Archive for the ‘In the news’ Category
A new study in Pediatrics has spawned provocative headlines, contrasting images of human milk as “a nourishing elixir, or a bacterial brew.” Researchers anonymously bought breast milk from 102 online sellers. Milk orders were often packaged poorly, arrived well above freezing, and — as one might expect with milk unrefrigerated for days — were rife with bacteria.
But that’s really not the whole story. First, consider who participated in the study. By design, the authors communicated with sellers only by email, and cut off the conversation if the sellers asked about the recipient infant or wanted to talk by phone or in person. Milk was shipped to a rented mailbox to make the process anonymous. Of the 495 sellers the authors contacted, 191 sellers never responded, 41 stopped corresponding before making a sale, and 57 were excluded because they wanted to communicate by phone or asked about the recipient baby. Another 105 did not complete a transaction, leaving 102 of the original 495 sellers approached who actually shipped milk. Of these, half the samples took more than 2 days to ship, and 19% had no cooling agent in the package.
It’s highly plausible that milk sent with no questions asked, via 2 day or longer shipment, and (in 1 and 5 cases) without any cooling whatsoever, was collected with less attention to basic hygienic precautions. The bacterial load in study milk samples therefore doesn’t tell us about the relative safety of milk obtained following a conversation between buyer and seller about the recipient baby and then shipped overnight on dry ice in a laboratory-quality cooler. Indeed, when the authors compared online milk purchases with samples donated to a milk bank after a screening and selection process, they found much lower rates of bacterial contamination. The authors acknowledge this limitation in the study, but that subtlety has been lost in the media coverage. Read the rest of this entry »
BLACK MOTHERS’ BREASTFEEDING ASSOCIATION RECEIVES GRANT TO HELP ERADICATE RACIAL BREASTFEEDING DISPARITIES
Can Genetic Analysis of Breast Milk Help Identify Ways to Improve a Newborn’s Diet?
New Rochelle, NY, June 4, 2013—The composition of breast milk varies from mother to mother, and genetic factors may affect the levels of protective components in breast milk that could influence a newborn’s outcomes. The potential to perform genomic studies on breast milk samples is explored in a Review article in Breastfeeding Medicine, the Official Journal of the Academy of Breastfeeding Medicine, published by Mary Ann Liebert, Inc., publishers. The article is available free on the Breastfeeding Medicine website.
Kelley Baumgartel and Yvette Conley, University of Pittsburgh, PA, reviewed the scientific literature to determine whether breast milk is an appropriate source for genetic material—DNA and RNA—to perform gene expression and epigenetic studies.
In the article “The Utility of Breast Milk for Genetic or Genomic Studies: A Systematic Review,” the authors describe the potential value of the genetic information obtained from breast milk, which can be collected easily and noninvasively. It could lead to a better understanding of the variability in breast milk and to strategies for optimizing the neonatal diet through fortification of donor breast milk, supplementation of the mother’s diet, or maternal lifestyle changes that would affect breast milk composition.
“The great majority of mothers produces milk that matches the needs of her infant amazingly well,” says Associate Editor David S. Newburg, PhD, Professor, Department of Biology, Boston College, Chestnut Hill, MA. “But for those few infants with exceptional needs, such as premature infants, or for mothers with uncommon mutations whose milk lacks the full complement of beneficial components, genetic and genomic analysis would both identify the mismatch and provide the information to produce a personalized complementary fortifier or supplement.”
A small study published in Pediatrics suggests that supplementing newborns with small quantities of formula may improve long-term breastfeeding rates. The results challenge both dogma and data linking supplementation with early weaning, call into question the Joint Commission’s exclusive breastfeeding quality metric, and will no doubt inspire intimations of a formula-industry conspiracy. Before we use this study to transform clinical practice, I think it’s worth taking a careful look at what the authors actually found.
First, I think it’s very important to be clear about what the authors meant by “early limited formula.” The authors used 2 teaspoons of hypo-allergenic formula, given via a syringe, as a bridge for mothers whose infants had lost > 5% of their birthweight and mom’s milk had not yet come in. At UNC, we use donor milk in a similar way, offering supplemental breast milk via a syringe as a bridge until mom’s milk production increases. Read the rest of this entry »
A newly published study in Pediatrics is receiving media attention due to its finding that “restricting pacifier distribution during the newborn hospitalization without also restricting access to formula was associated with decreased exclusive breastfeeding, increased supplemental formula feeding, and increased exclusive formula feeding.”
The study took place in a US hospital’s mother-baby-unit (MBU) before and after implementation of a new institutional policy restricting routine pacifier distribution as part of a breastfeeding support initiative. (The four other breastfeeding support measures adopted by the MBU included breastfeeding in the first hour after birth, feeding only breast milk in the hospital, keeping infant in same room with mother in the hospital, and giving mother a telephone number to call for help with breastfeeding after discharge.) Of note, pacifiers were stored in a locked supply management system as part of the new policy, but formula access was not limited in the same way.
The researchers retrospectively examined exclusive breastfeeding rates (as compared to breastfeeding plus supplemental formula, and exclusive formula feeding) before and after the change. They saw a significant decrease in exclusive breastfeeding (from 79% to 68%) paralleled by significant increases in both formula-supplemented breastfeeding (18% to 28%) and exclusive formula feeding (1.8% to 3.4%).
