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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