Abridged Comment Presented on July 11, 2019 at the USDA Dietary Guidelines Committee Meeting in Washington, DC
My name is Dr. Christie del Castillo-Hegyi, Co-Founders of the Fed is Best Foundation, a non-profit organization of health professionals and parents whose mission is to research and advocate for safe breastfeeding practices. We do this to prevent the complications of infant dehydration, excessive jaundice, and hypoglycemia from insufficient feeding, all known causes of brain injury, disability and rare deaths. I have come here representing over 700,000 supporters to raise awareness regarding these complications for the DGA committee as they prepare the infant nutrition guidelines.
Jaundice and dehydration are among the leading causes of newborn hospitalization in the U.S. making up to 78% of all newborn readmissions.
The leading risk factor for jaundice and dehydration is exclusive breastfeeding before full milk production, which primarily results from insufficient breast milk supply and secondly, from ineffective milk transfer.
The data show that 12-35% of previously healthy EBF newborns will develop excessive jaundice, 1 in 17 (5.7%) requiring phototherapy and 1 in 25 (4%) requiring rehospitalization.
Jaundice and dehydration are commonly accompanied by hypoglycemia and hypernatremia.
Research has shown that 10% of healthy EBF newborns develop detrimental levels of hypoglycemia by 6 hours of life.
These levels of hypoglycemia are associated with a 50% reduction in 4th-grade literacy and math proficiency and a 200-400% increased risk of neurological and developmental disabilities.
Alarming data has emerged that among breastfed newborns screened for hypernatremia in the first 48 hours, a defining condition of brain-threatening dehydration —- 36% were hypernatremic, which occurred by 5% weight loss, a weight loss widely regarded as normal.
Decades of research have shown these breastfeeding complications lead to attention deficits, impaired motor, sensory, behavioral, language, and cognitive development.
Research has now shown that underfed breastfed newborns who develop symptomatic hypoglycemia can have extensive brain injury on MRI resulting in severe disabilities.
These preventable outcomes are among the most devastating in all of medicine.
Why in 2019 are we failing to safely breastfeed newborn babies?
In 1989, the WHO published the Ten Steps to Successful Breastfeeding, which was subsequently translated into the Baby-Friendly Hospital Initiative. Step 6 recommends to “Give no food or water other than breast milk,” —-the Initiative’s primary quality metric.
This recommendation was created with minimal attention to the high incidence of insufficient breast milk in the days after birth. As a result, newborns who are crying and nursing for hours from hunger routinely do not get supplemented until they have developed medical emergencies. Mothers are advised to avoid supplementation with no education on the consequences of doing so if breastfeeding is not enough. They are not told until after their child has been harmed, by which time, a brain injury may have already occurred.
This serious gap in patient education results in approximately 60,00 rehospitalizations (after discharge) and an additional 130,000 newborn NICU/SCN admissions a year costing the U.S approximately $2.7 billion dollars. The care of a child who sustains brain injury can cost millions of dollars over their lifetime.
The Fed is Best Foundation asks the Committee to educate the public and health facilities on the importance of safe and sufficient infant feeding, on the safe minimum nutritional requirements of infants and the harmful effects of dehydration, excessive jaundice, and hypoglycemia.
We ask the committee to educate the public on the safe minimum nutritional requirements of infants to prevent these complications.
We ask for a responsible public health message that respects all the ways required to provide optimal infant feeding, regardless of a mother’s ability or decision to breastfeed.
Given the societal costs of breastfeeding complications, we believe that promoting safe infant feeding is the most pressing issue in maternal-infant health.
Focusing on reducing infant morbidity, hospitalization, long-term disability, and cost-of-care is vital to improving maternal, infant and child health outcomes. Equally important is the goal of protecting mothers from psychologically harmful public health messages that suggest a failure to adhere to the exclusive breastfeeding directive equals failure as a mother. If the goal is to provide all mothers who choose to breastfeed safe and optimal conditions to successfully achieve their goal and to equitably support and ensure infants are best-positioned to receive sufficient feeding support for optimal growth and brain development, the focus should be on healthy, sufficient and sustained breastfeeding, rather than absolute exclusive breastfeeding from birth to 6 months, which for an unacceptable number of dyads, can result in infant and maternal harm. Formula-feeding families also require comprehensive infant feeding support in order to achieve optimal health and developmental outcomes for their infants. This includes education on safe preparation and storage of formula milk and monitoring of infant growth as well. The current model of exclusive breastfeeding promotion in hospitals currently has no data on safety and evidence has emerged regarding its harms. Comprehensive reforms in infant feeding education and management require objective examination of the evidence by a multidisciplinary panel of experts without financial conflicts of interests on the benefits and the risks of the recommendations prescribed to support infant feeding. New parents require updated education as to the potential harms of insufficient feeding of infants, which include but are not limited to:
- Risk of feeding complications and need for hospital treatment of hyperbilirubinemia, dehydration, hypernatremia, hypoglycemia, and failure to thrive
- Brain injury and developmental disability from insufficient feeding complications
- Sudden Unexpected Postnatal Collapse and newborn drops/falls from maternal exhaustion caused by 24/7 rooming, unsupervised skin-to-skin care and prolonged breastfeeding; and
- Rare infant deaths from the above-listed conditions
Moreover, as the cost of litigation and cost of care related to insufficient feeding complications is increasingly burdening an already over-burdened health care system, these infant feeding safety issues need to be addressed urgently.
For sources click here.
For questions, please contact: christie@fedisbest.org
If I Had Given Him Just One Bottle, He Would Still Be Alive.
https://fedisbest.org/information-for-hospitals-ensuring-safety-for-breastfed-newborns/
NICU Nurse Discloses Newborn Admission Rates From Breastfeeding Complications in BFHI Unit
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