The whole point of this is to say that the items you mentioned are NOT a reason to feed formula or that the mother cannot breastfeed.  Babies can receive donor milk and that is acceptable.  The idea is to prevent things like hypoglycemia, hyperbilirubinemia and excessive weight loss that are due to LACK of breast milk and iatrogenic factors perhaps, not congenital problems.  

And starting in 2014, it's no longer optional to CHOOSE this measure if you have 1100 births per year or more. 



-----Original Message-----

From: Lactation Information and Discussion [mailto:[log in to unmask]] On Behalf Of Brenda Phipps

Sent: Saturday, October 26, 2013 3:38 PM

Subject: JHACO core measure concern



I work at a hospital with about 1100 births per year, and the OB Unit manager is exploring the possibility of accepting exclusive breastfeeding as one of the core measures. She has shown me the list of valid exceptions to exclusive breastfeeding, and they are all maternal-based - See below:



 Documented Reason for Not Exclusively Feeding Breast Milk. The Joint Commission describes the only acceptable maternal reasons for which “breast milk feeding should be avoided” as:



o HIV infection

o Human t-lymphotrophic virus type I or II o Substance abuse and/or alcohol abuse o Active, untreated tuberculosis o Taking certain medications, i.e., prescribed cancer chemotherapy, radioactive isotopes, antimetabolites, antiretroviral medications and other medications where the risk of morbidity outweighs the benefits of breast milk feeding o Undergoing radiation therapy o Active, untreated varicella o Active herpes simplex virus with breast lesions



We are wondering if hospitals who have chosen exclusive breastfeeding as a core measure are running into any problems with JHACO when the reasons for supplementation of formula are related to the infant, as in the case of excessive weight loss, hypoglycemia and jaundice, when mother is unable or cannot provide her own EBM? We ask this question because JHACO does not list medical reasons for the infant in the list above. Thank you!



Brenda Phipps, BS, IBCLC



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