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

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.

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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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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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Fed is Best Foundation Response to U.S. Delegation Actions at the World Health Assembly

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

The Fed is Best Foundation is dedicated to ensuring safe infant feeding for every single child, a goal that can be achieved with exclusive breastfeeding, combination feeding, exclusive formula feeding and tube-feeding. We have no political affiliation. We support all mothers to help their infant thrive with safe, sufficient and sustainable feeding in order to protect their health and optimize brain development. Recent news has broken about the U.S. delegation at the 71st World Health Assembly opposing the first draft of the Infant and Young Child Feeding resolution. We have provided a line-by-line break down of the first draft of the resolution, which was set to be proposed by delegates from Ecuador, as well as the proposed draft submitted by the U.S. delegation along with our interpretation of the lines that the U.S. delegates opposed.

In an editorial published in the New York Post, two pediatricians, Dr. Alma Golden and Dr. Brett Giroir,  who were key members of the U.S. delegation attending the 71st World Health Assembly, wrote about the rationale for the U.S. opposition of the first draft:

As pediatricians, US representatives at this year’s World Health Assembly in Geneva and supporters of breastfeeding throughout our professional careers, we were shocked to read recent headlines, in the New York Times and elsewhere, claiming that the administration has somehow called into question the importance of breastfeeding for infants.

The administration fully endorses breastfeeding, and the agencies where we work — Health and Human Services and USAID — communicate this unequivocally…We don’t just affirm these priorities in formal conference rooms in Geneva. For years, the US government…has invested millions of dollars to promote breastfeeding both at home and abroad.

All of which is to say: Breastfeeding wasn’t in dispute in Geneva. Rather, we raised objections to an early draft of the resolution we eventually supported, which made references to a controversial 2016 guidance document. The underlying policy goal of this guidance is unsupported by US nutrition guidelines and inconsistent with the practice of most families in our country…

In particular, the guidance recommends that countries impose stringent new regulations on the marketing of any commercially produced foods suggested for children between 6 months and 3 years old. Such restrictions, in our view, prevent parents from having access to all the factual information they might need. The guidance even advocates for the prohibition of free samples of formula — including in countries and conflict zones where supplies of formula could help save babies’ lives.

Most important, there are good and valid reasons, both medical and personal, why some mothers cannot breastfeed, or choose not to breastfeed exclusively. This is particularly true in situations where displacement, other trauma or malnutrition have made it impossible for mothers to breastfeed their children, and these babies’ lives are at risk without formula or other nutritional supplementation. Parents in these dire situations need all the information and choices available.

The issue of child malnutrition occurring in war torn countries has been reported on by CNN reporter Gayle Lemmon in her article, “Don’t make babies rely on breast milk in war zones,” where she interviewed members of Doctors Without Borders who reported taking care of many infants suffering from severe malnutrition as a result of the strict restrictions of the World Health Organization and UNICEF on formula donations.

‘Over the past couple of weeks we’ve seen an increase in the number of malnourished children needing treatment,” Doctors Without Borders’ Iraq country director Manuel Lannaud said in an interview released on the group’s Web site.

The surprising thing is that Lannaud and his colleagues at the humanitarian aid group didn’t place the blame for these underfed little ones just on war and the fact that the city was under siege. They also put the blame on other international organizations and policies that seek to do good.

“It isn’t a problem of access to food. The malnutrition we see here is primarily due to the scarcity of infant formula,” Lannaud wrote. “International organizations like UNICEF and the World Health Organization (WHO) promote breastfeeding … and provide infant formula, but only by prescription. We believe that distributing infant formula in a conflict situation like Iraq is the only way to avoid children having to be hospitalized for malnutrition.”

Doctors Without Borders says it agrees that breastfeeding promotion is a priority, but one that comes after dealing with the immediate crisis of a baby’s survival. Says Lannaud, if mothers “need formula, we give it to them.”

The mothers who need it are those facing down life-and-death situations each day, often while caring for multiple children in the shadow of war. That giving infant formula to them is so controversial speaks to a policy tripwire few outside the humanitarian realm even know exists: global “breastfeeding first” policies.

