Fed is Best Foundations Statement to USDA Healthy People Goals 2030

Christie del Castillo-Hegyi, M.D.

From December 2018 to January 2019, the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2030 published the proposed Healthy People 2030 Objectives for public comment. Of note, the proposed Healthy People 2030 objectives saw a marked change from the 2020 objectives, namely a reduction of the breastfeeding objectives from 8 goals to one, namely, “Increase the proportion of infants who are breastfed exclusively through 6 months” (MICH-2030-15 ). Among the objectives that were dropped from the list were:

  1. MICH-23 – Reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life.
  2. MICH-24 – Increase the proportion of live births that occur in facilities that provide recommended care (i.e. Baby-Friendly Hospital Initiative-certified hospitals) for lactating mothers and their babies.
Healthy People 2020 ObjectivesBaseline (%)Target (%)
Increase the proportion of infants who are breastfed (MICH 21)
Ever74.081.9
At 6 months43.560.6
At 1 year22.734.1
Exclusively through 3 months33.646.2
Exclusively through 6 months14.125.5
Increase the proportion of employers that have worksite lactation support programs (MICH 22)2538
Reduce the proportion of breastfed newborns who receive formula supplementation within the first 2 days of life (MICH 23)24.214.2
Increase the proportion of live births that occur in facilities that provide recommended care for lactating mothers and their babies (MICH 24)2.98.1
We applaud the removal of the last two objectives as patient safety issues have emerged from those two objectives, namely increased rates of neonatal jaundice, weight loss, hypoglycemia and dehydration readmissions. We have submitted the following statement regarding the Healthy People Goals for 2030 requesting for a revision of the current proposed objective and the addition of two new objectives.

Exclusive breastfeeding at discharge is a major risk factor for severe jaundice and dehydration. Both conditions can require in-hospital treatment and can result in permanently impaired brain development. Photo Credit: Cerebral Palsy Law

 

Revision of MICH-2030-15 calling for “Increase in the proportion of infants who are exclusively breastfed from birth to 6 months” to the following:

Increase the proportion of infants who are primarily breastfed through 4-6 months who have received sufficient nutrition to ensure optimal growth and brain development and to prevent feeding complications (e.g. hyperbilirubinemia, hypernatremia, dehydration, excessive weight loss, hypoglycemia and failure-to-thrive).

We have requested the following additions to the 2030 Healthy People Goals:

New Proposed Objective #1: Reduce the proportion of infants who require treatment and/or extended or repeat hospital admission for insufficient feeding-related hyperbilirubinemia, hypernatremia, dehydration, excessive weight loss, hypoglycemia and failure-to-thrive.

New Proposed Objective #2: Increase the proportion of parents who have made the informed choice to partially- or exclusively-feed formula to provide safe and sufficient nutrition to their infants to prevent feeding complications (e.g. hyperbilirubinemia, hypernatremia, dehydration, excessive weight loss, hypoglycemia and failure-to-thrive) and optimize growth and brain development.

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“Just Trust Your Body And There Will Be Enough Breast Milk”— I Was Devastated When I Learned She Was Starving

Corrine

I’ve been trying to write this for two months but my mama bear anger has been difficult to process. I’m done with obsessing now, and I hope telling my story will help me and any other mother who may be  feeling the same way. I want to move on from the anger so I can be the happiest and the best mother for my baby.

I researched extensively about birthing and breastfeeding while I was pregnant. I was extremely determined to breastfeed and I learned doing so meant I was a great mother and considering the information regarding the amazing benefits which went largely unchallenged, I just couldn’t understand why any woman wouldn’t want to do this. At no point did I ever read any literature or even speak to anyone who highlighted the difficulties of breastfeeding or that some women were biologically unable to breastfeed. At no point did it ever feel like it was a choice. There was no choice – good mothers breastfeed, they gave their babies the very best- the “gold standard” they called it.  My mindset had also taken on a deep suspicion of formula as an unnatural ‘chemical substance’ and basically a second-best feeding alternative and who wants to give their baby second best. Not only this but I had been repeatedly advised by mothers in support groups not to supplement as this reduced your supply and interfered with the breastfeeding relationship which would ultimately rob your baby of the “best”. There was absolutely no choice.

