2021 CCANN OFFICERS

President :KamelaLoo NNP-BCGilda Aum RNC-NIC President-Elect : Rose Kalebjian RNC-NICEducation Liaison :Kamela Loo NNP-BCDee Morris NNP-BCSecretary :Sarah Gil RNC-NICWebMaster: Francis Fung Newsletter : Coralee Agnas RNC-NICMOD Champion :Ashton Baker RNRecruitment : Angie Co RNFund Raising : Kim Collins RNC-NICEMCC : Rachel Isaac RN Leslie Williams, RNCommunity Service :Lisa Cline RN MEDICAL ADVISORS :

Dr. Indira ChandrasekarDr. Radhika NarangDr. Jimmy Lan

Save the Date: CCANN 2021 Fall Conference Limit of Periviability “Periviabilty : 22 Weeks is the New 23 Week” Article by Kamela Loo, NNP-BC

CCANN is excited to host our upcoming Fall Conference on October 16, 2021: “Periviabilty: 22 weeks is the new 23 weeks”.

For many decades the limit of variability had changed from 24 weeks to 23 weeks and to the newest 22 weeks. Recent advances in obstetric and neonatal world have resulted in the survival of infants born at 22 weeks’ gestation. What is this new limit of viability mean to the obstetric, perinatal and neonatal world? What will be the change of practice based on the new NRP? What is the survival data of periviable infants? This 2021 CCANN conference will bring new awareness to the limit of periviability and explore the concept and perception of various professionals.

1

Hello Spring

JOIN our CCANN organization, the multiple awardee and the current 2021 NANN recepient of Mid-Sized Chapter Award of the Year, the genuine advocate and leaders of advanced Neoantal Care. See Full Details Inside !

TABLE OF CONTENTS

* “Limit of Periviability conference” , CCANN Fall conference 2021, Save the date, - page 1* CCANN Fundraising activities - page 2* CCANN award-page 3*Fighter’s Advocate - page 4* CCANN Spring Virtual Conference - page 5-6* “We are Growing!” - page 7*NRP 8th edition changes - page 8*Back to School Photo by Siri Wride - page 9* Neonatal Handbook - page 9*Insights and Approaches to allergy management conference- page 10* Sponsors - page 10* Q&A Corner with Dr. Jimmy Lan -page 11

The proposed topics include:  1. Clinical Management of the Periviable Infant: -Discussion to be made about strategies to help these extreme preterm infants-Discussion about the current recommendations on first intention jet ventilator, ambiguous study on epogen and caffeine, and delayed cord clamping. 2. Periviabilty: New Frontiers in Obstetrics: 3. An Ethical Dilemma: Resuscitating a 22-week Infant: -Discuss the ambiguous choices of “Resuscitate” vs “Do not Resuscitate” 4. Perinatology: Joint Counseling of Extreme Preterm Infants:-Possibility of joint periviability counseling with neonatal and maternal-fetal medicine-Compare content of joint counseling-Identify barriers of joint periviability counseling

5. Palliative Care in the Periviable Infant: -Discuss end of life care for these infants and support for families

Although CCANN is unsure about whether this conference will be a live, virtual or combination of live and virtual due to the pandemic, we will keep all of you updated of upcoming conference status.

Save the date and join us!

CCANN Fundraising

CCANN is currently designing 2 products to be sold in the summer and the fall of 2021. This marks our first fundraising efforts for CCANN chapter since the beginning of pandemic, that was nearly 18 months ago.

Sweatshirt Sales : Bella + Canvas Unisex light weight Full-Zip Hooded Long Sleeve Tee in the vibrant color of Teal Triblend, Navy Triblend, and Maroon Triblend are selected. This year’s fall sweatshirts will be done in the design of “NICU” word in the Silver Glitter Vinyl and rhinestone heart. This is our very first collaboration with Fully Promoted Branded Products and Marketing Services, Fresno. They have been generously waived the setup fee and artwork fee for CCANN. The sweatshirt will be selling for $45.00 each for small to x-large and $50.00 for 2 XL sizes.

T-Shirt Sales : Screen printing on Bella+ Canvas T shirts are planned. We are in the process of pricing at this time. The current proposed t-shirt color to be light grey. The graphic design of NICU vibrant footprints and flowers, so full of life design.

