life are associated with neurodevelopmental outcomes and longer-term cardiovascular risk. However, the exact pattern of growth that results in optimal short- and long-term outcomes in these infants is not well defined. This talk will explore current patterns of growth, the evidence for the pattern of growth for optimal clinical outcomes, and what can be achieved in clinical practice. It will then go on to consider different strategies for nutritional care and how these can be implemented in clinical practice for preterm infants in the neonatal unit to achieve optimal growth.

Live Presentation Schedule Jun 20, 2023

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20-06-2023 14:00 20-06-2023 15:15 35 Optimizing Growth and Body Composition in Preterm Infants: Approaches to Neonatal Nutritional Care in Clinical Practice Current recommendations for the growth of preterm infants are that they should try and achieve the same pattern of growth they would they were still in-utero. This growth should be both the right quantity, but also the right quality in terms of body composition and the relative proportions of fat and lean tissue. This requires higher amounts of nutrition that can be difficult to deliver, meaning that preterm infants are at risk of poor growth and body composition that favours fat accretion over lean mass. This is important, as nutrition, growth and body composition in early life are associated with neurodevelopmental outcomes and longer-term cardiovascular risk. However, the exact pattern of growth that results in optimal short- and long-term outcomes in these infants is not well defined. This talk will explore current patterns of growth, the evidence for the pattern of growth for optimal clinical outcomes, and what can be achieved in clinical practice. It will then go on to consider different strategies for nutritional care and how these can be implemented in clinical practice for preterm infants in the neonatal unit to achieve optimal growth. GOLD Neonatal Online Conference false DD/MM/YYYY

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While approximately 80% of UK mothers initiate breastfeeding, by 3-4 months, just 15% of infants receive any breastmilk. Despite the low rates of breastfeeding nationally, in 2021-22, 64% of the NICU graduates in our unit were discharged receiving breastmilk. One possible reason for the higher rates of breastfeeding in this population may be our innovative home NGT feeding programme. In order to hasten discharge from NICU, many mothers feel under pressure to introduce bottles to meet “full oral feeding” criteria. The home nasogastric tube (NGT) feeding programme focusses on the infant’s and family’s needs, without rushing the infant towards full oral feeding, which some are not yet ready for. In this way, all oral feeds can be at the breast, with NGT feeds as required for supplementation. We aim to reduce unnecessary days in hospital, reduce readmissions post-discharge, keep families close to their infants, and embrace the integration of families as essential members of the neonatal care team. This presentation will discuss the practicalities of designing a discharge pathway that optimises parental confidence and ensures competence with home administration of NGT feeds. It will also discuss how to predict which infants are ideal candidates for short-term home NGT feeding, and how to transition to direct breastfeeding. Finally, the presentation will present a case for home NGT feeding as an intervention to protect the mother’s breastfeeding goals, optimise clinical outcomes for infants, and improve the experience of neonatal care for families.

Live Presentation Schedule Jun 13, 2023

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13-06-2023 13:00 13-06-2023 14:00 35 Protecting Breastfeeding by Facilitating Safe, Early Discharge from NICU with Home Nasogastric Tube Feeding While approximately 80% of UK mothers initiate breastfeeding, by 3-4 months, just 15% of infants receive any breastmilk. Despite the low rates of breastfeeding nationally, in 2021-22, 64% of the NICU graduates in our unit were discharged receiving breastmilk. One possible reason for the higher rates of breastfeeding in this population may be our innovative home NGT feeding programme. In order to hasten discharge from NICU, many mothers feel under pressure to introduce bottles to meet “full oral feeding” criteria. The home nasogastric tube (NGT) feeding programme focusses on the infant’s and family’s needs, without rushing the infant towards full oral feeding, which some are not yet ready for. In this way, all oral feeds can be at the breast, with NGT feeds as required for supplementation. We aim to reduce unnecessary days in hospital, reduce readmissions post-discharge, keep families close to their infants, and embrace the integration of families as essential members of the neonatal care team. This presentation will discuss the practicalities of designing a discharge pathway that optimises parental confidence and ensures competence with home administration of NGT feeds. It will also discuss how to predict which infants are ideal candidates for short-term home NGT feeding, and how to transition to direct breastfeeding. Finally, the presentation will present a case for home NGT feeding as an intervention to protect the mother’s breastfeeding goals, optimise clinical outcomes for infants, and improve the experience of neonatal care for families. GOLD Neonatal Online Conference false DD/MM/YYYY

