Keeping Your Baby Safe by Knowing Normal vs. Abnormal

by Christie del Castillo-Hegyi, M.D., Co-founder of the Fed is Best Foundation

In order to provide mothers and health professional a quick guide to preventing newborn brain injury in the first days of life, the following is a short slideshow on the scientific literature regarding the thresholds that predict newborn brain injury and developmental delay and disability in the first days of life related to insufficient feeding.

All complications of underfeeding, including jaundice, weight loss, hypernatremia, dehydration and hypoglycemia can be prevented with feeding sufficient milk before the complications occur. The scientific literature shows that by the time a child develops abnormal jaundice, hypernatremia or hypoglycemia, the brain injury that follows is irreversible and can result in long-term negative consequences to brain development, even when corrected.

We advise parents and health professionals to be knowledgable about what constitutes safe and unsafe lab values and weight loss so that all newborns can be protected.

 

Response to Anna Almendrala’s editorial from Dr. Christie del Castillo-Hegyi, Co-Founder of the Fed is Best Foundation

Your recent article in the Huffington Post titled, “The Scary But Rare Risk Linked to Exclusive Breastfeeding,” is yet another example of the untruthful and unethical promotion of exclusive breastfeeding as an all-benefit, no-risk choice for mothers.  The hiding of the common and dangerous complications of the Baby-Friendly protocol including the risks of starvation from avoiding supplementation is a violation of patient rights and threatens the brains and lives of newborns.

First of all, you identified the Fed is Best Foundation as a “parent-led” non-profit founded to push back against the social pressure to exclusively breastfeed. That is an inaccurate representation of our credentials as the Foundation was founded by an emergency physician, former NIH scientist and a Newborn ICU nurse and IBCLC.  We are also joined by Neonatal Nurse Practitioners, NICU Nurses, Labor & Delivery Nurses, Physicians, Scientists, Public Health Advocates, Attorneys and a Statistician. Furthermore, we were created to speak out against the unsafe and unethical practices of the Baby-Friendly Hospital Initiative and the WHO exclusive breastfeeding guidelines, which has hospitalized more babies on this planet for starvation-related complications than any other policy in the history of public health. We were created to write ethical breastfeeding guidelines that respect the patient rights of mothers to honest information so that she can protect her child. Lastly, we were created to write safe and evidence-based breastfeeding guidelines that don’t endanger children’s lives.

Jaundiced newborns requiring phototherapy in Vietnam

While it is rare for a child to die from dehydration caused by exclusive breastfeeding, it is not rare to experience brain-threatening complications that require hospitalization. The reason why these hospitalizations occur is because mothers are taught that insufficient breast milk is rare and therefore the need for supplementation is rare, which even Dr. Alison Stuebe of the Academy of Breastfeeding Medicine admits in her own editorial is necessary in as many as 1 in 7 babies.  Furthermore, their own jaundice protocol says that 10-18% of U.S. exclusively breastfed newborns experience starvation jaundice from insufficient milk intake, which require extended or repeat hospitalization for phototherapy to prevent or limit brain injury. The scientific literature has shown by the time a child needs phototherapy, they already have markers of brain injury leaking into their blood.  

The latest data on rates of hypoglycemia in healthy, term exclusively breastfed newborns showed that 10% experience levels low enough (<40 mg/dL) to cause long-term cognitive declines by 6 hours of life. The scientific literature has also shown that by the time they reach a glucose of 40 mg/dL, they are also leaking markers of brain injury in the blood. Yet few EBF healthy, term newborns are monitored for hypoglycemia.

In addition, you misquote the Oddie study on hypernatremic dehydration and represent dehydration as rare and when dehydration as defined by weight loss of greater than 10% is actually common, occurring to 14% of newborns in the largest study done to date. In other countries, they have been reported as high as 25%. Lastly, while the rates of laboratory-diagnosed hypernatremic dehydration are reported as rare, the number of exclusively breastfed newborns who experience it are likely to be far greater since EBF newborns do not get blood work unless their starvation is detected. If you don’t look for it, then it appears rare. However, the data on neonatal hypernatremia shows that it occurs as early as 7% weight loss, which happens to half of all exclusively breastfed newborns. This is not surprising since the blood volume of a child is 8.5% of their body weight, a weight loss of > 7% is likely to result in severe dehydration synonymous with hypernatremia.