At no point did I ever read any literature or even speak to anyone who highlighted the difficulties of breastfeeding or that some women were biologically unable to breastfeed. At no point did it ever feel like it was a choice.

Continue reading

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False News Report Used to Discredit Baby-Friendly Critic and Pediatrician

Christie del Castillo-Hegyi, M.D.

Another day, another distortion pushed by supporters of the Baby-Friendly Hospital Initiative, who no longer have any reasonable justification for endangering newborns with their policies, namely policies that increase the risk of accidental suffocation, newborn falls and starvation-related brain injury from strict exclusive breastfeeding promotion. Never in the history of Western medicine have we had decades of scientific evidence that a public health policy increases the risk of brain injury, disability and death in infants while millions of dollars are used to promote the policies’ “benefits” while actively suppressing knowledge of its risks. Since they no longer have any defense for their unsafe practices, they use the old and tired argument that anyone who criticizes or raises awareness on the safety issues of their policies must be funded and influenced by formula industry.

The most recent attempt to suppress the opinions of its critics occurred on December 18, 2018 when Women’s eNews published a highly biased and inaccurate article aimed at discrediting one of the BFHI’s critics, Dr. Ronald Kleinman, who published an editorial along with two other pediatricians, Dr. Joel Bass and Dr. Tina Gartley, in the medical journal JAMA Pediatrics regarding the serious safety issues associated with the BFHI protocol, entitled, Unintended Consequences of Current Breastfeeding Initiatives.

One of those risks they discussed is the risk of accidental suffocation and newborn falls during prolonged skin-to-skin care and breastfeeding in hospitals. Multiple policies of the BFHI contribute to these devastating outcomes. The first is the recommendation that babies “room-in” 24/7 with mothers who are exhausted and sleep-deprived from hours and even days of labor, some of whom receiving pain medication for post-operative pain. Their sleep-deprivation is made worse by the requirement to have full responsibility for the care of the infant without respite. Step 6 of the BFHI guidelines states that breastfed newborns should receive no food or water other than breast milk, which commonly cause near continuously crying and nursing due to persistent hunger, a phenomenon widely known as “Second Night Syndrome.”  Under these conditions, mothers have fallen asleep while breastfeeding their babies and doing prolonged, unsupervised skin-to-skin care, which in rare instances, have resulted in accidental suffocation of newborns, also known as Sudden Unexpected Postnatal Collapse. This has resulted in infant deaths and need for cardiopulmonary resuscitation, brain injury and lifelong disability among surviving infants. This phenomenon has become common enough to prompt the publication of an official American Academy of Pediatrics guideline entitled, “Safe Sleep and Skin-to-Skin Care in the Neonatal Period for Healthy Term Newborns,” which guides pediatricians on how to the reduce the risk of these complications among healthy, term newborns

According to the authors:

“An overly rigid insistence on these steps in order to comply with Baby-Friendly Hospital Initiative criteria may inadvertently result in a potentially exhausted or sedated postpartum mother being persuaded to feed her infant while she is in bed overnight, when she is not physically able to do so safely.”

They concluded that we should reconsider the call to increase implementation of the Baby-Friendly Hospital Initiative in the United States:

“Considering the available evidence, that recommendation [to increased implementation of the BFHI in the U.S.] should be reconsidered. If government and accreditation agencies wish to encourage and support breastfeeding, their focus should shift from monitoring Baby-Friendly practices and breastfeeding exclusivity to monitoring breastfeeding initiation rates coupled with evidence of lactation support both during and after the hospital stay…Hospitals should direct their efforts toward implementing practices that will promote breastfeeding safely, the common goal of both private and public groups with an interest in these issues.”

It is clear from this editorial that Dr. Kleinman, Dr. Bass and Dr. Gartley care about infant health and safety and wish to prioritize safe breastfeeding support of mothers and infants during the critical first days of life, which they do by calling for reforms of the BFHI policies and requirements that prevent that. Countless editorials by pediatricians and other physicians have expressed the exact same opinions about the rigid and unsafe guidelines of the BFHI, among them listed below this article.

