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.

California has a state mandate to require Baby-Friendly certification in all its hospitals by 2020, which require that 80% of eligible newborns be exclusively breastfed at discharge, the primary quality metric of the BFHI. Many California hospitals are working toward that designation and their exclusive breastfeeding rates at discharge are tracked by the California Department of Public Health. Among those hospitals were hospitals in the Kaiser Permanente system (although multiple Kaiser hospitals in Southern California appear to have recently relinquished their designation). Estimates of excessive jaundice in the Kaiser Permanente Northern California hospital system, which has among the highest exclusive breastfeeding rates at discharge, all except 2 reaching >80%, was published in JAMA Pediatrics in 2016, which showed that an astonishing 12% of newborns developed hyperbilirubinemia of >15 mg/dL. [Corrected 8/31/2018] Out of 104,428 newborns, that would have been 12,949 newborns (almost 12 babies a day) who developed significant hyperbilirubinemia. Among those newborns were 5.7% or 5952 newborns (5 babies a day) who required phototherapy. By comparison, a recently published article in the journal Neonatology showing the effects of supplementing breastfed newborns with oral glucose and formula to satisfaction yielded a neonatal hyperbilirubinemia rate of 1.3% and a phototherapy rate of 0.3%.

Another estimate of hyperbilirubinemia rates comes from a review published by leading jaundice investigator, Dr. Vinod Bhutani who estimates that severe jaundice rates (>17 mg/dL, >95th %ile) is 8 -10%, or 1 in 10 newborns. Severe jaundice is a known cause of more subtle brain injury and impairments in brain development called Bilirubin-Induced Neurological Disorder.

We have provided all the published data available through PubMed on rates of hyperbilirubinemia among breastfed newborns worldwide, which included hyperbilirubinemia rates as high as 35%.

In addition, among healthy, term exclusively breastfed newborns, 10% of vaginally-delivered newborns and 25% of cesarean-delivered newborns in this same hospital system lost >10% of their birth weight. In contrast, 7 out of 7075 formula-fed newborns lost >10% (0.1%) from another study at the same hospital system. [Corrected 8/31/2018]. This yields a minimum of a 100-fold increased rate of excessive weight loss in exclusively breastfed newborns. Given the serious complications associated with weight loss > 7% including hypernatremia and hyperbilirubinemia, this is an unacceptable complication rate among newborns experiencing the Baby-Friendly protocol.

Flaherman et al, Early Weight Loss Nomogram of Exclusively Breastfed Newborns, Figure 2A, Pediatrics, Jan 2015.

Failing to disclose the increased risk of hyperbilirubinemia and dehydration from early exclusive breastfeeding and the risks of developmental disabilities from such complications is unsafe and irresponsible. If Baby-Friendly USA truly believes in providing mothers accurate information, they should start off with telling them the most vital information required to protect their child’s safety, health and future potential. Namely, that:

  • Insufficient breast milk, particularly in the first days of life is common.
  • Persistent crying and nursing are signs of hunger, thirst and insufficient feeding.
  • Insufficient feeding of breast milk or formula can result in complications like dehydration, hyperbilirubinemia and hypoglycemia that require hospitalization and can result in brain injury, disability and death.
  • Supplementation with safe, laboratory tested donor milk and/or formula to satisfaction can correct and prevent serious and irreversible outcomes.

We ask Baby-Friendly USA to act responsibly, prioritize patient safety and publicly acknowledge the known risks of insufficient feeding from exclusive breastfeeding to all its subscribing hospitals, health professionals and the public. Disclosing these risk, the signs and consequences of breastfeeding complications to parents is the only way to eliminate breastfeeding tragedies given that these complications commonly occur at home shortly after discharge. We ask BFUSA to refrain from encouraging subscribing hospitals to dismiss reports of patient harm as spurious complaints coming from the Fed is Best Foundation, which they have done on their website. Examining cases of patient harm are vital to ensuring patient safety. We also ask that you correct the posts on your website accurately reflecting that we have invited you to a video-recorded web conference to discuss breastfeeding complications, an invitation which you have not accepted. Finally, we ask that you acknowledge the errors you have made in interpretation of data including the weight loss data above, the rates of insufficient breast milk in the first days of life, the size of the newborn stomach, the nutritional content of colostrum, the metabolic and neurological consequences of feeding newborns less than their requirement for several days, the meaning of crying in such newborns, the effects of supplementation on breastfeeding rates from the Cochrane Review data, which was used in the 2017 WHO guidelines, and many, many more vital concepts of infant feeding required to ensure patient safety.

