Lactnetters & PedTalk Pals

I have just received my December 98 issue (vol 152) of "Archives of
Pediatrics & Adolescent Medicine" and was dismayed to read an article on
pages 1187-1190 entitled "Decreased Response to Phototherapy for Neonatal
Jaundice in Breast-fed Infants". (K.L. Tan, FRACP, DCH   Singapore)

It is a published report of a "prospective" study (that means they decided
to do the study and look forward in time  - instead of "retrospective"
which is deciding to do a study and look back in time at what already
happened) that they are proposing evaluated the response of three groups of
infants [FF only, BF only, both BF & FF] to phototherapy.  They found that
their group 2 [BF only] took longer to "respond" to phototherapy than the
other 2 groups.

The clincher - the feeding pattern of the group 2 babies the article
states: "The group 2 infants were initially fed frequently (15-60 minute
intervals); the frequency, however, varied with the enthusiam of the
mothers.  During exposure, however, with lactation presumably already
established, the intervals averaged about 3 hours, as was the case for
group 1 & 3 infants, who were fed about every 3 hours from birth."
The average age of the babies in group 2? about 4 days old +/- about 21
hours.

The author's conclusion is :"The addition of formula to the feedings for
totally breast-fed infants, without suspension of breastfeeding, would
enhance the efficacy of phototherapy and reduce exposure time."

My problems with this study are these:
(1) lactation is not "already established" at 3.94 +/- 0.9 days
(2) an average of q 3 hour breastfeeds for a jaundiced baby is NOT frequent
enough
(3) The addition of formula to the diet is an inappropriate response to not
frequent enough breastfeeding
(4) The author does not seem to be aware of the connection between
inadequate breastfeeding frequency and "response to phototherapy"

I plan to write a response letter (big surprise).  Anyone care to join me?
Andrew MD? Dr. Rob?

Gail
Gail Hertz, MD, IBCLC
Pediatric Resident
author of the little green breastfeeding book - disclaimer: owner of Pocket
Publications