Sadly, hospitalizations for jaundice primarily caused by underfeeding from the Baby-Friendly protocol are common. In a paper published by a Baby-Friendly Hospital system, they revealed that 5.7-13% of all the babies born required hospitalization for phototherapy. Furthermore 12-20% experienced levels of hyperbilirubinemia that have been associated with multiple developmental and neurological disabilities.

The Baby-Friendly Hospital Initiative is 25 years old. It has no data on safety. Exclusively breastfeeding one’s newborn before having a full milk supply comes with an infinite-fold risk of underfeeding and excessive weight-loss, since recent data shows no supplemented or formula-fed newborn is at risk. It relies on the unproven notion that newborn babies can fast for 3 days without irreversible harm to the brain and vital organs. It operates with no knowledge of the number of calories colostrum can provide nor the true caloric requirements of newborns. Finally, it allows newborn babies to cry out of hunger for hours to days without sleep while withholding supplementation in the faulty belief that the torture of hunger they experience is worth the benefits of breastfeeding.

Landon crying and nursing continuously by the second day of life

So as you see, hospitalizations and complications from the exclusive breastfeeding guidelines are not rare and are in fact the leading causes of newborn hospitalization in the world. So not only are you falsifying that complications are rare in order to convince mothers to trust you with their children, you are hiding them at the risk of causing harm to a child that is severe and irreversible. While every mother is informed of the risks of formula, they are not informed of the risks of starvation; and the risks of starvation far exceed the risks of properly-prepared formula. Sadly, the only rare thing in breastfeeding is honesty in its promotion.

Lies killed Landon Johnson and lies are hospitalizing exclusively breastfed babies every single day.

#babyfriendly #fedisbest

母乳が不完全な育児の危険性に関する医者・親への手紙 (Japanese Translation)

同業者および親の方へ
私は元NIH(アメリカ国立衛生研究所)の科学者で、現在はアメリカで救急医を務めるクリスティ・デル・カスティロ・ヘジイと申します。過去にはブラウン大学で新生児における脳損傷の研究を行った経歴を持ち、神経障害を患う6歳の子供の母親です。私の子供は生まれてから数日間、完全母乳で育てる際に母乳量が少なかったことが原因で新生児黄疸、新生児低血糖症および重度の脱水症を引き起こしたことを伝えるため、この文面を書いています。初めての子供が生まれる母親として、妊娠中には母乳に関するすべてのガイドラインを読みました。不運なことに、ガイドラインや小児科医のアドバイスに従った結果、息子は4日間の間に全く母乳を飲むことなくICUでの治療が必要となり、その後には複数の神経発達症を患っていると診断されました。私自身が医者、および科学者という経歴を持っていたこともあり、このような症状を引き起こした原因を知るため論文審査が記された専門誌を探しました。その中で新生児黄疸、脱水症、低血糖症および発達障害には繋がりがある、数多くの証拠が見つかりました。ここに記されている私の考えが、親に発育を委ねる息子や多くの子供に当てはまることが伝えられるよう願っています。

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Starvation- and Jaundice-related Brain Injury, Autism and What Science Does and Doesn’t Say

Written by Fed is Best Co-Founder, Christie del Castillo-Hegyi, M.D.

Professionals in the medical community and parents have asked questions regarding whether or not newborn starvation from insufficient exclusive breastfeeding is linked to Autism Spectrum Disorder (ASD) in children and what research has been done regarding a possible connection.

The short answer is no. There is no definitive linkage, and we don’t have clear answers when we’re queried about this fact – because in fact, the science is not entirely clear on this point.

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Recent Article Discusses WHO Recommendation to Avoid Supplementation in Newborns Involves Risks…and Does Not Improve Breastfeeding Rates

Written by Fed is Best Co-Founder, Christie del Castillo-Hegyi, M.D.