To BFUSA’s request: We stand corrected. The most current estimate of newborn jaundice among exclusively breastfed newborns is not 10-18%, it is 5-33%. [Corrected 8/31/2018]

Unfortunately, more current and more accurate data is not available as BFUSA does not publish its complication rates.

ABM Revised Jaundice Protocol:…/22-jaundice-protocol-english…

To read our full account of data on rates of hyperbilirubinemia (jaundice) and phototherapy admissions in a Baby-Friendly-Compliant Hospital System, Kaiser Permanente Northern California, please read the updated blog,synthroid coupon

High Rates of Newborn Hospitalizations for Jaundice in Baby-Friendly-Compliant Hospitals


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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.

The study found that the variables that predicted higher odds of developing hypernatremia were the following:

Risk Factors for HypernatremiaIncreased Odds of Newborn Hypernatremia
Greater weight loss (mean 8.6%±2 vs. 6%) 


Male gender


Higher maternal education


Multiparity (not being a first-time mom)


Cesarean delivery



Hypernatremia is a known complication of newborn weight loss and male newborns may be at higher risk due to a higher metabolic requirements relative to females. Surprisingly, although primiparity (being a first-time mom) is a risk factor for delayed or insufficient lactogenesis II,[3] multiparity in this study was a risk factor. The authors hypothesized that first-time mothers may have received closer monitoring. They also found that high maternal education was a significant risk factor for neonatal hypernatremia as mothers with higher education are more likely to exclusively breastfeed.

Analysis of the data shows that the majority of hypernatremic babies were breastfed or mix-fed. It is unclear whether the volumes of supplementation were restricted in mix-fed newborns or if they started off as exclusively breastfed and subsequently met medical indication for supplementation since the data was collected right before discharge. 96.1% of hypernatremic newborns were breastfed, 74.5% exclusively breastfed, 21.6% mix-fed and 3.9% were exclusively formula-fed. Exclusively breastfed and mix-fed newborns had hypernatremia rates of around 37% while exclusively formula-fed newborns had a rate of 6.25%. This yields a 5.84-fold higher risk of hypernatremia for exclusively breastfed newborns relative to exclusively formula-fed newborns. Mixed-fed newborns (which may have included exclusively breastfed newborns who required supplementation before discharge) were at 6-fold higher risk of hypernatremia.

Feeding Method (FM)FM among hypernatremic newborns (% of total) n = 51Risk of hypernatremia per FM: hypernatremia cases/total (%) 
Exclusively breastfed

38 (74.5%)

38/104 (36.5%)

Mixed-fed (upon discharge)

11 (21.6)

11/29 (37.9%)

Exclusively formula fed

2 (3.9%)

2/32 (6.25%)


This is the first study done to show the true incidence of hypernatremic dehydration among healthy term and near-term newborns. This is alarming data as prior studies have concluded that hypernatremic dehydration is rare occurring to less than 2% of admitted newborns.[4]  Other studies have shown abnormal developmental scores among newborns who develop hypernatremia even with appropriate correction. Among them include a study showing newborns who developed hypernatremia ≥ 150 mEq/L, over half had abnormal developmental scores at 12 months of age.[5] Another showed 25% percent of newborns with hypernatremia had developmental delay at 6 months, 21% at 12 months, 19% at 18 months and 12% at 24 months of age compared to a rate of 0.3% for non-hypernatremic infants.[6]

