Breastfeeding Medicine

Physicians blogging about breastfeeding

CDC issues guidelines on breastfeeding and Ebola

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Both families and physicians are anxious about the potential impact of the Ebola virus for mothers and infants.

The CDC has recently issued guidelines for field and partner organizations regarding how to advise breastfeeding women with probably or confirmed Ebola infection:

“When safe alternatives to breastfeeding and infant care exist, mothers with probable or confirmed Ebola virus disease should not have close contact with their infants (including breastfeeding).

In resource-limited settings, non-breastfed infants are at increased risk of death from starvation and other infectious diseases. These risks must be carefully weighed against the risk of Ebola virus disease.”

The Ebola virus has been detected in the milk of infected women. For mothers who recover from Ebola, it is not known when it is safe to resume breastfeeding. The CDC recommends waiting to resume breastfeeding until milk can be shown to be Ebola-free in laboratory testing.

As the Ebola outbreak continues to evolve, the Academy of Breastfeeding Medicine recommends consulting CDC guidance on how to minimize risk for infants of affected mothers.

Written by bfmed

October 30, 2014 at 7:26 am

Breast Milk CMV and the risk of feeding the VLBW infant

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The recently published article by Josephson and colleagues confirms that serious infections due to postnatally acquired CMV in very low birth weight infants are a real concern. The study documented that properly screened (CMV seronegative) and filtered blood and blood components effectively blocks transmission of CMV from these previously documented sources and in turn confirmed that the primary source of transmission is maternal milk from seropositive mothers. Of the infants who were exposed to mother’s breast milk that was positive for CMV, 15 % developed serologic evidence of CMV disease and less than 3% developed significant clinical disease, including NEC, with a mortality of 60% (3/5).

Of importance to note was the fact that the study was performed primarily by a team of hematologists and transfusion experts and unfortunately lack any details as to the clinical course of the infected infants — there were no data on birth weight or gestational age data, no indication as to quantity of milk ingested, when breastfeeding was initiated, the percentage of raw milk ingested versus frozen thawed milk, post natal age of onset if disease, bowel biopsy or post mortem findings. Furthermore not all the mothers had their milk tested for presence of CMV. Thus, these significant methodological limitations preclude accurate mathematical calculations as to actual risk of feeding human milk to the VLBW infant. Furthermore, the absence of any basic clinical data precludes identifying who are the truly high-risk infants. Read the rest of this entry »

Written by aeidelmanmd

September 29, 2014 at 6:56 am

Posted in In the news, research

Mastitis Protocol Updated

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In case you missed it, the Academy of Breastfeeding Medicine Protocol #4, “Mastitis“, by Dr. Lisa Amir, was published in Issue #5 (May/June) of Breastfeeding Medicine.  The good news (or the bad news, depending on how you look at it) is that not much has changed since the previous version was published in 2008.  There are slightly expanded discussions of methicillin-resistant staph aureus and secondary candidal infections, and a brief explanation of fluid mobilization for symptomatic treatment of a swollen breast.  The style has been changed to include fewer paragraphs and more bulleted lists, which makes for easier reading and reference.  And of course the references have been updated.  It is of the high caliber we expect these clinical protocols to be, and relates the state of the art as it exists for the diagnosis and management of Mastitis today.  If you haven’t had a chance to take a look at it, check it out in Breastfeeding Medicine Volume 9, Number 5, 2014 pages 239-243, or go to the Academy of Breastfeeding Medicine website, and check under the Protocols and Statements tab.

Kathleen Marinelli MD, IBCLC, FABM is a neonatologist a Board member of the Academy of Breastfeeding Medicine, and Chair of the United States Breastfeeding Committee.

Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.

Written by kmarinellimd

July 3, 2014 at 1:14 pm

Newly Published! ABM Clinical Protocol #1: Guidelines for Blood Glucose Monitoring and Treatment of Hypoglycemia in Term and Late-Preterm Neonates, Revised 2014

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It is with great excitement that I announce that the long awaited publication of the 2014 Revision of the Academy of Breastfeeding Medicine Protocol #1 Hypoglycemia in Breastfeeding Medicine Volume 9, Number 4, 2014! The previous version was released in 2006. The authors, Nancy Wight MD, IBCLC, FABM and Kathleen Marinelli MD, IBCLC, FABM remain the same.

There have not been any earth shattering changes in the field since the last protocol was published. Importantly in fact there has been no progress in the definition of clinically relevant “hypoglycemia.” An expert panel convened in 2008 by the U.S. National Institutes of Health concluded that there has been no substantial evidence-based progress in defining what constitutes clinically important neonatal hypoglycemia, particularly regarding how it relates to brain injury, which is what concerns us all the most. We reiterate that the literature continues to support that transient, single, brief periods of hypoglycemia are unlikely to cause permanent neurologic damage. Therefore, the monitoring of blood glucose concentrations in healthy, term, appropriately grown neonates is unnecessary and potentially harmful to parental wellbeing and the successful establishment of breastfeeding. Read the rest of this entry »

Written by kmarinellimd

June 9, 2014 at 3:01 pm

Day of Action: get out from under the influence of a lifetime of formula marketing

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May 21, 2014 marks the 33rd anniversary of the World Health Organization’s adoption of the International Code of Marketing of Breast-Milk Substitutes (or “the Code”) in an effort to promote breastfeeding and limit formula companies’ influence over women’s infant feeding decisions.