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Until recently, routine monitoring of gastric residuals has been standard care in most neonatal intensive care units (NICUs). Rationale for this practice includes early recognition of feeding intolerance and necrotizing enterocolitis. However, gastric residuals are often used to direct feeding decisions and thus their use can result in delays and interruptions in feeding resulting in an increased risk of complications. Recent evidence suggests that the routine monitoring of gastric residuals prior to every feeding may not be clinically necessary and other clinical indicators may be sufficient to monitor for feeding intolerance and necrotizing enterocolitis. This presentation will describe practices clinicians are currently using to monitor gastric residuals In addition, an overview of current evidence including the risks and benefits of monitoring gastric residuals, alternatives to monitoring gastric residuals, and how to best change unit practice in order to decrease the routine use of aspirating and evaluating gastric residuals prior to every feeding will be presented.

Live Presentation Schedule Jun 12, 2023

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12-06-2023 15:00 12-06-2023 16:00 35 Routine Monitoring of Gastric Residuals: Practice and Research Update Until recently, routine monitoring of gastric residuals has been standard care in most neonatal intensive care units (NICUs). Rationale for this practice includes early recognition of feeding intolerance and necrotizing enterocolitis. However, gastric residuals are often used to direct feeding decisions and thus their use can result in delays and interruptions in feeding resulting in an increased risk of complications. Recent evidence suggests that the routine monitoring of gastric residuals prior to every feeding may not be clinically necessary and other clinical indicators may be sufficient to monitor for feeding intolerance and necrotizing enterocolitis. This presentation will describe practices clinicians are currently using to monitor gastric residuals In addition, an overview of current evidence including the risks and benefits of monitoring gastric residuals, alternatives to monitoring gastric residuals, and how to best change unit practice in order to decrease the routine use of aspirating and evaluating gastric residuals prior to every feeding will be presented. GOLD Neonatal Online Conference false DD/MM/YYYY

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Prematurity is the leading cause of death across the globe, mainly in low resource settings. Infants born at less than 32 weeks gestation, are prone to developing hypothermia, hypoglycemia, and hospital acquired infections after birth. For them, the initial 60 minutes of holistic approach is crucial for long-term outcomes. The “Golden Hour” of neonatal life is defined as the first hour of post-natal life in both preterm and term neonates. This concept includes practicing particular evidence based interventions in the initial sixty minutes of postnatal life for better long-term outcomes like marked reduction in hypothermia, hypoglycemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). This presentation will provide a look at the various components of neonatal care that are included in the “Golden hour” of preterm and term neonatal care. Healthcare professionals attending the birth of high risk infants like VLBW (very low birth weight, less than 1500 grams) or high-risk term neonates should be well trained in attending such deliveries and should be able to implement all the management protocols during the golden first 60 minutes of life.

Live Presentation Schedule Jun 6, 2023

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06-06-2023 15:00 06-06-2023 16:00 35 The Golden Hour of Neonatal Life: Improving Outcomes Through Evidence-Based Interventions Prematurity is the leading cause of death across the globe, mainly in low resource settings. Infants born at less than 32 weeks gestation, are prone to developing hypothermia, hypoglycemia, and hospital acquired infections after birth. For them, the initial 60 minutes of holistic approach is crucial for long-term outcomes. The “Golden Hour” of neonatal life is defined as the first hour of post-natal life in both preterm and term neonates. This concept includes practicing particular evidence based interventions in the initial sixty minutes of postnatal life for better long-term outcomes like marked reduction in hypothermia, hypoglycemia, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP). This presentation will provide a look at the various components of neonatal care that are included in the “Golden hour” of preterm and term neonatal care. Healthcare professionals attending the birth of high risk infants like VLBW (very low birth weight, less than 1500 grams) or high-risk term neonates should be well trained in attending such deliveries and should be able to implement all the management protocols during the golden first 60 minutes of life. GOLD Neonatal Online Conference false DD/MM/YYYY

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Human neurobiology is highly sensitive to stressors. Adverse early life experiences create stress that have the possibility to change brain chemistry, anatomy and gene expression. These changes can predispose a baby to impaired emotional regulation, poor cognitive development, and increased risk of cardiovascular, metabolic and immune system dysfunction. In addition, chronic stress can become trauma and have a long term effect. In the neonatal unit the infant, parents and staff are experiencing stress. This presentation will focus on the role of sensation and how we can use sensory experiences to create healing environments, enhance optimal development and minimise stress and trauma.