2

Dear Kamela, Congratulations! The Central California Chapter has been selected to receive the 2021 Mid-Sized Chapter of the Year Award! The National Association of Neonatal Nurses (NANN) is pleased and proud to acknowledge your chapter’s accomplishments and contributions. While this year’s conference might look different, we continue to look forward to honoring the Central California Chapter during NANN’s Virtual 37th Annual Conference, September 13-15, 2021. Your chapter will receive a check in the amount of $700, a trophy honoring your achievement, and recognition in future NANN publications. To accept your award, please complete the following: 1. Confirmation: Please email Madison Fortman, NANN Operations Coordinator, at

mfortman@nann.org confirming that you accept the award by Wednesday, June 23.

2. Chapter Photo: By Wednesday, June 23, email a high-resolution photograph (in JPEG or GIF format) of your officers to mfortman@nann.org. The photograph will be used in conference materials and a future NANN publication.

3. Mailing Address: Please indicated where you would like the check and trophy mailed by

Wednesday, June 23.

4. Miscellaneous: NANN plans to put together a video showcasing all the 2021 award recipients. The video will include a voice-over highlighting some of the chapter’s accomplishments. In the next two weeks, you will receive the drafted text that we hope to incorporate in the video. We will ask you to review the text to make sure we are accurately highlighting aspects of your career and accomplishments.

Once again, congratulations on your chapter’s achievement. We look forward to celebrating the Central California Chapter! Sincerely, Linda Merritt Linda Merritt, PhD RNC-NIC CNE Award Selection Task Force Chair

3

WINNER Congratulations CCANN !

FIGHTER’S ADVOCATE

By ; Danielle “Dee” Morris , NNP-BC Valley Children’s Hospital

The road to Neonatal Nurse Practitioner for me was not a straight line. After working for 15 years in the food & beverage industry, I realized I needed a purpose in life other than making people momentarily happy. My initial journey into medicine began as a Respiratory Therapist and after discovering the calm, purposeful, and exciting environment of the Neonatal Intensive Care Unit, I was hooked. In my first solo week off orientation, I attended a delivery and witnessed life in all its extremes: a 300 gram, 23-week GA infant born due to placenta accreta, gasping to breathe, and desperately clinging to life. In accordance with his parents’ wishes, we tried valiantly to save his life but without success.

Those 20 minutes lasted hours in my mind. I wasn’t sure how to react or digest the brief life and death of that tiny being. How could he die? Had I done everything right? He tried so hard, why couldn’t we save him? If his parents knew he wouldn’t survive, why did they make us do all those things: compressions, intubation, lines, boluses, epi, epi, epi….? There was no immediate answer, only the gentle reassurance of my peers. Only a brief time out, soft tears, and a respectful silence for his gentle soul.

As an RT, bedside RN and now as an NNP, I continue to wrestle with death’s perpetual grip to give a mother one more minute with her baby, or a grandpa an opportunity to see his grandchild for the first and only time, or to reassure a big sister that her little sister is real. Why do I do this knowing the outcomes are bad? Why do we all stand shoulder to shoulder, a wall of knowledge and fierceness and strength when the fabric of life is unraveling before our very eyes? Because.We are the protector of dreams. We are the shield for the weak. We are the first to hold each infant and sometimes the last. We are mentally, physically, and emotionally present when others do not have the strength. I want each infant to know they are a gift with meaning and purpose, no matter how they came to be or what life has in store for them. They matter because they matter to me – because we all have potential. And potential is worth fighting for.I am not an NNP for the money, prestige, or power. It isn’t owed to me nor do I have some magical gift to cure the masses. I’m not special or a genius - I work hard to absorb new data while retaining my training and experiences. I work in the NICU because I’m a fighter, BUT I became an NNP because I’m also an advocate for infants, families and peers. An advocate focused on mentoring, coaching, and being present when the cruelties of Mother Nature beckon from the wings.

*Dee is excited to join CCANN. She is a current member of the Sandia Area NANN chapter in New Mexico, NANN, ANA, AARC and is excited to bring her experience in fundraising, accounting, and education to our group. Her medical career began as a Respiratory Therapist and she obtained her BSN from the University of New Mexico and APRN-MSN from Regis University in Denver, Colorado. Prior to health care, her background included accounting, marketing, and large-scale food & beverage operations with strong staff management and customer service focus. She is excited to begin working with such a large and active group of committed professionals.

“ Every bird , every tree , every flower reminds me what a blessing and privilege it is - just to be alive “ - Marty Rubin

Bird in Spring

4

CCANN was proud to present its second virtual conference, “Neonatal Nutritional Awareness”, including two meetings, one on March 23rd and the other on April 24th. The wide variety of speakers were wonderful, full of information and the latest evidence-based research. The Zoom presentation was well-organized and thankfully the speakers were all able to present without any major technological issues! Thank you for all 80+ attendees who registered and participated, and in return, earned 6 CEUs for the events.

