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Subject:
From:
Rachel Myr <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 15 May 2013 13:19:02 +0200
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I've had a chance to read the entire article now. Sample size was
minuscule, 40 babies in all, 20 in each group.  Because of this, none
of the differences between the groups reached statistical
significance, and I find it remarkable that they were able to get it
published at all, because it looks more like a pilot study to examine
the feasability of doing a properly dimensioned trial which could
actually shed new light on the subject of how best to support
exclusive breastfeeding in babies with a weight loss of over 5% at 36
hours of age, which was the group from which they recruited
participants.

One of the strongest associations with exclusive breastfeeding in
their material, *in both groups* was multiparity.  When you only have
20 mothers in each group, it is clinically relevant, but not
statistically significant, that 14 of the mothers in the intervention
group were multips, but only 10 in the control group. The authors do
mention this in the discussion part of the article, the part that
doesn't make it into the abstract and certainly isn't highlighted in
the press releases. The authors don't mention the (also not
statistically significant, but equally clinically relevant) difference
in mean gestational age between the groups. The intervention group
babies were about a week closer to term than the controls (just over
39 and 38 weeks, respectively).  So, the control group consisted of
more primips and less mature babies, and we shouldn't be surprised
that the average number of days before lactogenesis II in the control
group was longer than in the intervention group.

The mothers who were recruited to the study had expressed an intent to
breastfeed exclusively but were not averse to supplementation, and
this is also mentioned in the discussion. The authors are well aware
that the very inclusion criteria for the study might have biased it in
favor of less exclusive breastfeeding among subjects.

What I am trying to point out is that there are numerous possible
explanations for their findings besides the one that is getting an
inordinate amount of media coverage in the dumbed-down version 'Early
formula gives more breastfeeding'.  We can, and should, wonder whose
media machine saw to it that this teensy weensy study got spread all
over the world the same day it was published in the journal of an
organization that receives millions of dollars each year from the
formula industry. Studies are published all the time, GOOD studies,
studies with enough participants to give proper statistical power to
the findings, and we don't hear about them, while this one is
everywhere.

Got to run for work now, where the study made a largeish splash on Monday. :-(
Rachel Myr who would rather be helping mothers actively, instead of
doing damage control, in
Kristiansand, Norway

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