- I've watched in horror as the British media including the Sun, Mirror and Metro have covered the tragic story of a newborn who died from dehydration, in the inaccurate, irresponsible, scare-mongering style only they can.
Headlines have included:
"If I Had Given Him Just 1 Bottle, He'd Still Be Alive"Which the cynic in me struggles to believe isn't a play on one of breastfeeding's most hard hitting papers "Just One Bottle Won’t Hurt” -- or Will It?".
"Cluster Feeding Led to Newborn's Death"
This one irks me as "cluster feeding" is a totally normal, typical part of feeding - yet parents everywhere will now be terrified, but perhaps that was the plan? This baby wasn't "cluster feeding" - when a term, healthy baby feeding well and typically several weeks old, takes a number of feeds back to back over two or three hours, in order to fill up their tummy and support a longer sleep stretch of 5 or 6 hours.
This baby wasn't "clustering", he was starving. He was trying constantly to get food - he didn't die from cluster feeding, no "feeding" was taking place, he died from insufficient milk intake.
The level of ignorance from doctors who have been quoted on the subject goes beyond cringe-worthy, to downright shocking - although it's no surprise the press have jumped to support the "fed is best" campaign, when it's all about readership not facts.
Until I started reading studies and facts from other sources, I don't think I would have believed how much manipulation goes on to sell the desired angle to the audience - click bait headlines and half the facts, deliver a very different picture to the truth.
So let's talk about the story this week.
Indeed tragically a breastfed baby died due to insufficient milk intake. This much is true.
However a number of key details that parents should be aware of:
1) This was the USA FIVE years ago!
Practices and protocols surrounding infant feeding and hydration in the UK are completely different. The risk of hypertraenemic dehydration in some US hospitals is recorded as relatively high, particularly in comparison to the UK.
A 2013 study analysing almost 1,000,000 births in the UK and Ireland found just 62 cases of severe neonatal hypernatraemia, equivalent to just seven in every 100,000 births and an individual risk of 0.007%. No baby died, had seizures or coma or was treated with dialysis or a central line. At discharge, babies had regained 11% of initial birth weight after a median admission of 5 (range 2-14) days and none had long-term damage. (3)
A 2013 study analysing almost 1,000,000 births in the UK and Ireland found just 62 cases of severe neonatal hypernatraemia, equivalent to just seven in every 100,000 births and an individual risk of 0.007%. No baby died, had seizures or coma or was treated with dialysis or a central line. At discharge, babies had regained 11% of initial birth weight after a median admission of 5 (range 2-14) days and none had long-term damage. (3)
2) This was medical ignorance; numerous warning signs were ignored by healthcare providers:
According to newspaper reports, the baby cried for abnormally long spells:
"Mother whose baby cried all day didn’t realise he was starving to death" (Mirror)And had lost a concerning amount of weight even prior to discharge:
"Landon was discharged from hospital on the third day of his life, having lost 9.7 per cent of his body weight - considered 'routine' and 'unremarkable'."Considered "routine" and "unremarkable" by whom?
The American Academy of Pediatrics states:
“Weight loss in the infant of greater than 7% from birth weight indicates possible breastfeeding problems and requires more intensive evaluation of breastfeeding and possible intervention to correct problems and improve milk production and transfer.”The International Lactation Consultant Association and the Registered Nurses' Association of Ontario specify that:
A loss of more than 7% of birth weight, continued loss after day 3, or failure to regain birth weight within a minimum number of days (i.e., 10 days or 2–3 weeks, respectively) are signs of ineffective breastfeeding.The Academy of Breastfeeding Medicine advises:
"Possible indications for supplementation in term, healthy infants [include] weight loss of 8% to 10% accompanied by delayed lactogenesis (day 5 or later).” (1)So we have a concerning situation - a baby with a bigger than typical weight loss, who is crying excessively, being discharged without any feeding plan to ensure adequate intake. This was a huge gamble.
If my child was in hospital showing every sign of kidney failure and a team of kidney specialists all failed to recognise this -you can bet I'd be looking for answers as to how on earth they were so incompetent they missed the blooming obvious. I'd be campaigning not that we should all be given artificial kidneys, but that those paid and employed to care for those with kidney conditions, could a) identify when they were failing, b) know the safest course of action to take should this arise.
The debate surrounding the number of women with "failed lactation" is thrown about - but in terms of saving lives, knowing a figure isn't key to outcome; even one baby suffering a preventable condition as a result of poor practice is too many. As long as we have trained healthcare professionals who can then educate caregivers, we can save lives - it's not an invisible situation where baby goes from fine to desperately ill without warning.
3) Neither the British media, nor fed is best have made parents aware that far more babies die as a direct result of infant formula e.g bacterial contamination and as a result of not being breastfed.