CCANN co-presidents Kamela Loo, NNP and Gil-da Aum, RN as well as the emcee, Rachel Harrison, RN kicked off Day 1 of the conference with Andi Markell, a Medical Science Liaison for Prolacta Bioscience with 20 years of experience as a neonatal dietician. She presented on the topic of “Next Level NICU Nutrition: Personalized Approach to Growth and Nutrition”, really driving the point of the importance of appropriate nutrition during the first 2 weeks of life for our infants in the NICU. We learned different methods to interpret growth including the usage of length boards, weight gain and z-scores. She also showed us studies regarding exclusive human milk diet vs. bovine vs. a mixed diet vs. formula and their influence on growth and tolerance.

For Day 2 of the conference, our first speaker was Dee Morris who is a Valley Children’s Hospital Neonatal Nurse Practitioner and also CCANN’s Educational Liaison. She presented on the foundations of NICU nutrition – the fundamentals and best practices in the NICU profession. It was a nice refresher and reminder for more experienced nurses and good building blocks for newer NICU nurses to provide positive nutritional outcomes for babies.

The second speaker, Karen Jaramishian, is the Lead PN Pharmacist at VCH and has been working there since 1981! She explored everything we need to know about parenteral nutrition in the NICU – from the goals to the components to the computer system which it is handled with in the hospital. She is a wealth of knowledge and it was wonderful that she took the time to educate us on the topic. One tidbit she shared with us is that each PN bag we hang is about $700!

Dr. Radhika Narang, the Medical Director of Neonatal Transport and Neonatologistat VCH, presented “BREAST is BEST! Let’s talk about the NEXT BEST!”. She discussed how to meet the increased nutritional needs of the preterm infants. She helped us explore the world of fortification to breast milk as well as formulas. Dr. Narang informed the attendees on the indications for using Soy vs. hydrolyzed

CCANN’s Spring Virtual Conference on Neonatal Nutrition By : Rose Kalebjian, RNC-NIC

SPRING

5

vs. Amino Acid based formulas instead of regular Cow-based formulas.

Dr. Alan Lucas presented from London, United Kingdom. He founded the Child Nutrition Research Centre at the Institute of Child Health in London, where he is now Emeritus Professor of Paediatric Nutrition. Dr. Lucas disclosed he is a consultant for the company Prolacta and the formula company Wyeth. He called out the immediate risks of feeding the VLBW babies cow milk protein.  Prolacta products are 100% human milk based and when fed per protocol are shown clinically shown to reduce major morbidities including mortality, surgical NEC, medical NEC, sepsis, BPD, ROP and PDA.  Dr. Lucas reported long-term “programming” risks associated with feeding cow protein to the VLBW including lower neurodevelopmental outcomes of 7 IQ points.  

Last but not least was our final speaker, Neonatologist Dr. Wen-Chun Jimmy Lan from VCH, who presented 10 interesting nutritional case studies. The audience was able to participate in these studies by selecting the correct answer to multiple choice questions Dr. Lan had posed. He had clearly reviewed the answers with us after each study. It was a very interactive and informative talk, and a fantastic way to pull the information previously learned to conclude the conference!

During the short breaks, we had our vendors present their products. Jennifer Montoya, the US Silentia Representative and our special event sponsor, advertised the company’s privacy screen system. Ross Nicholls from Mead Johnson Nutritional showcased the company’s products and presented two videos that promotes its human milk fortifier. Cassandra Wendling from Johnson’s Baby advertised skin care lotions and shampoos as well as the overall well-being of the babies using them. Ame Heinemeyer of Prolacta Bioscience presented to promote the company’s human milk nutritional products for NICU babies. CCANN would like to thank these vendors for all of their support during this Covid pandemic. We would also like to send a special shout-out to Luke from Silencia who put this Zoom virtual conference together, making it possible for all of us to enjoy and learn together from the comfort of our own homes!

In addition to wealth of knowledge, attendees received a “goodie bag” containing the newest edition of NICU Handbook & headsbands from CCANN, skin products from representative Cassandra Wendling of Johnson & Johnson. What a great treat for all medical professionals !

LEARNING

Rachel, Gilda and Kamela

6

The National Association of Neonatal Nurses (NANN) is a statewide alliance of neonatal nurses within the United States. Since its foundation in 1984, it has over forty sub-chapters under its wings. To become a member of NANN-Central California Chapter (CCANN), one must also be a member of NANN as well. Annually, the cost of NANN membership is $130 and the cost of CCANN membership is only $25.