The largest study to date of weight loss in healthy, term exclusively breastfed newborns at a large Baby-Friendly-certified health system showed that greater than half lost > 7% of birth weight.[7] Ten percent weight loss is still commonly viewed as “normal” and “safe” for newborns to lose with little to no data supporting it. Among hypernatremic newborns, the mean weight loss was 8.6% +/- 2.7. Given that blood sodium levels are not universally-screened, a true hypernatremia incidence of 31% (36-38% among breastfed newborns) predicts that many more cases of hypernatremia are left undiagnosed and untreated potentially resulting in occult brain injury. The signs of hypernatremic dehydration predicting poor outcomes are poor feeding, seizures, fever and lethargy.[6] Given that the signs of poor feeding can be subtle and commonly missed among health professionals (or even normalized by the BFHI guidelines)[8] and given that parents are given little to no education on the signs and consequences of hypernatremic dehydration, there are likely many cases of hypernatremia among breastfed newborns that are being missed resulting in cases of brain injury that could go undetected for several years until a child begins to miss developmental milestones.


The recommendation of the author was to screen for hypernatremia at weight loss cut-offs depending on a newborn’s risk factors. For the highest risk category of males born by c-section to a multiparous, highly educated mother, it was recommended to begin screening for hypernatremia at 4.77% weight loss.

Hypernatremic dehydration is a devastating unintended consequence of current initiatives aimed at increasing exclusive breastfeeding rates at discharge, the quality metric of the Baby-Friendly Hospital Initiative. Given the high incidence of hypernatremia among healthy, term and near-term newborns, particularly among exclusively or near-exclusively breastfed newborns before copious milk production, we recommend screening for hypernatremia above 5% weight loss and sooner among  high-risk newborns who are exhibiting signs of persistent hunger and distress. Unrestricted supplementation for mild hypernatremia (145-146 meQ/L) can prevent need for hospitalization and the negative consequences on subsequent brain development.



  1. Oddie, S. J., Craven, V., Deakin, K., Westman, J. & Scally, A. Severe neonatal hypernatraemia: a population based study. Arch. Dis. Child. Fetal Neonatal Ed. 98, F384-387 (2013).
  2. Ferrández-González, M. et al. Weight loss thresholds to detect early hypernatremia in newborns. J Pediatr (Rio J) (2018).
  3. Dewey, K. G., Nommsen-Rivers, L. A., Heinig, M. J. & Cohen, R. J. Risk factors for suboptimal infant breastfeeding behavior, delayed onset of lactation, and excess neonatal weight loss. Pediatrics 112, 607–619 (2003).
  4. Moritz, M. L., Manole, M. D., Bogen, D. L. & Ayus, J. C. Breastfeeding-associated hypernatremia: are we missing the diagnosis? Pediatrics 116, e343-347 (2005).
  5. Koklu, E. et al. A review of 116 cases of breastfeeding-associated hypernatremia in rural area of central Turkey. J. Trop. Pediatr. 53, 347–350 (2007).
  6. Boskabadi, H. et al. Long-Term Neurodevelopmental Outcome of Neonates with Hypernatremic Dehydration. Breastfeed Med (2017). doi:10.1089/bfm.2016.0054
  7. Flaherman, V. J. et al. Early Weight Loss Nomograms for Exclusively Breastfed Newborns. PEDIATRICS 135, e16–e23 (2015).
  8. Kellams, A., Harrel, C., Omage, S., Gregory, C. & Rosen-Carole, C. ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017. Breastfeed Med 12, 188–198 (2017).
  9. Ben, X.-M. Nutritional management of newborn infants: Practical guidelines. World Journal of Gastroenterology 14, 6133 (2008).


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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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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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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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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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Exclusively Breastfed Newborns Have Double the Risk of Being Rehospitalized

By Christie del Castillo-Hegyi, M.D.

This week, the journal Academic Pediatrics, published a study conducted by the Newborn Weight Loss research group led by Drs. Valerie Flaherman and Ian Paul, which consisted of 143,889 healthy, term and near-term newborns born at the Baby-Friendly Northern California Kaiser Permanente hospital system from 2009-2013.[1] They included newborns who were discharged from their birth hospitalization without requirement of intensive care, which includes newborns who developed jaundice before discharge. They looked at the effects of mode of feeding, namely exclusive breastfeeding and exclusive formula feeding during the birth hospitalization on the rates of rehospitalization and number of outpatient follow-up visits. In addition, they looked at the effects of percent weight loss on the same outcomes.