Bacterial Contamination
In April 2016, the CDC released a new report, warning of a bacteria called Cronobacter Sakazakii, one of the most lethal contaminants found in paediatric food and/or milk formula, with an estimated mortality rate as high as 80%. This bacteria has been isolated from items in the home such as vacuum cleaner bags - and thus often contamination of the powder can also occur once the tin has been opened. Using recommended protocols to reconstitute the powder significantly reduces risks - trace levels of bacteria are unlikely to cause harm, but multiplying in warm milk can significantly increase the load.This information isn't new.
In 2008 the CDC Morbidity and Mortality Weekly Report covers two cases and states:
In June 2016, just two months later, 27 day old Axel Burnett tragically succumbed to the meningitis & sepsis caused by Cronobacter bacteria.
On her Facebook page his mum Jamie says:
"Previous investigations have found Cronobacter spp. cultured from prepared formula, unopened Powdered infant formula (PIF) containers, and the environment where PIF was reconstituted, clearly implicating PIF as the source of outbreaks. "
Infants throughout the world consume PIF, some exclusively. PIF preparers should be aware that PIF is not sterile and can contain pathogenic organisms (e.g., Cronobacter spp.). Preparers also should be aware that PIF can be contaminated extrinsically (although mechanisms for such contamination are not well defined) and that bacteria can multiply rapidly in reconstituted PIF. Consequently, WHO has developed guidelines for preparation of PIF, including reconstitution with water hot enough to inactivate Cronobacter organisms (3). Universal adoption of these guidelines can aid in implementation of safer PIF preparation, storage, and handling.Yet we don't know is what prompted the 2016 safety update...
In June 2016, just two months later, 27 day old Axel Burnett tragically succumbed to the meningitis & sepsis caused by Cronobacter bacteria.
On her Facebook page his mum Jamie says:
"We are so mad and so upset that Enfamil Gentlease would not put a warning label on the label knowing this could happen! Our baby boy got tooken from contaminated formula, did we know this would happen? No, why? Because NO ONE WARNED US!"
His mum tried to raise awareness of the issue online, founding a "Justice for Baby Axel" page, which has received over 11,000 likes. Despite this still no major news station or parenting site has covered the story.
"This bacterium is an emerging opportunistic pathogen that is associated with rare but life-threatening cases of meningitis, necrotizing enterocolitis, and sepsis in premature and full-term infants. Infants aged <28 days are considered to be most at risk. Feeding with powdered infant formula (PIF) has been epidemiologically implicated in several clinical cases."
One study found:
Do you know how many babies die per year of Cronobacter from infant formula? No? Neither does anyone else. As the CDC explained in 2008, in the United States; formal surveillance and reporting systems exist only in Minnesota.
Yet parents are still not aware how important safe formula preparation is, we only have to look at how popular products like the "Perfect Prep" machine are. Despite concerns the small amount of water released in the "hot shot", may rapidly fall below 70 when it hits the powder, not sustaining the temp for 2 minutes to effectively eradicate all bacteria present - nobody appears to have examined this further.
"The presence of Enterobacter sakazakii and other Enterobacteriaceae was surveyed in 82 powdered infant formula milk (IFM)
Although Enterobacteriaceae were enumerated from one powdered IFM sample (Klebsiella ozaenae, 200 cfu/g), 7/82 had detectable Enterobacteriaceae after enrichment in EE broth."
Do you know how many babies die per year of Cronobacter from infant formula? No? Neither does anyone else. As the CDC explained in 2008, in the United States; formal surveillance and reporting systems exist only in Minnesota.
Yet parents are still not aware how important safe formula preparation is, we only have to look at how popular products like the "Perfect Prep" machine are. Despite concerns the small amount of water released in the "hot shot", may rapidly fall below 70 when it hits the powder, not sustaining the temp for 2 minutes to effectively eradicate all bacteria present - nobody appears to have examined this further.
Lack of breastmilk & formula use
A review published in the journal Archives of Disease In Childhood titled, “Marketing breast milk substitutes: problems and perils throughout the world,” suggests:"Currently, suboptimal breastfeeding is associated with over a million deaths each year and 10% of the global disease burden in children"In her article with over 100 references - Dr Folden Palmer estimates over 9000 US infant lives are lost each year due to lack of breastfeeding. She says:
"The final relative risk for formula feeding comes out to 2—that’s double the risk of death for American infants who are fed with formula, compared with babies who are fed naturally.A 2010 a study published in Pediatrics quoted 1000 lives:
A multitude of studies demonstrate that when breastfeeding is accompanied by formula supplementation, illness and death rates are much closer to those of babies who are fully formula-fed. Studies also reveal conclusively that the longer breastfeeding lasts, the greater the measurable difference in illness and death rates."
"The United States incurs $13 billion in excess costs annually and suffers 911 preventable deaths per year because our breastfeeding rates fall far below medical recommendations," the report said.There's also a whole heap of interesting studies and reading on risks of not breastfeeding here.
We need to realise this one sided approach from our media, is purely to appease their readership. The "Fed is Best" campaign is anti-feminist, paternalistic propaganda, to try and convince parents how they feed their baby doesn't really matter. It does.
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