Information for Hospitals: Ensuring Safety for Breastfed Newborns

Among the leading causes of newborn extended and repeat hospitalizations are complications of insufficient feeding in exclusively or near-exclusively breastfed newborns. The most common reasons for insufficient feeding are due to insufficient colostrum/breast milk production and delayed onset of copious milk production. Insufficient feeding results in the complications of excessive weight loss, dehydration, hyperbilirubinemia, hypernatremia and hypoglycemia. These complications not only lead to preventable hospitalizations and health care costs, but can also lead to brain injury and permanent disability among affected newborns.  These complications not only put newborn patients at serious risk, but also put health providers, hospitals and the health care system at risk.

Insufficient breast milk is common, especially in the first days of life.

  • 22% of motivated, lactation-supported exclusively breastfeeding mothers experience delays in copious milk production that increase the risk of excessive weight loss in their newborns by 7-fold.[1]
  • 4244% of first-time mothers have similar delays in copious milk production.[2,3]

As a result, complications of insufficient feeding among exclusively breastfed newborns are common. The most recent studies show:

  • 10% of healthy, term vaginally-delivered and 25% of cesarean-delivered newborns develop excessive weight loss of > 10%, which increase the risk for excessive jaundice (hyperbilirubinemia), hypernatremic dehydration and hypoglycemia, all known causes subtle to severe impaired brain development.[4]
  • 10% of all healthy, term EBF newborns and 23% of first-born EBF newborns develop levels of hypoglycemia (<40 mg/dL)[5] severe enough to increase risk of lower academic achievement and developmental delay.[6,7]
  • A glucose of less than 46 mg/dL within the first 24 hours of life has been associated with a 3.7-fold increased risk of brain injury on MRI and a 4.8-fold increased odds of lower motor, cognitive and language scores at 1 year of age.[8]
  • Cognitive impairment from hypoglycemia can have life-long effects as evidenced by a study of 1395 newborns showing that newborns who develop transient hypoglycemia of less than 40 mg/dL was associated with a 50% reduction in passing the fourth-grade proficiency test in literacy and math. Even a glucose less than 45 mg/dL was associated with a 38% reduction in passing the literacy test.[6]
  • 12-35% of well-monitored exclusively breastfed newborns develop hyperbilirubinemia and 5.7% of newborns born in hospitals with high exclusive breastfeeding rates require phototherapy.[9-17] The majority of hyperbilirubinemia is caused by non-hemolytic jaundice from insufficient feeding.[18] In comparison, a recently published study showed freely supplemented breastfed newborns have a hyperbilirubinemia rate of 1.3% and a phototherapy rate of 0.3%.[19]
  • A recently published study showed that 36% of healthy, term breastfed newborns develop hypernatremia (>145 mEq/dL), which can occur by 4.8% weight loss,[20] a complication that is a known cause of injury to the brain and vital organs and increases the risk of developmental delay,[21] disability [22] and rare death in previously healthy newborns.[23]
  • Exclusive breastfeeding at discharge has been associated with a 2- to 11-fold higher risk of re-hospitalization for jaundice and dehydration.[24,25]
  • A U.S. study has shown that jaundice, feeding problems, and dehydration combined are the primary cause for 37% of all readmissions within the first 30 days of life. [26]
  • Hospital certification in the Baby-Friendly Hospital Initiative has been shown to result in a doubling of hyperbilirubinemia rates among newborns (10.88% to 23.77%), greater weight loss, higher mean hospital days and higher mean days of phototherapy. [27]

This page has been created to provide hospital administrators, health insurers and health care providers information on how to ensure patient safety related to infant feeding, particularly for exclusively breastfed newborns.