Over the years CCANN was one of the largest subchapters, but the chapter went through the struggle of membership recruitment and retention due to the economy, pandemic, member retirement and staff relocation. Despite this past year’s pandemic, CCANN has had a jumpstart in recruiting new members and retaining old members.

Angie Co, our 2021 chapter recruitment officer is downright busy and is doing a fantastic job in her membership recruitment and retention. CCANN currently has 102 members and is growing in numbers. CCANN is offering a generous discount during the pandemic. For each new member, CCANN waives the sub-chapter fee of $25. In addition, they get to attend the April 24th’s CCANN Virtual Spring Conference on NICU Nutritional Awareness for free! Group NANN membership discount was also offered: a group of three members received a $10 discount and a group of 10 members received a $20 discount. Each new member will only pay $130 instead of $200 (CCANN membership $25 + free conference $45). What a fantastic savings to allow members to join a premier professional organization of neonatal nurses!

Being a NANN / CCANN member has many benefits:1. Ensures professional credibility. 2. You get to influence in advocating neonatal nursing practice regulation and policy and the health of the neonate and families. 3. It broaden horizons by neonatal networking with a diverse group of peers, collaborating, and volunteering . 4. Continuing professional development and access to professional resources.5. Opportunity to receive discounts on educational events and conferences both regional and national level.NANN gives each of its members a free subscription of the “Advances in Neonatal Care” magazine. The NANN website is also a wealth of information for evidence-based practices and updates in the care of the sick neonate.

NANN has always been true to its mission statement: “To be the professional voice that shapes neonatal nursing through excellence in practice, education, research and professional development”.Building new connections is critical part in every nurses’ professional growth.Meet and learn from your peers. CCANN welcomes you to join us and be an advocate to connect with the NICU nurses in the Central Valley and experience being a part of this strong, inspirational and compassionate organization.

Become a CCANN member and get connected!CCANN Membership

Footnote: https://nann.org/membership institutional benefits/May 2021

We Are Growing!Gil-Da Aum, BSN, RNC-NIC

CCANN Co-President

Happy Butterfly in Spring

7

NRP 8th Edition Practice Changes Dr. Indira Chandrasekar , VCH Neonatologist

Umbilical cord management plan added to 4 prebirth questions, replacing “How many babies?” with “Umbilical cord management plan?” The new 4 pre-birth questions: (1) Gestational age? (2) Amniotic fluid clear? (3) Additional risk factors? (4) Umbilical cord management plan?

Initial steps reordered to better reflect common practice. ‘Maintain normal temperatures” has been removed. Current Initial steps: Warm, dry, stimulate, position airway, suction if needed.

An electronic cardiac monitor is recommended earlier in the algorithm From “An electronic cardiac monitor is the preferred method for assessing heart rate during cardiac compressions” it is changed to “When an alternative airway becomes necessary, a cardiac monitor is recommended for the most accurate assessment of the baby’s heart rate.”

Epinephrine intravenous/intraosseous (IV/IO) flush volume increased. “From 0.5 to 1 mL normal saline flush with 3 mL normal saline (applies to all weights and gestational ages).

Epinephrine IV/IO and endotracheal doses have been simplified for educational efficiency. The suggested new initial IV or IO dose = 0.02 mg/kg (equal to 0.2 mL/kg). The suggested endotracheal dose (while establishing vascular access) = 0.1 mg/kg (equal to 1 mL/kg)

Expanded timeframe for cessation of resuscitative efforts Current recommendation - If confirmed absence of HR after all appropriate steps performed, consider cessation of resuscitation efforts around 20 minutes after birth (decision individualized on patient and contextual factors) .

Bar graph of CCANN membership from year 2008 - 2021

8

2021 CCANN NEONATAL NUTRITIONAL AWARENESS VIRTUAL CONFERENCE SERIES Education Event Sponsored by Abbott Grant

WHEN? Tuesday, March 23,, 2021 12pm-1pm PST Saturday, April 24, 2021 8am – 1pm PST

WHERE? Invitational Online Forum Providers approved by the California Board of Registered Nurses: BRN Provider No: 15253 Earn 6 CEUs and learn from experts in the field of Neonatal Nutrition Perfect for Bedside RNs, NNPs, Lactation RNs, students, dieticians, and PCTs

Registra)on Fee: Members: $25.00

Non-Members: $45.00 Students: $15.00

Preferred payment

methods: venmo@CCANN (Kamela Loo) OR

Pay by mail: CCANN

8709 N. Fuller Fresno, CA 93720

Registra)on methods (one-)me registra)on for Part I

& II): 1. Scan here with smartphone camera:

2. Visit this link: h;ps://us02web.zoom.us/webinar/register/7916135856763/WN_7iz2SYd6SFK_v4i_eTrZWw 3. E-mail CCANN2008@gmail.com

a. Full Name b. Address c. Email address d. License number ***for CE Credits

This webinar will cover the nutritional needs of our neonates

Agenda PART I:

Tuesday, March 23rd 1200-1300 PST Zoom Meeting - Online Meeting Platform

1200-1300 Next Level NICU Nutrition: Personalized Approach to Growth and Nutrient Intake A. Markell RD, LD, MSL-BC

PART II: Saturday, April 24th 0800-1400 PST

Zoom Meeting - Online Meeting Platform

0800-0845 Foundations of Nutrition in the NICU D. Morris, MSN, NNP-BC0845-0900 Silentia Vendor Product Presentation

0900-0945 Parental Nutrition and Premature Infants Jaramishian, Pharm D

Prolacta Bioscience Product Presentation

1000-1045 Preterm Nutrition – Time to Take Stock A.Lucas, MD: Professor of Paediatric Nutrition; Institute of Child Health,London, UK1045-1100

1100-1145 Breast is Best, Let's Talk about the Next BestR. Narang, MD1145-1200 Mead Johnson Product Presentation

1200-1245 Nutritional Potpourri: Basics, Problem Solving, & Case Study W. Lan, MD

K. 0945-1000 P

Syneos Health Product Presentation

CCANN’s Spring Virtual Conference on Neonatal Nutrition Flyer

Front and Back

“Back to School” Photo Sessions By: Sarah Gil, MS, CNS, NNP-Intern

Throughout the pandemic, CCANN has continued fundraising efforts to support the community. Currently, Siri Wride, RN of Siri Wride Photography (SWP) and recipient of the 2020 CCANN Community Service award, will be donating all proceeds received for “back to school” photo sessions at a cost of $30; a special that she also ran last year. A special thank you to Siri for her continued generosity in CCANN’s collaborative community service effort. The proceeds will be donated to Ronald McDonald House (RMHC) and Terri’s House. RMHC allows parents to stay close their hospitalized child as well as provide fundamental medical and dental care to underserved communities while Terry’s House serves families of patients in critical care area of Community Regional Medical Center. Thank you members and friend CCANN for your continued support in our community service endeavors. For more information regarding Siri Wride Photography, feel free to email at siriwridephotography@gmail.com or call 559.326.2047.

Congratulations, Siri Wride, BSN Winner of 2020 CCANN Community Service Award By : CCANN Officers

Siri Wride, BSN is a Neonatal nurse and the sole proprietor of Siri Wride Photography (SWP) who provides family and children photography services located in the Central Valley. Siri has a professional demeanor, while creating a fun, energetic quality in her sessions, which is displayed in her work.

Siri generously donated her technical skills and artistic vision by offering Back-to-School Mini sessions on August 1 and August 8, consisting of 10 minutes and 3 images for only $30.00 per child. These mini sessions were a joint effort between SWP and CCANN in raising funds for Feeding America-COVID 19.

She reached her fundraising goal of $1,000.00, and donated those earnings to Feeding America with Central California Association of Neonatal Nurses (CCANN) matching! That was $2,000.00 donated to Feeding America. Siri considered that as “a great way to give back to our very supportive and deserving community”.

CCANN would like to recognize Siri Wride’s act of kindness and her extraordinary effort in fundraising to support the worthy cause of Feeding America. She is the winner of the 2020 CCANN Community Service Award.

Congratulations, Siri! Check out her Facebook business page for more information on her great work.

COMMUNITY SERVICE Ashton Baker, BSN & Kamela Loo, MSN, NNP-BC

CCANN continues our mission of supporting worthy causes during the pandemic of COVID-19. We had participated in notable causes of Feed America in support of COVID-19 victims, March of Dimes virtual walk to celebrate the March for Babies, and most recently, American Red Cross to support the California Fire victims and firefighters. We will be sup-porting the Community Food Bank to feed the hungry during the holiday time and Toys for Tots to bring joy to the needy children during Christmas.Feeding America: Feeding America says it best: “With school closures, job disruptions, and health risks, millions of Americans will turn to food banks for much-needed support. They can’t do it alone and you can help.” CCANN reacts to this statement and decides to help ensure that families

Siri Wride VCH NICU RN Photographer

COMMUNICATIONS :

CCANN TEAM

CCANN2008@gmail.com

4

Happy Fall Everyone Neonatal Handbook Kamela Loo, MSN, NNP-BC, FNP-BC CCANN Chapter Founder

Since 2008 CCANN Chapter’s inauguration, CCANN continues to maintain the goal of serving our community and bridge the gap between the various hospital’s nursing and multidisciplinary professionals in our valley. The publication of Neonatal Handbook, 6th Edition, will be used to further build the NICU knowledge, inspire and foster professional growth with a simple aim of providing excellent and safe care to the little ones that we all love to care for and work with daily. This resource book is refrained from monetizing and no copy right infringement is intended. This book is for educational purposes only and should not be used to replace medical advice, or substitution of individual institutional policies and procedures.