According to the Washington Post, Jacob Thompson died of accidental suffocation when a nurse put him next to his mother, Monica Thompson, to breastfeed while she was sleepy and groggy. One-hour later, he was found unresponsive. Skin-to-skin care, maternal exhaustion and unsupervised breastfeeding in the postnatal period are known risk factors for Sudden Unexpected Postnatal Collapse. Six days later, Jacob died.

In response to a blog post I wrote, which I have since retracted, we received a message from the Massachusetts General Hospital (MGH) Senior Vice President for Research and Research Integrity Officer for the Harvard-affiliated MGH for Children, Dr. Harry Orf, Ph.D. regarding the Women’s eNews article. He wrote the following:

I want to let you know that the article on which your disappointment is based was inaccurate and highly misrepresentative.  I can attest that Dr. Kleinman has been diligent about appropriately disclosing all of his relationships because I conducted the assessment of these relationships following a complaint filed by an outside physician. I can assure you there was absolutely nothing unethical found in this review. In addition, you should know that Dr. Kleinman responded fully and honestly to every one of the questions he was asked by the Women’s eNews reporter. She, however, chose to misrepresent his words and produced a story that clearly was designed to discredit him.”

Dr. Orf shared with me the letter he sent to the reporter where he directly stated to the reporter, Rebecca Gale, “I found your story irresponsible and quite troubling.”

He stated the following  about the story’s inaccuracies:

“I cannot figure out how you could produce the article you did if you had looked at the work that Dr. Kleinman has done, reviewed his papers, or followed up with the various associations that you mischaracterize as among his “vast industry connections.” I know that Dr. Kleinman provided straightforward and comprehensive responses to your many questions. And I am dismayed – and, frankly, stunned – that you chose to ignore most of this information, in some cases including in your story the opposite of the response he had given you with no balancing comment. As a result, you produced a misrepresentative and inaccurate story that seemed to be designed to fit the narrative that you set out to write – a narrative that had nothing whatsoever to do with fact.”

“Let me give you some specific examples of errors, misstatements and misleading comments.

  • The premise in your headline and lead paragraph that Dr. Kleinman has come under scrutiny is flawed. He has not come under scrutiny. Harvard received one complaint, which was reviewed, as we are obligated to do. Our assessment identified no problems or concerns – nothing. 
  • In response to your question about whether industry-funded research influences outcomes, Dr. Kleinman said, “There certainly have been some high-profile examples of industry-initiated studies that have not had the appropriate firewalls between the funder and the investigators, and the influence of the funder is obvious.”  Your article, however, twisted his comment around, saying, “Kleinman believes ‘appropriate firewalls’ exist, even in the face of other high-profile examples where industry influence is present.” This is a total mischaracterization of his response.    
  • You wrote that Dr. Kleinman has financial connections to juice manufacturers. This is not true, yet you included it even though Dr. Kleinman told you he has never received compensation nor had a relationship with the Fruit Juice Association. Perhaps you should have checked with the association directly if you didn’t accept Dr. Kleinman’s response.
  • You wrote, “Harvard’s review did not find any official fault, but due to recent investigative reporting by the New York Times and ProPublica, light has been shed on the conflict of interest for scientists in all fields.” Dr. Kleinman was not part of the NYT/ProPublica piece, and attempting to draw such a connection is grossly misrepresentative.
  • You repeatedly suggested that Dr. Kleinman has published articles critical of breastfeeding. Dr. Kleinman has been a consistent and strong supporter of breastfeeding for 40 years and made this clear in his responses to you.
  • The story alleged Dr. Kleinman has had an ongoing relationship with Nestle. Dr. Kleinman explained in his response that the relationship with Nestle involved him co-chairing two international symposia – one more than 20 years ago, the other more than 10 years ago. These were two discrete interactions with no relationship between Dr. Kleinman and Nestle since.
  • Similarly, your story said Dr. Kleinman is a consultant for Burger King. As he noted in his response, Dr. Kleinman attended a one-day advisory meeting more than 10 years ago aimed at improving the nutritional profile of the meals Burger King serves. This advisory group included a future surgeon general and other prominent scientists and nutritionists from across the country. He has had no further interaction with Burger King since that single meeting.
  • Your story suggested that Dr. Kleinman’s engagement as a member of the Alliance for Potato Research and Education led to a paper promoting potato consumption among children. In fact, nothing in the cited review paper, which was about vegetable consumption and young children, promoted potatoes or concluded that children should eat more potatoes. In addition, Dr. Kleinman had explained that his role as an advisory committee member involved evaluating research proposals seeking funding from the APRE. He himself never received research funding from the organization.
  • You said Dr. Kleinman was on the board for US Dietary Guidelines 2010.  He was not and never has been. 