Today more than 20 organizations and thousands of moms and citizens are participating in a day of action led by Public Citizen, directed at the largest formula makers in the U.S. and Canada – Mead Johnson (manufacturer of Enfamil), Abbott (Similac) and Nestle (Gerber Good Start — and aiming to end the unethical practice of promoting formula in health care facilities, particularly through the distribution of commercial discharge bags with formula samples – a longstanding violation of the code.  Efforts include the delivery of a petition with more than 17,000 signatures to Mead Johnson at its headquarters outside of Chicago as well as to Abbott and Nestle;  sending photos and messages to companies on Facebook, Twitter and other online platforms; and blogs such as this one.  The day of action is not meant to advocate against formula use in cases where it is necessary, but to focus on the need to give mothers unbiased information about infant feeding, information that hasn’t been influenced by formula companies.

In reflecting on the influence of formula companies, I realized that the history of my life  parallels the history of the Code:

 The 27th World Health Assembly in 1974 noted the general decline in breastfeeding related to different factors including the production of manufactured breast-milk substitutes and urged Member countries to review sales promotion activities on baby foods and to introduce appropriate remedial measures, including advertisement codes and legislation where necessary.

I was born a bit before this.   My mom says that she wanted to breastfeed me but that nobody, including hospital personnel, could tell her how.  My baby book contains the crib card with the formula company logo.

Read the rest of this entry »

Written by neobfmd

May 21, 2014 at 5:25 am

Help Your Clients Understand Their Rights in the Workplace

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With more than half of women with infants employed, simple workplace accommodations are critical for breastfeeding success. By helping moms understand their rights as a breastfeeding employee and plan for their return to work, lactation care providers can support a successful transition so that working moms are supported to reach their personal breastfeeding goals.

The federal “Break Time for Nursing Mothers” law requires employers to provide break time and a private place for hourly paid employees to pump breast milk during the work day. The United States Breastfeeding Committee’s Online Guide: What You Need to Know About the “Break Time for Nursing Mothers” Law compiles key information to ensure every family and provider has access to accurate and understandable information on this law. Read the rest of this entry »

Written by kmarinellimd

May 5, 2014 at 3:38 pm

Breastfeeding Management: It’s so much more than just the latch

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Breastfeeding initiation and the period of the first month after birth for the mother and infant can often be complicated by medical and psychosocial challenges which may be difficult for lactation specialists alone to address. In a published article in March 2014 in the Journal of Human Lactation, we describe an integrated mental health approach which we have coined the ‘Trifecta†Approach’ as a model of breastfeeding management. († We borrow the term Trifecta which is a betting term for predicting 1st , 2nd and 3rd places in a horse race. It is also synonymous with the likes of winning an Oscar award for a movie). Our breastfeeding consultation clinic developed a multidisciplinary team comprised of : 1) a pediatrician specializing in breastfeeding medicine (myself), 2) a lactation consultant (nurse with IBCLC), and 3) a clinical psychologist specializing in infant mental health and child development.

The Trifecta

The Trifecta Conceptual Model

The lactation consultant and I take the detailed history on mother and baby together, and try to include a pre- and post- feeding weight and assist with latch and positioning.
Since breastfeeding often gets the blame if the baby is not growing well, we occasionally need to obtain other laboratory studies (e.g. Vitamin D levels) or pulse oximetry monitoring (e.g. low oxygen levels due to snorty breathing helped detect a congenital laryngeal problem that required surgery).

We also offer practical advice about ‘simplifying your life’ in the first week and recognizing the reality of having a new baby:

  • Minimizing hosting ‘afternoon teas’ (or even dinners) for visitors to admire the new baby
  • Enlisting help with meals i.e. simplified meal plans, creative with take-out meals and use of paper plates
  • Taking a break from laundry, cleaning, chores and running errands
  • Getting much needed rest with having someone take the ‘baby out of the building’ so that mother can sleep in a quiet house

After we complete our assessment and make plans for follow-up, our psychologist goes in for a debrief of sorts and reviews the Edinburgh Postpartum Depression Screen (EPDS) score. Our psychologist is able to get more information about previous mental health issues and provide more advice about self-care. We find that most families need help with the dramatic change that happens in their partnership after baby and the shock that for most this is ‘not the warm fuzzy Downy TV commercial’ they expected!! Read the rest of this entry »

Written by mayabunik

April 11, 2014 at 1:04 pm

Posted in Breastfeeding, policy

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