Archive for the ‘Protocols’ Category
While the birth of neonatology was in the late 1800s with the development of the incubator, it was only in the 1970’s when the modern NICU was established with the neonatal respirator. More advanced respirators and other technologic developments, including important medications such as surfactant and nitric oxide, have dramatically improved the outcome of preterm infants. Yet, one of the most important “new developments” to improve the care of these infants, is feeding an exclusive human milk diet. It is now clear that exclusive breastmilk decreases preterm mortality and the incidence of necrotizing enterocolitis, sepsis, BPD and ROP, while increasing infant brain volume and neurodevelopment in infancy, childhood and adolescence.
Therefore, it is noteworthy that three AAP committees, the Committee on Nutrition, the Section on Breastfeeding and the Committee on Fetus and Newborn, the committee that writes policies for neonatologists, combined to write a policy statement supporting the use of pasteurized donor human milk in high risk preterm infants, with priority for those less than 1500 grams, when mother’s milk is not available. It states that the use of donor human milk in preterm infants is consistent with good health care. It recognizes that the use of donor milk is limited by its availability and affordability. It asserts boldly that the use of donor human milk should not be limited by an individual’s ability to pay. It urges health care providers to advocate for policies that assure reimbursement for its cost, while expanding the growth of milk banks by improving governmental and private financial support. Read the rest of this entry »
A heart-wrenching story has been circulating on social media about an exclusively breastfed baby who suffered brain damage after 4 days of ineffective feeding. The mother, Dr. Christie del Castillo-Heygi, is a physician, and she shares how she was reassured that all mothers can make milk, and did not realize until she engaged a lactation consultant at 96 hours postpartum that her child was profoundly dehydrated.
It’s a tragic story. Dr. del Castillo-Heygi is petitioning public health leaders to warn all parents about the risk of irreversible brain damage with exclusive breastfeeding. That warning would directly challenge efforts across the US, and around the world, to emphasize the value of exclusive breastfeeding and the risks of unnecessary supplemental feeding. This push for exclusive breastfeeding is part of efforts to implement the Baby Friendly Hospital Initiative, a set of quality improvement efforts that increase the likelihood that women achieve their personal breastfeeding goals. For healthy infants, supplementation can interrupt the demand-drives-supply physiology of breastfeeding, reduce a mother’s milk supply, confuse baby’s latch, and expose the infant’s gut to allergens that may impact lifelong health.
So who’s right? Well, it’s complicated – and my sense is that this debate reflects the challenges of ensuring that families have the knowledge and support they need to initiate and sustain breastfeeding in the early weeks after birth.
We might start by acknowledging, once and for all, that not all mother-baby dyads are able to breastfeed exclusively. Reproductive physiology is not infallible. 10.9% of women have difficulty getting pregnant or carrying a baby to term. 15 to 20% of pregnancies end in miscarriage, 10% of infants are born preterm, and 1 in 100 infants are stillborn. Similarly, less than 100% of women can exclusively breastfeed. Read the rest of this entry »
The long awaited protocol revision on Contraception and Breastfeeding by Drs. Pamela Berens and Miriam Labbok is out. This revision on a crucial topic has useful information for those counseling mothers regarding contraceptive choices. One to two times a month I encounter a mother in my consultative breastfeeding practice who has been placed on some type of hormonal contraceptive and now she is struggling to make milk. In this revision there are a few new tables and a section describing in depth the individual contraceptives choices, summarizing the evidence and the associated studies. The bottom line remains: “Until more extensive well designed research exists , it would be prudent to consider hormonal contraceptive methods as potentially having some risk of decreasing the mother’s milk supply.” Options such as Lactational Amenorrhea Methods (LAM) and Natural Family Planning (NFP) and emergency contraception are discussed and associated management issues are also addressed. As with all ABM protocols, this protocol benefitted from formal feedback from our expert board members and reviewers, ensuring that it not only has practical information but also has an international approach. Share it with your colleagues and leave a copy at a work station!
Maya Bunik, MD , MSPH, is Co-Chair of the ABM Protocol Committee and a Fellow of the Academy of Breastfeeding Medicine. She is an Associate Professor of Pediatrics at University of Colorado, Children’s Hospital Colorado. She sees patients in both primary care and breastfeeding consultation and has published a book Breastfeeding Telephone Triage and Advice.
Blog posts reflect the opinions of individual authors, not ABM as a whole.
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.
Newly Published! ABM Clinical Protocol #1: Guidelines for Blood Glucose Monitoring and Treatment of Hypoglycemia in Term and Late-Preterm Neonates, Revised 2014
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 »
We know that in the first six months of life infant nutrition is very important for growth and development, but it doesn’t just end there. These early decisions about how babies are fed have an ongoing impact throughout childhood and into adulthood. Therefore, finding opportunities to optimize infant feeding during this period is crucial to ensure infants are able to reach their potential.
Exclusive breastfeeding for the first six months of life is the most appropriate method of infant feeding, yet many babies are not exclusively breastfed at all, or only for a limited time. This is in spite of the fact that most mothers are aware that breastfeeding is the best option for their babies, and the majority initiate breastfeeding immediately after birth.
Mothers who have the support of family, physicians, nurses and health workers are more likely to continue to breastfeed when they run into unexpected breastfeeding problems or are uncertain of what they should do. If these problems are complex, or the mother has specific medical issues, having a physician with breastfeeding knowledge and expertise is even more important. However, many physicians have not had the training or experience to provide the help and assistance mothers need. Read the rest of this entry »
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?
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