Newest ABM Protocol Released from the International Meeting in Miami Today: Allergic Proctocolitis in the Exclusively Breastfed Infant

We are here in sunny Miami at the 16th Annual International Meeting of the Academy of Breastfeeding Medicine–our “Sweet Sixteenth” birthday party!  What better way for me, a member of the Board of Directors and the Chair of the Protocol Committee to celebrate the accomplishments of our organization than to see the e-pub release today, live from the meeting, of our newest clinical protocol, #24: Allergic Proctocolitis in the Exclusively Breastfed Infant?

For those who do not know the process involved, all  protocols are the work of the Academy of Breastfeeding Medicine through the Protocol Committee, but have “lead contributors” who do all the primary research to first produce an annotated bibliography with levels of evidence.  The annotated bibliographies are available as a member benefit on the Members Only Web Page.  Then the lead contributors write the protocol.  For this protocol, those authors are my colleague Dr. Adam Matson at Connecticut Children’s Medical Center and the University of CT School of Medicine, and myself.  The process is long and labor-intensive — Not unlike gestation.  The protocol then goes to expert reviewers both in the United States and abroad.  These experts send us their comments, which are incorporated into the protocol.  It then goes to the Protocol Committee, a dedicated, hard-working group of eleven ABM members who review the document and each make their own comments.  These comments are then incorporated into the protocol.  Then it is sent to the ABM Board of Directors for THEIR comments.  And you guessed it–those are incorporated, or not, as deemed appropriate, as with previous commenters.  After these are incorporated, it may go back to the original primary contributors to make sure they are in agreement with all the comments/additions/deletions that have occurred.   Then, and only then, does it go to the ABM  Board for vote, and must pass by 2/3 majority vote, before it can be submitted in final form for publication in our journal Breastfeeding Medicine, posted on our website and released to all for use–the “birth”.  Do you think it stops there??  Well, it does–for 5 years.  At which point all protocols must be reviewed and revised as per any new literature that has been published.  So the process then repeats  itself.

Today’s release is all the more remarkable because it occurred with a super-human collaborative efforts of members of the Protocol Committee, staff of ABM, and the editors, publishers and staff of our journal publisher Mary Ann Leibert.  THANK YOU ALL!!!!  We were already working hard to get it through the process and voted on in the past few weeks so this release could happen here at the meeting.  And then Winter Storm Alfred hit the east coast of the United States, knocking out power to the publishing company, and yours truly (ask me about camping out in my own home with no power, lights, heat, water, toilets, etc after 12 inches of October snow and trees and power-lines down so you couldn’t even venture out of your own non-functioing home…) making email communication impossible, and essentially halting the whole process. It pays to be a life-long Girl Scout in situations such as this.  But I digress.  Team ABM prevailed despite everything, and out it went as an  e-pub, and was posted on the ABM website,  during our Board of Directors meeting, live, today!

So what about the protocol itself–Allergic Proctocolitis in the Exclusively Breastfed Infant?  Adam and I became interested in this subject a number of years ago when I was his attending neonatologist, and he was my fellow.   We kept seeing cases in the NICU of babies on own mothers’ milk who would be doing well, thriving, and then all of a sudden develop bloody stools.  Necrotizing enterocoltis (NEC)??  No!  Normal exams, normal labs, maybe a little fussy, ” just” blood in the stool.  They got made NPO, hadX-rays looking for pneumatosis intestinalis,  some labs, maybe even antibiotics until we were sure it was not NEC.  In the history, sometimes just before this happened they had been placed on commercial human milk fortifier, made from cow’s milk.  Or sometimes mom was an avid dairy product consumer.  Or sometimes it just happened.  In discussing at neonatology meetings, our colleagues were seeing this too.

In talking to pediatricians and family practitioners who took care of term healthy babies, they were also seeing something like this–babies on exclusive human milk feedings, who developed blood streaked or even bloody stools, who were otherwise healthy.  Thus was born our interest in the topic of allergic proctocolitis.  We have had a tremendous amount of interest in having such a protocol published by ABM.  It is apparently an issue many of you have seen or do see.  We hope you find this protocol useful.  We don’t have all the answers–our charge is to present the problem, give you some of the background, and condense for you what is known now in November 2011 concerning the cause, diagnosis and treatment.  We end with more questions and the need for research.  Like all good clinical “states of the art and science” we hope to leave you thinking, and maybe inspire someone out there to look into this area more.  (We know a great journal you can publish your research in–just ask us!  Hint: It starts with Breastfeeding and ends with Medicine).  We find the subject fascinating.  And it is a clinical dilemma that presents itself on your doorstep.

So, Happy Birthday ABM Conferences!  Sixteen is certainly a sweet number.  We are thrilled to have been a part of the celebration and contributed in our small way.   Check out the protocol, and all our protocols, on our website.  And wishes for many more birthdays!

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

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