The WHO breastfeeding policies are not without flaws and aggressive promotion of exclusive breastfeeding has resulted in harm, namely an epidemic of newborn hospitalizations for jaundice, dehydration and hypoglycemia, known causes of brain injury and developmental disability, in the U.S. and across the globe. In addition, there has been a rise in accidental suffocation of newborns, called Sudden Unexpected Postnatal Collapse, from prone positioning during to skin-to-skin care and breastfeeding, made worse by maternal exhaustion from 24/7 rooming-in, practices encouraged but the WHO Ten Steps and by Baby-Friendly policies. The promotion of exclusive breastfeeding from birth has contributed to an epidemic of neonatal jaundice in the developed and developing world, which has contributed to an epidemic of perinatal brain injury and cerebral palsy particularly in the developing world, where few health care resources are available to monitor and treat exclusive breastfeeding complications. Promoting exclusive breastfeeding from birth over the local, traditional practices of supplemented breastfeeding (with wet nursing, animal milk or sugar water) until the onset of copious milk production has discouraged a practice that breastfeeding mothers used to prevent hunger and starvation-related complications like jaundice, dehydration and hypoglycemia, which now are the leading causes of newborn rehospitalization in the world.

Incidence of severe neonatal jaundice (bilirubin ≥ 20 mg/dL) in Low- and Middle-Income countries. The data reported correspond to hospital statistics. [Greco, et al, Neonatology 2016;110:172-180]

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Breastfeeding, Supplemental feeding, Formula-Feeding, Fed is Best

Letter to Doctors and Parents About the Dangers of Insufficient Exclusive Breastfeeding and the Baby-Friendly Hospital Initiative

(En español)

Dear Colleague and Parent:

My name is Christie del Castillo-Hegyi and I am an emergency physician, former NIH scientist, with a background in newborn brain injury research at Brown University, and mother to a 6-year-old child who is neurologically disabled. I am writing you because my child fell victim to newborn jaundice, hypoglycemia and severe dehydration due to insufficient milk intake from exclusive breastfeeding in the first days of life. As an expectant mom, I read all the guidelines on breastfeeding my first-born child. Unfortunately, following the guidelines and our pediatrician’s advice resulted in my child going 4 days with absolutely no milk intake requiring ICU care. He was subsequently diagnosed with multiple neuro-developmental disabilities.  Being a physician and scientist, I sought out peer-reviewed journals to explain why this happened. I found that there is ample evidence showing the links between neonatal jaundice, dehydration, hypoglycemia and developmental disabilities. I wish to explain to you how I believe this could apply to my son and the many children whose care you are entrusted with. Continue reading

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The ‘Second Night Syndrome’ is Abnormal and This is Why

Written by Jody Segrave-Daly, RN, MS, IBCLC

As a NICU/nursery nurse and IBCLC who has worked with newborn babies her entire nursing career, I was mystified when I first heard the phrase “second night syndrome.” When I began to research where the phrase came from, it became clear that this phrase is not based on any scientific research, but rather based on a theory that describes behavior of exclusively breastfed newborns on their second day of life. I think it is a frightening phrase for new parents to hear, as the word “syndrome” is defined as a group of signs and symptoms that occur together and characterize a particular abnormality or condition. 

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The truth is, the “second night syndrome” is a theory that describes abnormal newborn behavior.

Babies can go into a very deep, recovery sleep period after the first 2 hours from birth. This period can range from 8-12 hours after birth and is often a time that babies may not wake up on their own to feed every 2-3 hours. Babies often need gentle encouragement from their parents to wake them up for feeding sessions. Some babies will nurse for 5 minutes or suckle on a bottle for 5 minutes or less and fall back asleep. It’s well known that babies are fasting during this time and if they have enough caloric reserves, they may tolerate this fasting period without complications. Nursery nurses are quite skilled with performing clinical assessments of babies to ensure they are stable. They are looking for signs of hypoglycemia or low blood sugar levels, jaundice and other abnormal clinical markers.  Ten percent of healthy, full-term exclusively breastfed newborns develop hypoglycemia in the first days of life and may require specialized care until they are stable.  All babies are transitioning from intrauterine to extra-uterine life and need skilled observation from the nurse while they are bonding with their parents in their room.