“I can speak firsthand to Dr. Kleinman’s commitment to upholding rigorous standards of research integrity because I was the one who reviewed a complaint filed by an outside physician alleging that Dr. Kleinman failed to disclose industry relationships and had deliberately misinterpreted data.” 

“I think you are also aware that others have subsequently corroborated the risk of adverse events in the first month of life. In fact, the World Health Organization, which founded the Baby Friendly Hospital Initiative, has pointed out that prolonged unmonitored skin-to-skin care may pose a risk for newborns, as Dr. Kleinman and others had identified.”

Regarding the story’s own financial conflicts of interests:

“Finally, Ms. Gale, at the end of your article, Women’s eNews acknowledges that this investigative series has been funded by the W.K. Kellogg Foundation. It has come to my attention that the Kellogg Foundation also provides significant support for the Baby Friendly Hospital Initiative and funds research of some of the individuals who have led the campaign to discredit Dr. Kleinman. Given that the focus of your article is on appropriate disclosure of conflicts, particularly around the Baby Friendly Hospital Initiative, it is surprising to me that Women’s eNews would not require that these relationships be fully disclosed to its readers.”

It appears the story has numerous inaccuracies and suffers from its own financial conflicts of interest. With that, I would like to submit my formal apology to Dr. Kleinman and express my sincere regret in not confirming the facts of the story before publishing my own piece expressing disappointment about the story’s allegations. I hope that those who were engaged in libel against Dr. Kleinman are properly disciplined.

In order to protect the health of women and children, we must have accurate reporting of facts. Apparently, the purpose of the article was intended to suppress and discredit reporting of facts regarding serious safety issues of the Baby-Friendly Hospital Initiative. Sadly, when you are losing the public relations fight, when your policies are increasingly criticized by pediatricians, other physicians and the general public and hospitals are relinquishing their Baby-Friendly status in response to multiple reports of harmed infants, you do whatever you can to survive.


List of articles From Pediatricians and Other Physicians criticizing the Baby-Friendly Hospital Initiative:

The Baby Friendly Hospital Initiative and the ten steps for successful breastfeeding. a critical review of the literature by Pediatrician/Neonatologists Dr. Enrique Gomez-Pomar, MD and Dr. Robert Blubaugh, MD

Another Year, Another Failed Breastfeeding Policy Push By WHO, UNICEF by Pediatrician, Jamie Wells, M.D.

Breastfeeding Improvement Initiatives May Increase Risk of Newborn Falls by Pediatrician, Clay Jones, M.D.

Efforts to Encourage Breastfeeding Like the Baby-Friendly Hospital Initiative (BFHI) May Have Unintended Consequences by Pediatrician, Harriett Hall, M.D.

Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms, by Pediatrician and Breastfeeding Research Investigator, Valerie Flaherman, MD, MPH1Isabelle Von Kohorn, MD, PhD2

Closing Newborn Nurseries Isn’t Good for Babies or Moms by Dr. Amy Tuteur

The ‘breast is best’ policy backlash, By Elissa Strauss, CNN (which quotes multiple physicians critical of the BFHI)

Commentary: Safety issues with skin-to-skin care must be acknowledged, by Joel L. BassM.D., FAAP and Tina GartleyM.D., FAAP

“Is Baby-Friendly Baby Safe?,” Fetus & Newborn Conference 2018 Lecture Presented by Dr. Jay Goldsmith

Stop the hyperbole when it comes to breastfeeding by Pediatrician, Roy Benaroch, M.D.

Breastfeeding increases the risk of newborn readmission. Now what do we do?, The Pediatric Insider, Roy Benaroch, MD

 

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Neonatal Nurse Practitioner Speaks Out About The Dangerous And Deadly Practices Of The BFHI

by Christine K.

