Breastfeeding Medicine

Physicians blogging about breastfeeding

Archive for the ‘research’ Category

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

How often does breastfeeding come undone?

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One afternoon in my lactation clinic, I saw two mothers who came to see me because they couldn’t make milk. One was pregnant with her second child, and the other was considering a third pregnancy. Each described how they had looked forward to breastfeeding, taken classes, put their babies skin-to-skin and birth, offered the breast on demand, and then waited, for days, and then weeks, for milk that never came in. As the second mother came to the end of her story, she said, “No one ever told me this could happen. Have you ever heard of a woman not being able to make milk?”

“Yes,” I said. “There’s one in the very next room.”

The dogma is that inability to breastfeed is rare – “like unicorns,” one blogger wrote – but I was seeing an awful lot of unicorns in my clinic. I couldn’t help but wonder – how often does breastfeeding come undone? Read the rest of this entry »

Written by astuebe

March 27, 2014 at 4:23 pm

Reports on breastfeeding sibling study are vastly overstated

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A recent analysis of breastfeeding’s effects on child health is making headlines that some of the benefits of breastfeeding have been overstated.

The authors examined behavioral assessments of children born between 1978 and 2006. When they compared breastfed children with formula-fed children, they found that the breastfed kids were healthier and smarter, as many other studies have previously reported. However, they then looked at families in which only some of the children had been breastfed, and they found that whether or not siblings were breastfed did not significantly affect their health outcomes. The authors argue that this proves that a child’s family – not infant feeding – is what really determines long-term child health, and breastfeeding doesn’t really matter.

The biggest problem with this conclusion is that the study ignored anything that happened in these families before their children reached the age of 4, disregarding well-established links between ear infections, pneumonia, vomiting and diarrhea and the amount of human milk a baby receives. There’s strong biological evidence for these relationships, because formula lacks the antibodies and other immune factors in breast milk that block bacteria from binding to the infant gut and airway. For preterm infants, formula exposure raises rates of necrotizing enterocolitis, a devastating and often deadline complication of prematurity. And evidence continues to mount that formula feeding increases risk of Sudden Infant Death Syndrome. Furthermore, mothers who don’t breastfeed face higher rates of breast cancer, ovarian cancer, diabetes, high blood pressure and heart attacks. None of these outcomes were addressed by the recent sibling study. The paper’s authors note they were interested in longer-term outcomes in childhood, but that’s been lost in the news coverage, which has effectively thrown out the breastfeeding mom and baby with the bath water.

Read the rest of this entry »

Written by astuebe

March 1, 2014 at 2:25 pm

Online milk sales, beyond “buyer beware”

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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 »

Written by astuebe

October 21, 2013 at 5:38 pm

Breastfeeding and depression: It’s complicated

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A recent Facebook post by Jack Newman has elicited passionate discussion about the relationship between breastfeeding and postpartum depression. Dr. Newman posted an email he’d received yesterday:

My baby is 3 months old and breastfeeding has been “bliss” for me so far. We both enjoy our relationship and it is very important for me as I have postpartum depression and right now breastfeeding is the only thing that works as I would have hoped and planned. (My comment: Many mothers tell me that they are told to stop breastfeeding for medication for postpartum depression and say that they are so upset because “breastfeeding is the only thing in their life that is working”. Do doctors ever think of this?).

I’m happy to report that I’m a doctor, and I do think of this — in fact, at UNC, we’re starting a 5-year NIH-funded study to try to understand the relationship between breastfeeding, postpartum depression, and infant attachment.  Our pilot data suggest that this relationship is complicated. We recruited 52 women who were intending to breastfeed and either did or did not have a history depression and/or anxiety. During pregnancy, mothers provided baseline blood samples, completed questionnaires, and had a standardized psychiatric interview to assess their history. Mothers came to our lab with their babies at 2 and 8 weeks postpartum, and we measured hormone levels while they breastfed their babies.

During pregnancy, we found that mothers who had higher levels of the hormone oxytocin had lower scores on the EPDS, a standard measure of depression, consistent with another recent study of oxytocin and mood symptoms.  When mothers returned at 2 weeks, we did not find any relationship between mood and hormone levels during breastfeeding, but at 8 weeks, the mothers with higher depression and/or anxiety had lower levels of oxytocin during breastfeeding (see figure). They were also less happy, and more stressed, depressed, irritated and overwhelmed, during the entire feeding visit than mothers who were not anxious or depressed.

Screen Shot 2013-05-30 at 10.54.15 AM

Maternal neuroendocrine response to feeding 8 weeks among women with depression/anxiety symptoms (dashed line) or without mood symptoms (solid line).

These results raise some interesting questions about the conventional wisdom that breastfeeding prevents depression. It could be that mothers who have lower oxytocin levels have trouble with breastfeeding and also feel more anxious and depressed. Or it could be that, for mothers whose baseline oxytocin is lower, breastfeeding gives them a boost that’s essential for them to feel connected to their babies. Read the rest of this entry »

Written by astuebe

May 30, 2013 at 11:31 am

Posted in Breastfeeding, research

Early, limited data for early, limited formula use

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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 »

Written by astuebe

May 13, 2013 at 6:27 am