We gave credit to Bunnell Incorporated, CDC and HeartBabyHome.com for allowing us to share the Jet information and cardiac images. We are extremely grateful for NANN/ Abbott Educational Grant, and without it, the printing of this book would be impossible.

Special acknowledgement and thank you to my colleagues and CCANN Advisors who never stopped, but only encouraged and supported this special project to become a reality.

The Neonatal Handbook is already out for distribution for those who desire

CCANN during Pandemic Time-2020 Kamela Loo, MSN, FNP-BC, NNP-BC

Kamela Loo NNP-BC CCANN Founder

Gilda Aum RNC-NIC CCANN Co-President

Endocrinology Conference Poster

CCANN Helping-Hands

This has been a strange year, to say the least. In early 2020, we were celebrating the 200th Birthday of Florence Nightingale as well as The Year of the Nurse and Mid Wife. This year, NANN and CCANN were also recognizing the nurses for all their amazing work and accomplishments in the NICU. Additionally, we were amidst the COVID-19 pandemic which turned the whole world upside down. As of November 2, 2020, SARS-CoV-2 has infected over 46,856,468 people and caused 1,205,745 deaths worldwide.The State of California has the highest number of COVID-19 cases of all the U.S. states (Elflein, 2020).The global economy has been severely impacted. Schools and businesses have been closed, jobs have been disrupted and the health of millions of Americans is still at risk.

As neonatal nurses, we often face the risk of COVID-19 exposure during deliveries because of the unknown COVID-19 status of infants. We have added plastic gowns, gloves, N95 masks and CAPRs to our normal uniforms. Our faces are nearly unrecognizable with the additional protective equipment. We salute all of the health care heroes and those who are in the frontlines of the fight against COVID-19 while recognizing our lives will never be the same again.

CCANN has also been impacted by the global pandemic. We observed the rules of social distancing, wearing masks and avoiding social gatherings. Our Spring Educational Conference and Breakfast Conference were both canceled due to CDC recommendations. The Fall Educational Conference became our first virtual conference. CCANN members used the video communication program, ZOOM, to participate in the educational conference, “Neonatal Endocrinology Pearls,” and submit the October 24, 2020 annual chapter report. Registration for the virtual conference was completed via QR code, and the attendee roster was compiled electronically. The chief officers of CCANN, including Gil-Da and myself, felt anxious and uncertain hosting our first ZOOM educational event. My seven-year-old granddaughter, Kara, laughed at us and said it was “so easy!” 74 people registered for the virtual educational event. The conference was

7

Salute to our healthcare superheroes

Siri Wride VCH NICU RN Photographer

9

“ Enthusiasm is common but Endurance is rare . . .”

-Angela Duckworth

Captured Just Right

2021 Sponsors Acknowledegement

promoting professionalism and enhancing clinical growth.

All CCANN members and the Spring Nutritional Conference attendees will get one free copy. We would like to extend our invitation for others to join NANN/CCANN or renew their membership. For those non-members who would like a copy, please request through Gil-Da Aum and Angie Co. Donations to cover the cost of printing can be accepted for future editions of handbook.

“Do your little bit of good where you are;it’s those little bits of good put together that overwhelm the world”

~Desmond Tutu~“Perfection is not attainable,

but if we chase perfection we can catch excellence”~Vince Lombardi~

PLEASE J OIN US FOR A VIRTUAL PRESENTATION ON

Current Insights and Approaches to Allergy Management

Date: Thursday, January 28, 2021 Virtual Program

Login details will be provided upon registration

Presented By: Michael Haight, MD, MHA Pediatric Gastroenterologist

University of California San Francisco & Fresno

Fresno, CA

Program Agenda: 5:45 PM PT Login

6:00 PM PT Presentation

Hosted By: Ross Nicholls

ross.nicholls@rb.com (559) 314-4840

RSVP By:

Tuesday, January 26, 2021

Learning Objectives: • Empower community pediatricians to improve and standardize diagnosis of allergic conditions • Understand the importance of early dietary intervention to support lifelong health • Enhance awareness of the evidence for the roles of probiotics and the microbiota in atopic

outcomes

To register for this event, please visit:

MJNportal.com/registration and enter the event code below

Event Code: 26620

Please Note – emails are required for registration

10

Current Insights and Approaches to Allergy Management

The CCANN members were invited to attend the Mead Johnson Pharmaceutical company sponsored virtual event entitled : “The Current Insights and Approaches to Allergy Management” with Dr. Michael Haight , a Pediatric Gastroenterologist from UCSF as the guest speaker of the said conference last January 26, 2021.