When the Fed Is Best Foundation was launched two years ago, a few nurses sent us messages about their experiences working in a Baby-Friendly Hospital Intiative (BFHI) hospital. They shared common concerns about watching exclusively breastfed babies crying out in hunger from not enough colostrum while being refused supplementation just so that high exclusive breastfeeding rates were met. Two years later, we now receive messages from nurses, physicians, lactation consultants and other health professionals, regularly. They express their concerns while asking for patient educational resources. They tell us their stories and they need support and direction on what to do about unethical and dangerous practices they are forced to take part in. We collected their stories and are beginning a blog series on health professionals who are now speaking out about the Baby Friendly Health Initiative (BFHI) and the WHO Ten Steps of Breastfeeding.

Christine K. is a Neonatal Nurse Practitioner currently working in a BFHI Hospital with 25 years of experience. She has worked in both BFHI and non-BFHI hospitals and talks about her concerns about taking care of newborns in the Baby-Friendly setting.

Regarding Unsafe Skin-To-Skin Practices

In BFHI facilities, skin-to-skin is mandated. The protocol calls for skin-to-skin at birth, for the first hour, then ongoing until discharge. New mothers are constantly told that it is important for bonding, for breastfeeding, for milk production and for temperature regulation of the newborn. Baby baths are delayed for skin-to-skin time and nurses are required to document in detail the skin-to-skin start and end times. There is no education on safety regarding skin-to-skin time, only that it is to be done. I have been responsible for the resuscitation of babies who coded while doing skin-to-skin. One died, and the other baby is severely disabled. Mothers are not informed of the risks of constant and unsupervised skin-to-skin time. Mothers have complained to me that they felt forced to do skin-to-skin to warm up their cold or hypoglycemic infant because they are told skin-to-skin time will help their infant resolve these issues when in fact it doesn’t. There is also no assessment of the mother’s comfort level with constant skin-to-skin. It’s very discouraging to hear staff say things like, “That mother refused to do skin-to-skin,” like it was a crime or an act of child abuse. The judgement is harsh on mothers who fail to follow the protocol. I have noticed that partners are pushed to the side, especially in the first hour of life, not being able to hold their newborn, due to this strict policy. Their involvement has been discounted in the name of the exclusive breastfeeding protocol. Continue reading

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Nurses Are Speaking Out About The Dangers Of The Baby-Friendly Health Initiative

When the Fed Is Best Foundation was launched two years ago, a few nurses sent us messages  about their experiences working in a BFHI hospital. Some of the nurses felt comfortable speaking out because they left their jobs or retired early, as they did not want to be part of the restrictive breastfeeding policies that were implemented. They shared common concerns of watching exclusively breastfed babies being refused supplementation,while babies were crying out in hunger from not enough colostrum which resulted in NICU admissions.

Two years later, we now receive messages from nurses, physicians, LC’s and other health professionals, regularly.  They express their concerns while asking for help and for patient resources. They tell us their stories and they need support and direction of what to do about unethical and dangerous practices they are forced to practice. We collected their stories and are beginning a blog series of health professionals who are now speaking out about the Baby Friendly Health Initiative and the WHO Ten Steps of Breastfeeding. Continue reading

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“Is Baby-Friendly Safe?”: BFHI Safety Issues Discussed at National Neonatology Conference

Full video presentation available at Contemporary Forums Online.

Las Vegas, Nevada — On September 6, 2018, the national neonatology conference, “The Fetus and Newborn Conference” was held in Las Vegas, Nevada. Among the speakers was Jay Goldsmith, M.D., Neonatologist and Professor of Pediatrics at Tulane University, Member of the American Academy of Pediatrics Section on the Fetus and Newborn who gave a talk entitled, “Is Baby-Friendly Baby Safe?”