Yellow with Grayscale Photos Photographer General Media Kit (20)

Risk factors for delayed onset of full breast milk production

After babies begin to ‘wake-up’ from their deep recovery sleep period on their second day of life, they will begin to exhibit stronger hunger cues to nurse or bottle feed, every 2-3 hours and they become much more alert. This is a new opportunity for parents to bond because their babies become alert again, opening their eyes while gazing at their parent’s adoring faces. Some babies are a bit demanding during this time because they are very hungry. Newborn babies are very easy to console after their feeding by being held and snuggled. Every nursery nurse will tell you if a baby is not content after feeding, something is wrong. I suspect this is where the word “syndrome” came from, which describes abnormal infant behavior. Continue reading

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Dr. del Castillo-Hegyi Raises Awareness at the U.S. Task Force for Research Specific to Pregnant and Lactating Women at the NIH

Bethesda, MD—On February 26, 2018, Dr. Christie del Castillo-Hegyi, Co-Founder of the Fed is Best Foundation traveled to the NIH to raise awareness on the gaps in breastfeeding protocols, research and education that is leading to common and serious complications in exclusively breastfed newborns.

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What Is “Cluster-Feeding”And Is It Normal?

Written by: Jody Segrave-Daly, RN, MS, IBCLC

Cluster feeding is a phrase that is used to describe infant feeding behavior. Generally, it’s breastfeeding or bottle feeding that is in a different pattern from your baby’s typical feeding pattern. It is described as breastfeeding sessions or bottle-feeding sessions that are much shorter and more frequent, for 3-4 hours of the day. It often happens during a baby’s fussy period of the day. 

Cluster feeding is a phrase that sometimes is also called “comfort-feeding.”  As parents, we react to infant cries and feeding cues, so naturally we will assume a baby is hungry and when we feed them, they will be satisfied. But some babies will snack and will not take a full feeding during their cluster-feeding time; this is normal. Some babies simply want to suckle on a pacifier after nursing or bottle feeding. This is because their bellies are full, but they want to suckle for soothing and not for a feeding of milk.  Some breastfeeding babies will suckle, using non-nutritive sucking patterns for soothing only. Some babies will also want to be held and snuggled or may want to be carried or want movement, while suckling too!   

Cluster feeding can happen during growth spurts as well, but babies generally take in more milk during this time. It can also happen during times when a baby is not feeling well, teething or is tired or cranky.  And it’s true—some babies don’t cluster feed at all. My exclusively breastfed babies never did and preferred sucking on a pacifier, after nursing for comfort. 

When is cluster feeding considered normal?

  • It happens after a mother’s full milk supply is in, after birth.
  • It is during a limited time period of 3-4 hours in 24 hours.
  • The breastfeeding mother has adequate milk supply.
  • Baby is having plenty of dirty and wet diapers.
  • The baby is gaining enough weight.

If you are concerned that you are not making enough breast milk, or your baby isn’t transferring enough milk, you can do a simple check to see if you are.

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Starvation Jaundice and Bilirubin-Induced Brain Injury in Breastfed Newborns

Lecture Delivered by Dr. Lawrence Gartner, Director of Baby-Friendly USA

We have uncovered a lecture provided to lactation consultants at a prominent breastfeeding conference given by Baby-Friendly USA Director, Dr. Lawrence Gartner, who discussed the risk of brain injury from starvation-related jaundice, called kernicterus, 90% of which occurs to breastfed babies who lose excessive weight, according to his lecture. Yet despite this training, no information on the risk of preventable brain injury from starvation-related jaundice in breastfed newborns exists in patient-directed breastfeeding literature published by breastfeeding advocacy groups other than our own.

 

 

 

 

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