The learning objectives of the conference is to empower community pediatricians and healthcare providers to improve and standardize the diagnosis of allergic conditions. The conference reinforced the importance of dietary intervention to support lifelong health. And lastly, this medical forum enhance awareness of the roles of probiotics and microbiota in atopic outcomes in patients.

“There are no secrets to success . It is the result of preparation, hard work and learning from failure . . .”

- Collin Powell

with MD CORNER

Dr. Jimmy Lan

11

ONE ONE

ON

Questions Answers`

Q1 :Mother: 15 yo G1P1Term infant, admitted at 2 days of age for jaun-diceMother reluctant to continue breastfeedingBreasts are engorged and soreBaby not satisfied after breastfeedingDoes not want to wake up at night to pumpTo counsel her, you tell her that all of the fol-lowing are benefits of breastfeeding except:

A1:a) Decreased risk of infectionsb) Decreased risk of allergies and autoimmune diseasec) Decreased risk of SIDsd) Decreased risk of childhood and adulthood obesitye) Decreased risk of jaundicef) Improved bondingg) Improved brain maturation

Q2: Mother: 31 yo G1P1, HIV+Term infant, well-appearingAdmitted for anti-retroviral treatment due to mother’s HIV+ statusInfant is hungry and crying, what do you feed him?

A2a) Let the mother breastfeedb) Let the mother pump, then feed the EBMc) Let the mother pump, freeze the EBM, and only feed previously frozen EBMd) Donor breast milke) Term formulaf) IV fluids or PN

Q3:Mother: 39 yo G7P6No prenatal care, term home birth 7 days agoExclusively breastfedAdmitted from the ED forSevere jaundiceBloody stools and bleeding gumsDifficulty clotting after blood drawWhat is the most likely cause for the infant’s presentation?

A3:a) Necrotizing enterocolitisb) Cow’s milk protein allergyc) Hemorrhagic disease of the newbornd) Biliary atresiae) Non-accidental trauma

CCANN Game Plan Mechanics Draw date : Aug.31, 2021 Submit your answers to : ccann2008@gmail.com Who ever got the most correct answers will be enetered in a raffle draw for a free 2021 CCANN Fall conference registration, starbucks gift card plus much more !

Q4:Mother: 28 yo G3P3Fever, cough, loss of smell 4 days prior to deliv-eryCOVID-19 positive prior to deliveryWell-appearing infant, Apgars 9/9Infant is hungry and crying, what do you feed him?

A4:a) Let the mother breastfeedb) Let the mother breastfeed with a maskc) Separate the infant from the mother, instruct the mother to pump, have the father feed the expressed milkd) Term formula, instruct the mother to pump and dump until she has a negative COVID-19 teste) Donor breast milkf) IV fluids or PN until infant’s COVID-19 test comes back

Q5: Mother: 16 yo G1P1Shoulder dystocia, perinatal depression, neona-tal encephalopathyCord gas: 6.94/92/-16Undergoing therapeutic hypothermiaInfant is very irritable, what do you feed him?

A5a) Let the mother breastfeedb) Term formulac) Elemental formulad)Soy formulae) Keep NPO, start PN

Q6:Mother: 24 yo G2P1PPROM, preterm birth at 25 weeksBirth weight 640 gramsRDS, intubated, given surfactantHemodynamically stableWhat do you feed this infant on DOL #1?

A6:a) Expressed breast milk or donor breast milkb) Preterm formulac) Term formulad) Elemental formulae) Keep NPO, start PN and ILf) Keep NPO, start PN and SMOF

Q6 cont1:Same patient (25 weeks, 640 grams), DOL #2RDS, good blood gases, weaning on the venti-latorHemodynamically stable but has a murmurEchocardiogram shows a moderate PDAWhat do you feed this infant?

