Hi all,

In a message dated 5/25/99 4:19:44 PM Eastern Daylight Time, Suan Wittner
wrote:

<< I think this discussion is pointing out how "studies" can skew in many
 directions, depending on the specific data analyzed. (as we have seen so
 often in bf or sids) That is why it can be so important to note what subjects
 and their specific dynamics are included. <snip>

 Since non-ritual circumcision is usually done earlier, bf may be less well
 established anyway, and any "events" are looked at as possible culprits. >>

In a study conducted at Rochester (NY) General Hospital on using
acetominophen to relieve pain in neonatal circumsion, the feeding behavior of
the babies was noted both before and after the procedure. The two feedings
prior to the circumcision were used to judge how well the infant was feeding.
In breastfed infants, if the baby fed poorly at either of the 2 feedings
prior to the procedure, then breastfeeding behavior was considered
unsatisfactory. The baby had to breastfeed well at *both* feedings prior to
the circumcision for the feeding to be judged satisfactory. It is standard
protocol at the hospital for nurses to record the breastfeeding behavior of
BF infants. For artificially fed babies, formula intake for the two feeds
prior to the circumcision was averaged. All the infants in the study fed well
preoperatively.

Postoperative feeding behavior was also judged by two feedings. Feeding
behavior was judged to have deteriorated in breastfed babies if the baby fed
poorly in two feeds, refused to breastfeed, or required formula
supplementation ( baby symptomatic with blood glucose <50 or the mom chose to
feed ABM). In formula fed babies, feeding was considered to have deteriorated
if the baby took less than 50% of the preoperative volume of formula.
In the breastfed babies, 18% of the group receiving acetominophen and 37% of
those receivng a placebo fed poorly postoperatively. Of the formula fed
babes, 33% of those who got acetominophen fed poorly and 15% of those who
received a placebo fed poorly. The differences between the acetomnophen and
placebo groups was not statisically significant in either the breastfed or
formula fed babies.

The authors note in the discussion "Thus the observed deterioration in the
ability to breastfeed may potentially contribute to breastfeeding failure.
Furhermore some neonates in this study requires formula supplementation
because of maternal frustration with attempts at breastfeeding, or because
the neonate was judged unable to breastfeed postoperatively. This finding is
disconcerting because early formula supplementation is associated with
decreased breastfeeding duration"

Warmly,
Carol Kelley  LLLL
Taylors SC USA
mailto:[log in to unmask]

Reference:
Howard CR, Howard FM and Weitzman ML. Acetominophen analgesia in neonatal
circumcision: the effect on pain.  Pediatrics  1994 93(4):641-646

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