Emily complains that she is a little surprised by the reaction to this test and compares it to test weighing.  And I'm a bit confused by her reference to it being "absurd to use this without other interventions".  This "test" is not an intervention.  It is an assessment.

I personally never recommend using any assessment indicator in isolation from thorough observation and a thorough history, which she does not mention.  I do question a single study being used to define clinical practice.  

Test weighing has a long history of use AND misuse.  When I read the literature I read every single one of the 32 studies (iin their entirety -- not just the abstracts) of all the peer-reviewed research comparing test weighing to other indicators, as well as new (really badly designed studies by neonatologists who knew diddly squat about the meaning of accuracy and precision) and actually did my own original research as well.  So, with that predominance of comparisons I can say with confidence that using scales for test weighing is "highly accurate for assessing intake of a SINGLE feed".  Which means of course that you have to do  a lot of extra work with test-weighing or any other less accurate assessment of intake to determine how one feed compares to lost of other feeds.  Meaning you cannot use it alone and you have to understand what you are looking at.

For instance:
When did the baby last feed?  If it was an hour before, it might be different than if it was 6 hours before the test weigh,
Was the mother pumping?  And if so, how long ago did she do that? If she just pumped an hour before it might be quite different than if she had not fed the baby or pumped for 8 hours before the feeding.
What was the baby's pattern of feeding?  If the baby was trained to sleep 8 hours at night and fed at 6 am it might be different from the baby who was fed regularly all night long.  

Let's take another example: diapers.  
Laurie-Nomsson Rivers actually examined this widely used indicator -- which is often misclassifed as an indicator of intake.  It is NOT an indicator of intake, it is an indicator of "OUTPUT" which is used as "PROXY" for "INTAKE".   The studies on this have never really been very good at looking at predictive value and the cutoff values using in the various studies she had reviewed when  she presented at an ILCA conference differed.  She actually used a great statistical tool, the receiver operating characteristic curve to compare diapers against weight loss and found that its predictive value was not good enough to use in isolation.  Weight loss itself is not a direct indicator of "INTAKE" either.  It is a measure of the "OUTCOME" of "INADEQUATE INTAKE" and as such -- doesn't allow you to PREVENT excessive weight loss from occurring.

Again, you never use this in isolation.

Now, I have gone through the archives for the original reference for "the study" that shows that this is an effective assessment tool and I did not find any references for an original peer-reviewed article.  Perhaps I am missing that reference and someone did post it.  If so, I'd really appreciate a link to the full version of this article and preferable "articles".  I have never seen any indicator accepted in nutritional sciences because of a single study.  And, with all due respect to Thomas Hale expertise in pharmacology, as someone with epidemiological I would want to see more than theoretical extrapolation from pump studies.  I would want to see a serious comparison of other methods of estimating "production" with predictive values attached.  

In the end, however, Jane Kershaw gave what I consider the only reasonable use for this particular indicator.  That is showing mothers the difference between that very satisfying larger bottle of milk you get when you wait longer intervals and the reality that you may get more milk in 24 hours even though each pumping will look smaller by pumping more frequently.  I personally think there are easier ways to convey that information to women who must exclusively pump, but I can imagine it might be useful for some mothers.  So -- in the case she sited, she is using this so-called newly invented (and as far as I'm concerned not fully tested "indicator" as an educational tool or possibly a tool to assess response to the intervention of frequent pumping, rather than a diagnostic tool. 

Who is the God of Lactation Practice that determined this to be the new "Standard of Practice"?  Did a panel of experts at IBLCE sit down and decide this is now what we must do?  And if so, for all cases of potential low supply?  Or did Thomas Hale propose this as a "Standard of Practice"? Or did he merely suggest this is a good tool for some purposes?

Seriously, if anyone sends me the link to the original study or hopefully studies, I will read the entirety of the evidence.

Best regards, 

Susan Burger

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