Overall, 6.2% (1 in 16) of the healthy term newborns studied were readmitted; 4% were vaginally delivered and 2.2% were Cesarean delivered. This represents 8921 newborns over the five year period, almost 5 babies per day. They showed that exclusively breastfed newborns had slightly more than double the risk of being rehospitalized, even when adjusted for gestational age, birth weight and maternal race/ethnicity. Exclusively breastfed newborns also had significantly more (32% more) outpatient visits in the first 30 days after birth compared to exclusively formula-fed newborns. The leading cause of readmission was for hyperbilirubinemia or jaundice and need for inpatient phototherapy. The purpose of phototherapy is to reduce blood bilirubin levels in order to prevent or limit brain injury, a complication of insufficient feeding and dehydration commonly found in exclusively breastfed newborns before the onset of copious milk production (lactogenesis II).

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Fed is Best Foundation Presentation to WHO Officials on Breastfeeding Complications, Hospitalizations, Brain Injury and Disability

Christie del Castillo-Hegyi, M.D., Co-Founder

On Sept. 22, 2017, senior members of the Fed is Best Foundation, and guests including a neonatologist from a leading U.S. tertiary care hospital who wished to remain anonymous and a pediatric endocrinologist, Dr. Paul Thornton, M.D, from Cook Children’s Hospital Fort Worth, lead author of the Pediatric Endocrine Society’s newborn hypoglycemia guidelines met via teleconference with top officials of the WHO Breastfeeding Program: Dr. Laurence Grummer-Strawn, Ph.D.Dr. Nigel Rollins, M.D. and Dr. Wilson Were, M.D. to express their concerns about the complications arising from the BFHI Ten Steps and to ask what, if any, monitoring, research, or public outreach the WHO has planned regarding the risks of accidental starvation of exclusively breastfed newborns. The Foundation members who attended were 1) Christie del Castillo-Hegyi, MD, Co-Founder, 2) Jody Segrave-Daly, RN, IBCLC, Co-Founder, 3) Julie Tibbets, JD, Partner at Alston & Bird, LLP, Pro-Bono Attorney for the Foundation, 4) Brian Symon, MD, Senior Advisor, and 5) Hillary Kuzdeba, MPH, former quality improvement program coordinator at a childrens hospital , managing infant feeding projects and Senior Advisor.

This is a video of the presentation given to the WHO officials:

We believe all babies deserve to be protected from hunger and thirst every single day of their life and we believe that education on Safe Infant Feeding should be free. If you would like to make a donation to support the Fed is Best Foundation’s mission to teach every parent Safe Infant Feeding, please consider making a one-time or recurring donation to our organization.

Donate to Fed is Best


Thank you from the Fed is Best Foundation!



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Why the Academy of Breastfeeding Medicine Guidelines for “Medically Necessary” Supplementation Make the Baby-Friendly Hospital Initiative Unsafe

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

On September 22, 2017, senior members of the what is clomid. We learned that the WHO has never studied the complications of the WHO Ten Steps to Successful Breastfeeding and the Baby-Friendly Hospital Initiative (BFHI). We learned they have no studies commissioned to monitor the complications. Despite being presented data on the complications caused by allowing newborns to fast for days to achieve exclusive breastfeeding, they declined our offer to help make the guidelines safer and more ethical.  To watch the presentation given to the WHO officials, please go to this link. We learned that they have known about the risks of brain injury from exclusive breastfeeding and yet refuse to inform the public and health professionals. We learned that their provision for preventing brain injury consisted of telling health professionals to look out for “convulsions, lethargy and being unable to feed,” which are late signs of newborn brain injury. As a result, the WHO Ten Steps and the BFHI has created to an epidemic of infant feeding complications, hospitalizations, brain injury and disability in the developed and developing world. This constitutes one of the largest and most egregious violations of patient and human rights in the history of public health. They have asked for comments from the public regarding their draft revision of the breastfeeding guidelines, which make no changes to the recommendation, “give infants no food or drink other than breastmilk unless medically indicated,” while providing patients no information on the risks of avoiding supplementation. This is the official response of the Fed is Best Foundation to their request. Continue reading

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