A6 cont1:a) Expressed breast milk or donor breast milkb) Preterm formulac) Term formulad) Elemental formulae) Keep NPO, start TPN and ILf) Keep NPO, start TPN and SMOF

12

Spring Rest and Get Together with FRIENDS

Kitty cat

Q6 cont2:Same patient (25 weeks, 640 grams), DOL #7RDS, increasing FiO2 requirement on the ven-tilatorLouder murmur with low diastolic blood pres-sure and MAP, started dopamineMore acidotic on blood gasEchocardiogram shows a large PDA with rever-sal of diastolic flowBenign abdominal examWhat do you feed this infant?

A6 cont2:a) Expressed breast milk or donor breast milkb) Preterm formulac) Term formulad) Elemental formulae) Make NPO, continue TPN and ILf) Make NPO, continue TPN and SMOF

Q7:Mother: 27 yo G2P1, uncomplicated pregnancyTerm infant, discharged home with motherBreastfed exclusivelyPresented to ED at 7 days of age with mucousy, blood-streaked, loose stools, fussinessBenign abdominal exam, no anal fissuresCBC/d notable for 12% eosinophiliaInfant is hungry and crying, what do you feed him?

A7:a) Let the mother breastfeedb) Term cow’s milk formulac ) Lactose-free formulad) Hydrolyzed or elemental formulae) Soy formulae) IV fluids or TPN

Q7 cont:2 years later…Same mother: 29 yo G3P2, uncomplicated pregnancyTerm infant, well-appearingOlder sibling had cow’s milk protein allergyInfant is hungry and crying, what do you feed him?

A8:a) Let the mother breastfeedb) Tell the mother go to on a dairy-free diet for 2 weeks, then she can breastfeedc) Term formulad) Soy formulae) Hydrolyzed or elemental formula

Q8:4 week old term infant with gastroschisis, s/p closurePN since birthMild PN-associated liver disease with DB 2.5Now stooling with minimal Replogle output, surgeons wish to start feedingsMother not pumpingWhat do you feed?

A8:a) Donor breast milkb) Term formulac) Preterm formulad) Pregestimile) Elemental formula

13

Ducklings

Q9:6 month old ex-24 week infant with history of NEC, s/p extensive bowel resection, jejunosto-my and short gut syndromeTolerates only minimal continuous feedings of elemental formulaPN-dependentDespite being on SMOF and Actigall, DB has risen to 7.4What can be done to treat this progressive cholestasis?

A9:a) Nothingb) Discontinue SMOFc) Cycle PN over 20 hoursd) Switch SMOF to Omegavene) Small bowel and liver transplant

Q10:8 mo ex-26 week infant with chronic lung disease, tracheostomy, GTCurrently on Neosure 24 kcal/oz, 150 ml/kg/dShould any changes be made to his diet?

A10:a) No changes, he is now at the 50th percentileb) Increase caloric intake due to increased caloric demands from chronic lung diseasec) Decrease caloric intake due to excessive growth

14

CCANN Lunch and Learn

Join us in congratulating this year’s Mid-Sized Chapter of the Year Award, the Central California Chapter. Considering the challenges of the global pandemic, the Central California Chapter saw a drop in membership. This drop, however, did not deter the Central California Chapter leadership from making the most of a unique year. In the fall, the Central California Chapter successfully ran its first virtual conference, “Neonatal Endocrinology Pearls.” The fall conference ran smoothly and was virtually attended by 75 members. All proceeds from the Central California Chapter’s fall conference were then donated to the American Red Cross to support the California fire victims and firefighters. The Central California Chapter continued to give back during the pandemic, donating $2,000 to the Feeding America COVID-19 Response Fund. We are so impressed and inspired by the Central California Chapter’s ability to make the most of what has been a stressful, extraordinary year. Keep up the amazing work!

NANN Response to CCANN Mid-Sized Chapter Award 2021

Lunch & Learn

• When: July 15th 1100-1400• Where: The Palms Restaurant

7550 N. Palm #101, Fresno, CA 93711

• Agenda:• 1100-1130: Registration & Sign-up • 1130-1200: CCANN meeting• 1200-1245: What’s New with NRP? with I. Chandrasekar, MD• 1245-1300: Mead Johnson Sponsor Announcements• 1300-1400: Skip that Beat! with K. Loo, NNP-BC, FNP-BC

• Who: Free for CCANN members $20 Non-members

• What: 2.4 CEUs (Provider approved by the California Board of Registered Nursing# 15253)

• Menu:Chicken Kebab or Salmon Kebab with rice pilaf and fresh vegatables

• RSVP: Text name to Angie Co, 619-962-9551 by 7/10/21

Sponsored by

RSVP : Limited Seats Available