Live Presentation Schedule Jun 12, 2023

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12-06-2023 13:00 12-06-2023 14:00 35 The Role of Sensation in the NICU: Creating Healing Environments Human neurobiology is highly sensitive to stressors. Adverse early life experiences create stress that have the possibility to change brain chemistry, anatomy and gene expression. These changes can predispose a baby to impaired emotional regulation, poor cognitive development, and increased risk of cardiovascular, metabolic and immune system dysfunction. In addition, chronic stress can become trauma and have a long term effect. In the neonatal unit the infant, parents and staff are experiencing stress. This presentation will focus on the role of sensation and how we can use sensory experiences to create healing environments, enhance optimal development and minimise stress and trauma. GOLD Neonatal Online Conference false DD/MM/YYYY

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Recent evidence has shown healthy term babies have episodes of low blood glucose concentrations, in the first few days after birth, which can last for long periods, similar to those babies identified as being at-risk for neonatal hypoglycemia. Suggesting low blood glucose concentrations may be part of metabolic transition. Neonatal hypoglycemia in at-risk babies is important because it is common and linked with neurosensory impairment and death. Screening is recommended for babies identified as being at-risk, which is routinely performed by heel-prick lances. Half of the babies identified as being at risk, will become hypoglycemic. If hypoglycemia is diagnosed, treatment is recommended. The aim of treatment is to increase the blood glucose concentration, and therefore available glucose for cerebral metabolism. The glucose concentration at which brain injury occurs remains unclear. Therefore, while current treatment thresholds are determined by evidence, expert opinion also contributes to treatment recommendations. Consequently, there are international variations in screening regimes and treatment thresholds. However, feeding and oral dextrose gel are the most common treatments for neonatal hypoglycemia. Learn more about the research and thoughts on best practice for preventing and managing hypoglycemia in neonates.

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Long NICU stays, invasive oral procedures, chronic lung disease, and gastrointestinal complications can contribute to a complex oral feeding journey for premature infants. Frequently, the NICU journey prioritizes bottle feeding over breast feeding. Breastmilk supply and transfer are challenging for mothers and infants born very premature. At the time of NICU discharge, most very premature infants remain fragile oral feeders with weak breast-feeding and bottle-feeding skills, and some require tube feeding support. Community-based breastfeeding support is often lacking, and breastmilk intake and direct breastfeeding diminish beyond discharge. The authors will highlight four remarkable case studies of very premature newborns who were discharged home on nasogastric tube feeding. All four babies had a complex oral feeding journey in the NICU with minimal opportunity to develop breastfeeding skills. Parent comments will be shared, including barriers and facilitators for breastfeeding. Take away messages will focus on helpful strategies to support families taking home a fragile feeder and progressing toward positive, enjoyable oral feedings and more importantly, weaning from tube support and advancing breastfeeding.

Live Presentation Schedule Jun 6, 2023

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06-06-2023 19:00 06-06-2023 20:00 35 “The Little Engine That Could”: Breastfeeding Journeys of Very Premature Babies on Home Tube Feeds Long NICU stays, invasive oral procedures, chronic lung disease, and gastrointestinal complications can contribute to a complex oral feeding journey for premature infants. Frequently, the NICU journey prioritizes bottle feeding over breast feeding. Breastmilk supply and transfer are challenging for mothers and infants born very premature. At the time of NICU discharge, most very premature infants remain fragile oral feeders with weak breast-feeding and bottle-feeding skills, and some require tube feeding support. Community-based breastfeeding support is often lacking, and breastmilk intake and direct breastfeeding diminish beyond discharge. The authors will highlight four remarkable case studies of very premature newborns who were discharged home on nasogastric tube feeding. All four babies had a complex oral feeding journey in the NICU with minimal opportunity to develop breastfeeding skills. Parent comments will be shared, including barriers and facilitators for breastfeeding. Take away messages will focus on helpful strategies to support families taking home a fragile feeder and progressing toward positive, enjoyable oral feedings and more importantly, weaning from tube support and advancing breastfeeding. GOLD Neonatal Online Conference false DD/MM/YYYY

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