References

Second Night Syndrome: Complications in Exclusively Breastfed Newborns

Complication of insufficient feeding in exclusively breastfed newborns, like hyperbilirubinemia and hypoglycemia are common. The early signs of those complications are frequent or constant crying and prolonged or unsatisfied nursing (where baby latches and unlatches in response to insufficient milk at the breast). These signs are also called the Second Night Syndrome, which put an infant … Continue reading Second Night Syndrome: Complications in Exclusively Breastfed Newborns

Informed Consent Regarding Risks of Insufficient Feeding

The most important duty of hospitals and health professionals is to respect patient autonomy and ensure patient safety. One of the most important ways health professionals and hospitals preserve patient autonomy and safety is to provide them all the information required to make safe decisions regarding their infant’s health. Complications related to insufficient feeding of … Continue reading Informed Consent Regarding Risks of Insufficient Feeding

Complications from the Baby-Friendly Protocol

The Fed is Best Foundation has received tens of thousands of stories from mothers whose children have suffered serious starvation-related complications while exclusively breastfeeding with insufficient breast milk. The most common reasons mothers cite for these complications were failures by their health providers and health educators to teach them about: the signs of insufficient feeding … Continue reading Complications from the Baby-Friendly Protocol

Baby-Friendly Protocol Complications in the Media

Serious complications associated with strict adherence to the Baby-Friendly Hospital Intiative and the WHO Ten Steps to Successful Breastfeeding have led to preventable hospitalizations for jaundice, dehydration and hypoglycemia, known causes of impaired brain development. Some hospitals have seen deaths and near-deaths due to suffocation from accidental bed sharing, called Sudden Unexpected Postnatal Collapse. These … Continue reading Baby-Friendly Protocol Complications in the Media

Starvation Jaundice and Brain Injury in Underfed Breastfed Newborns

Lecture Delivered by Dr. Lawrence Gartner, Director of Baby-Friendly USA This is 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 … Continue reading Starvation Jaundice and Brain Injury in Underfed Breastfed Newborns

Dangers of Insufficient Exclusive Breastfeeding Grand Rounds Presentation

 Santa Fe, New Mexico—On May 2-3, 2018, Dr. Christie del Castillo-Hegyi, Co-Founder of the Fed is Best Foundation had the honor of giving the following presentation to the largest hospital in Santa Fe, NM, CHRISTUS St. Vincent whose safety and quality improvement program is leading the way toward optimizing newborn breastfeeding support. The Grand Rounds conference was held … Continue reading Dangers of Insufficient Exclusive Breastfeeding Grand Rounds Presentation

Hospitals That Have Relinquished Their Baby-Friendly Status Since 2016

Data comparing list from 2016 to September 2018 Adventist Healthcare Shady Grove Medical Center, Rockville, MD Alice Peck Day Memorial Hospital, Lebanon, NH AnMed Health Women’s and Children’s Hospital, Anderson, SC Bridgton Hospital, Bridgton, ME Castle Medical Center, Kailua, HI CentraState Medical Center, Freehold, NJ Feather River Hospital, Paradise, CA IU Health Goshen Hospital, Goshen, … Continue reading Hospitals That Have Relinquished Their Baby-Friendly Status Since 2016

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

Neonatal Nurse Practitioner Speaks Out About Dangerous Practices of the BFHI

The most common encounters that I see with exclusively breastfed babies during their hospital stay are the complications of not receiving enough colostrum. It is very common to hear frantically crying babies on the mother-baby units because they are hungry and are not satisfied from breastfeeding. This happens every single shift I work. Mothers are … Continue reading Neonatal Nurse Practitioner Speaks Out About Dangerous Practices of the BFHI

Open Letter to Obstetric Care Providers and Health Facilities on the Importance of Safe Infant Feeding

Dear Obstetrician-Gynecologist, Family Practitioner, Midwife or Health Administrator, I am writing to you as a mother and advocate for Fed is Best. You may have seen the story of Landon Johnson, who was welcomed into the world by his parents in February 2012.  Like most new parents, Landon’s mom and dad were lead to believe … Continue reading Open Letter to Obstetric Care Providers and Health Facilities on the Importance of Safe Infant Feeding