In the talk, he discussed the case of an Oregon woman who has filed an $8.6 million lawsuit against her hospital, Portland Adventist Medical Center, and a nurse who cared for her and her baby after accidentally suffocating her newborn after falling asleep with him in her hospital bed. According to the Washington Post, she had delivered her son by cesarean section a few days earlier and was given narcotic pain medication and sleep aids. A nurse gave her newborn to her while she was still drowsy and groggy to breastfeed in her hospital bed. About an hour after being left to breastfeed, the baby was found gray, not breathing with compromised vital signs in the mother’s arms after which he was rushed to the nursery. The baby received CPR and was put on life support but the child sustained severe and permanent brain injury. He ultimately died at 10 days of age. Continue reading

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Response to Baby-Friendly USA Regarding Rates of Hyperbilirubinemia Among Exclusively Breastfed Newborns

Christie del Castillo-Hegyi, M.D. and Jody Segrave-Daly, RN, IBCLC

We at the Fed Is Best Foundation give mothers across the globe a platform to tell their stories about how their babies suffered needlessly because they were denied information and supplementation for their hungry babies while under the care of the Baby-Friendly Hospital Initiative/WHO Ten Steps to Successful Breastfeeding protocol. Our Foundation has grown rapidly and demands significantly more time than we currently have because we are a 100% volunteer organization.  We are inundated with messages from mothers, health professionals and media on a daily basis. We try very hard to prioritize what we can do collectively, every single day. Our first priority is to respond to mothers in crisis who contact us needing assistance on how to safely feed their distressed breastfed baby because they were not educated on appropriate supplementation. Baby Friendly USA (BFUSA) found time to critique our interpretation of studies and written materials, so we were forced to take time away from mothers to update written materials and clarify our interpretations. Our goal is to be completely transparent and we have provided our detailed response below with corrections and clarifications given publicly available published data. If there have been errors in interpretation of published information, then we go back to the original published data to provide better data for the public, which we have done below. We believe we have a responsibility to inform parents, the public, medical insurance companies and BFHI hospitals about the risks of exclusive breastfeeding when insufficient. We believe parents deserve to know that the BFHI has an exclusive breastfeeding (EBF) threshold mandate to meet if the hospital wants to remain credentialed. The mandate results in tens of thousands of newborn admissions every year in the U.S. alone, which we chronicle on our page. For the safety of infants across the globe, we will continue to provide education on how to recognize serious complications of exclusive breastfeeding and how every parent can prevent them.

Starvation jaundice (hyperbilirubinemia) of the newborn is defined as abnormally high bilirubin in a newborn who loses >8-10% weight. It is caused by insufficient elimination of bilirubin due to insufficient caloric intake from exclusive breastfeeding in the first week of life. This well-established phenomenon has been discussed by neonatologist Dr. Lawrence Gartner, who is listed as a Director on the Baby-Friendly USA website, in a lecture given to lactation consultants (not just physicians and nurses as stated by BFUSA) at a 2013 California Breastfeeding Conference, previously posted on their website. This public lecture was provided to educate lactation consultants regarding dangerous levels of jaundice that can occur in previously healthy breastfed babies that result from inadequate intake of calories from exclusive breastfeeding. Under Fair Use laws, dissemination of educational material for non-profit educational purposes is protected and we were subsequently asked to post the full lecture by Dr. Gartner via email. The Academy of Breastfeeding Medicine jaundice protocol acknowledges that exclusively breastfed newborns are at higher risk of hyperbilirubinemia from insufficient milk intake (“suboptimal intake”) and excessive weight loss. The vast majority of newborn hyperbilirubinemia is caused by starvation jaundice. Their protocol also states that 98% of kernicterus, or the most severe form of brain injury from jaundice, occurs in breastfed newborns. Nearly all of starvation jaundice can be prevented with timely and adequate supplementation. Nearly all newborns with starvation jaundice show signs of poor feeding including excessive crying and frequent, unsatisfied nursing or lethargy before they develop levels of hyperbilirubinemia that result in impaired brain development. While BFUSA has not previously denied the increased risk of hyperbilirubinemia in breastfed newborns, they have not routinely disclosed them to parents or subscribing hospitals, which has the unfortunate effect of causing hospitalizations that would have been prevented by supplementing a crying underfed newborn. Unfortunately, many parents and health professionals are taught that the signs of poor feeding including crying and hours of unsatisfied nursing are normal, widely known as the “Second Night Syndrome.” These unfortunately are also the earliest signs of other complications like acute bilirubin encephalopathy, kernicterus, hypernatremic dehydration and hypoglycemia, all known causes of brain injury and permanent disability, which can occur if those signs are overlooked as normal and supplementation is avoided in order to meet the goal of exclusive breastfeeding.