While it is tempting to conclude “thus pacifier use is necessary in supporting exclusive breastfeeding”, it’s also important to note that the study in question states that “no specific script was instituted to verbally instruct parents on infant soothing techniques” either before or after restricting pacifier use. Thus it is equally tempting to conclude that desperate parents will resort to culturally familiar ways to soothe crying newborns — and in US culture, those include bottles and pacifiers.
It would be interesting to see a similar study conducted in a setting that emphasizes supporting parents in learning alternative ways to comfort their babies, such as skin-to-skin care and cue-based breastfeeding. It might also be interesting to see weight loss at discharge, and/or jaundice requiring phototherapy, as an outcome measure.
Kimberly Lee is a neonatologist and member of the Academy of Breastfeeding Medicine. She has previously written about pacifiers and breastfeeding in her blog post, “A sucker born every minute:” Pacifiers and breastfeeding.
Posts on this blog reflect the opinions of individual ABM members, not the organization as a whole.
Fact or fiction: Is breastfeeding actually linked with a lower risk of childhood obesity? The common thinking for the past several years has been “yes,” based on comprehensive analyses from the US Agency for Healthcare Research and Quality and the World Health Organization. However, two recent articles have disputed these conclusions. Considerable media attention has surrounded new data from the Promotion of Breastfeeding Intervention Trial (PROBIT), published in the Journal of the American Medical Association (JAMA) on March 13, and in a January 31 article in the New England Journal of Medicine (NEJM) on obesity myths by Casazza et al. We discuss both articles’ conclusions, as the public tries to make sense of all the conflicting information. Read the rest of this entry »
Lisa Selvin’s provocative article, “Is the Medical Community Failing Breastfeeding Moms?” has elicited a wide range of reactions from the breastfeeding community. Some have argued that the piece, which focuses on unmet needs of mothers who encounter physiologic problems with breastfeeding, “sensationalizes” breastfeeding, making it sound so treacherous and difficult that mothers should avoid it altogether.
I would argue that there’s a very fine line between “sensationalizing” and “truth in advertising.” Reproductive biology is imperfect — some couples can’t conceive, and some pregnancies end in miscarriage or stillbirth. The silence around these losses and the isolation that women have historically experienced has probably worsened the suffering for many women. On the other hand, emphasizing these risks and creating a culture of fear harms the majority of mothers who will have successful pregnancies and births. Read the rest of this entry »
Reviewing the proceedings of the Fourth Annual Summit on Breastfeeding1 was an informative and inspiring experience for me. Still, I must confess to a measure of disappointment regarding the absence of any meaningful discussion about paid maternity leave as a strategy to improve upon breastfeeding rates in the United States. This is curious, considering that paid maternity leave was the second most common topic for public comment in the preparation of The Surgeon General’s Call to Action to Support Breastfeeding2. I suspect that the reason for this omission from the Summit agenda was an unspoken presumption that a national paid maternity leave policy is not going to happen, and so it makes no sense to talk about it. If true, I would like to challenge this presumption. Read the rest of this entry »
To the Editor:
RE: “The Milk Wars”, The New York Times, July 14, 2012
In her column “The Milk Wars,” Alissa Quart asserts that exclusive breastfeeding is “a kind of harm-reduction or abatement… part of a collective dream of reducing all danger to nil.” She goes on to suggest that breastfeeding is “less important than advocates claim.”
In fact, breastfeeding is the physiologic way to feed a human infant. When this physiology is disrupted, health risks increase for mother and child. A systematic review of the evidenced based literature has concluded that infants who are formula-fed face increased risks of ear infections, pneumonia, gastrointestinal infections, allergies , malignancies, obesity and sudden infant death syndrome. Mothers who do not breastfeed are more likely to develop breast cancer, ovarian cancer, type 2 diabetes, hypertension and cardiovascular disease.
Ms. Quart correctly states that there are multiple societal barriers to breastfeeding, but the solution is not to downplay the importance of normal human physiology. Instead, we must implement public health strategies that address these barriers and lead to support for all mothers and infants. As Dr. Regina Benjamin stated in the Surgeon General’s Call to Action to Support Breastfeeding, “the time has come to set forth the important roles and responsibilities of clinicians, employers, communities, researchers, and government leaders and to urge us all to take on a commitment to enable mothers to meet their personal goals for breastfeeding.” The Call to Action is the cornerstone of breastfeeding policy in the United States, and it specifically focuses on removing societal barriers so that mothers can achieve their own breastfeeding goals, not on “mandating” nursing.
In her column, Ms. Quart did not mention the Surgeon General’s Call to Action and instead cited results and opinions from an anecdotal web search to characterize “today’s lactation rhetoric.” Mothers – and readers of the New York Times – deserve better quality research and discussion about health policy. The issues are not one of maternal guilt or life style but rather a basic concern for the well being of mothers and their infants.
Arthur I. Eidelman, MD, President,
Academy of Breastfeeding Medicine
This letter was submitted to the editor of The New York Times on July 16, 2012
Have you registered for the 17th Annual International Meeting in Chicago?
See you in the “Windy City” on October 11-14, 2012!