In the latest issue of The Journal of the American Medical Assocation (JAMA), pediatricians and public health investigators Dr. Valerie Flaherman, M.D., M.P.H. and Dr. Isabelle Von Kohorn, M.D., Ph.D. co-wrote an editorial on the United States Preventative Services Task Force (USPSTF)’s updated recommendations for primary care interventions that support breastfeeding. Continue reading

The Scientific Evidence on the Effects of Underfeeding on the Newborn Brain

A Review of the Literature by Dr. Christie del Castillo-Hegyi

We have received some questions here at the Fed is Best Foundation regarding the science of infant feeding and preventing accidental newborn starvation from insufficient breast milk intake.  Some have said there is no evidence that insufficient milk intake in newborns causes brain injury, developmental delays and disabilities.  We’d like to take the opportunity to open up a discussion on this very important topic.

The general body of medical and scientific literature largely supports that babies who are not fed enough calories and fluid through breastfeeding can develop excessive  jaundice, severe dehydration and hypoglycemia – all complications that can cause brain injury if not corrected. This isn’t exclusive to humans. In fact, the basic rule of nature is that no creature, particularly mammals, can live without food. Continue reading

Power Pumping: Does it Work?

Written by Jody Segrave-Daly, RN, IBCLC, The Momivist & Co-Founder of The Fed Is Best Foundation

What is power pumping?

Power pumping refers to when a breastfeeding mother uses a breast pump to remove as much
breast milk as she can in rapid (concentrated) intervals, in an attempt to stimulate her milk supply.

The theory behind power pumping is that it hyper-stimulates the prolactin hormone cascade that stimulates breast milk production, by completely emptying the breasts. Mothers report that this process takes 4-7 days to begin seeing any results and some report not seeing a difference at all. The science on this theory is as split as the results are. Continue reading

Fed Is Best 101: What is Newborn Jaundice?

Today begins the first of a series of posts dedicated to informing parents about infant health conditions related to feeding. We begin with Newborn Jaundice, which comes up frequently in our discussions here at The Fed Is Best Foundation.

Jaundice is not a disease or illness, but the name of a symptom found in babies (and some adults) whose livers can’t clear out a yellow-colored substance called bilirubin (bil-eh-ROO-bin). Continue reading

Markers of Brain Injury is Present in the Blood of Newborns Requiring Phototherapy for Jaundice

by Dr. Christie del Castillo-Hegyi, M.D. 

A study published in the journal Pediatrics and Neonatology in September, 2014 showed that newborns diagnosed with hyperbilirubinemia, or abnormal jaundice, high enough to require phototherapy had significantly higher blood levels of S100b, a protein known to be released by damaged brain cells when significant brain injury occurs.  They studied 62 jaundiced newborns who required phototherapy and compared them to 30 healthy non-jaundiced newborns and compared the relative levels of S100b in the blood, as well as other molecules that are associated with oxidative stress, a phenomenon that occurs when living cells die.  All except 2 babies in each group were breastfed and none had G6PD, a condition that causes abnormally high bilirubin unrelated to breastfeeding-related dehydration.

They found that the babies who had hyperbilirubinemia high enough to require phototherapy (bilirubin levels of 20.58±2.96 mg/dL) had significantly higher levels of S100b than the healthy babies, (S100B levels 87.3± 2.63 pg/mL in healthy babies vs. 124.97 ± 123.05 pg/mL in phototherapy babies; p = 0.032).  They also found higher levels of MDA, a marker of oxidative stress from cell death, in the babies requiring phototherapy as well (5.55±0.6 nmol/mL vs. 7.72±0.75 nmol/mL; p<0.001).  The levels of S100b was NOT reversed by phototherapy, suggesting that phototherapy neither increased brain cell death nor reversed it.  The purpose of phototherapy is to prevent further brain injury caused by hyperbilirubinemia but it does not reverse brain injury.

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High Rates of Newborn Hospitalizations for Jaundice Requiring Phototherapy in a Baby-Friendly Hospital System

By Christie del Castillo-Hegyi, M.D.

The true rate of hospitalizations of newborns for phototherapy due to jaundice has been recently published in JAMA Pediatrics published online April 11, 2016. In a study of 104,460 babies born between January 2010 and December 2013 in the Kaiser Permanente Northern California (KPNC) Healthcare System, a total of 10,583 newborns experienced jaundice requiring phototherapy, a rate of 10.1% over the three year period. Seventy-one percent of these hospitalizations were extensions of the original birth admission, which means pathological jaundice was detected before discharge and the newborn’s hospital stay was extended to reduce the pathological effects of bilirubin, namely brain injury.

Severe newborn jaundice and phototherapy increase the risk of developmental disability

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