Continue reading

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WHO 2017 Revised Guidelines Provide No Evidence to Justify Exclusive Breastfeeding Rule While Evidence Supports Supplemented Breastfeeding

Christie del Castillo-Hegyi, M.D.

The WHO health policy that has been responsible for millions of preventable hospital admissions of newborns for insufficient feeding complications is Step 6 of the Ten Steps to Successful Breastfeeding: “Give no additional food or fluid other than breast milk unless medically indicated.” Complications of insufficient feeding from exclusive breastfeeding before copious milk production are now among the leading causes of newborn extended and repeat hospitalization, namely jaundice (hyperbilirubinemia), dehydration and hypoglycemia.

In 2017, the World Health Organization published its guidelines updating its recommendations for “Protecting, Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services,” which outlines the evidence for the WHO recommendations on breastfeeding support for newborns in health facilities based on the Ten Steps to Successful Breastfeeding. Here is the evidence presented to justify the recommendation to avoid supplementation in breastfed newborns.

The WHO guidelines authors went on to conclude the following:

How did very low quality of evidence turn into moderate quality evidence for exclusive breastfeeding particularly when the evidence showed improvement of breastfeeding rates in supplemented breastfed newborns? Continue reading

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Jillian Johnson: My Message To Parents During World Breastfeeding Week-Just One Bottle

By Jillian Johnson

It took all of the courage I had to put aside the debilitating amount of guilt I carried for five long years to tell Landon’s story—his birth, the first days of his life and how he died. In fact, I still don’t know where I found that courage, but I am convinced Landon gave me the strength. I wasn’t prepared for the intense scrutiny my story received. I was utterly shocked because people came out of nowhere to discredit my story with a vengeance, but I quickly learned how to be gracious in such a vulnerable time.

After all, nothing anyone could say to me could hurt me more than the death of my newborn baby.

I can remember a very specific time, when I was sitting in the waiting room of the hospital and Landon was on life support. My dad was there with me and we were talking about Landon’s prognosis and I won’t ever forget him telling me what a special little boy he was and that he would do great things. I couldn’t quite wrap my head around what his words meant because Landon was most likely going to pass away, and my dad was talking about how he’s going to do great things. I never dreamed that his death would change the lives of so many people across the globe. Continue reading

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Hypernatremic Dehydration is Common and Occurs to a Third of Healthy Newborns

Christie del Castillo-Hegyi, M.d.

Newborn hypernatremia is a serious complication of early exclusive breastfeeding of newborns caused by insufficient feeding of milk. It is defined as an elevation of blood sodium levels (≥ 145 mEq/L) in response to insufficient fluid intake and most commonly occurs at day 3-4 of life, typically the point of greatest weight loss of a newborn. It is the most severe complication of dehydration and excessive weight loss and increases the risk of brain injury, developmental delay/disability, seizure disorder, vital organ injury and death. Oddie et al. showed that up to 98% of hypernatremia occurs in exclusively or near-exclusively breastfed newborns and the study group found the diagnosis of hypernatremia was rare.[1] However, since blood sodium levels are not universally-screened, which could result in missed cases of hypernatremia, it has been unclear just how common the condition is among newborns.

Steph Montgomery’s daughter jaundiced, dehydrated and hypernatremic at day 5 with 20% weight loss due to insufficient breast milk intake from low supply

A recently published prospective study of 165 healthy newborns ≥ 35 weeks gestational age looked at rates of hypernatremia (>145 mEq/L) in the first 3 days of life.[2] They examined multiple variables that predict hypernatremia as well as the threshold weight loss values at which increased hypernatremia risk occurs. The results were astounding.

The study found that out of 165 newborns 51 or 30.9% developed hypernatremia.

The majority of cases occurred by 5% weight loss, the lowest percentage weight loss occurring at 4.77% weight loss, especially for male infants delivered by cesarean delivery to a mother with higher education level. Continue reading

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