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Subject:
From:
Maureen Minchin <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Fri, 4 Sep 1998 01:55:17 +1100
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>Does anyone know of standards that have been set by WHO or other such
organizations?  <
WHO/UNICEF's medical criteria for supplementation are part of the BFHI
Global Criteria and guidelines. BFHI is the only global quality assurance
programme where postpartum women are concerned. I'm enclosing the revised
version (mostly linguistic change, but some tightening/correction of
criteria - eg, PKU is always a cause for monitoring but not always an
indication for supplements, and so Oz experts felt it should not be named
as though supplementation was inevitable) adopted in Oz as the BFHI
standard. Some one else can pot the Global version: I can't find it in the
bowels of this computer, only the OZ revision.

" 5.6 "Acceptable medical reasons" for supplementation

A few medical indications in a maternity facility may require that
individual infants be given fluids or food in addition to, or in place of,
breastmilk.

It is assumed that severely ill babies, babies in need of surgery, and
extremely low birth weight infants (less than 1,000 grams) will be in a
special care unit.  Their feeding will be individually decided, given their
particular nutritional requirements and functional capabilities, though
breastmilk is recommended whenever possible.  These infants in special care
are likely to include
*infants with very low birth weight or who are born preterm, at less than
1500g or 32 weeks gestational age
*infants with severe dysmaturity with potentially severe hypoglycaemia, or
who require therapy for hypoglycaemia, and who do not improve through
increased breastfeeding or by being given breastmilk.

For babies who are well enough to be with their mothers on the maternity
ward, there are very few indications for supplements.  In order to assess
whether a facility is appropriately using other fluids or breastmilk
substitutes, any breastfed infants receiving additional supplements must
have been diagnosed as:
* infants whose mothers have a serious illness which precludes
breastfeeding [indications deleted as not universally agreed as always
mandating supplements: in fact we couldn't think of any condition short of
bilateral mastectomy where we'd want the documents to suggest that every
mother with that condition must give supplements/alternatives]
* infants with inborn errors of metabolism [specifics deleted as -other
than galactosaemia, which is obvious and breastfeeding impossible - not
universally agreed as always mandating supplements]
* critically dehydrated infants [almost never seen in the immediate
postpartum period, though of course they can be if outborn in the bush and
admitted later]
* infants whose mothers are taking medication which is contraindicated when
breastfeeding [very rare indeed]

When breastfeeding has to be temporarily delayed or interrupted, mothers
should be helped to establish or maintain lactation, for example by manual
or hand-pump expression of milk, in preparation for the time when
breastfeeding may be begun or resumed.

For a full discussion of this and related issues see:  Chapter 3, Health
factors which may interfere with breastfeeding.  In: Infant feeding: The
Physiological Basis.  Bulletin of the World Health Organization, 67,
supplement (1989)."

The paediatricians who helped develop this certainly wouldn't think
supplementing 50% of babies an acceptable figure.

Maureen Minchin, IBCLC. Christ Church Vicarage, 14 Acland St., St.Kilda,
Vic. 3182 Australia. tel/fax: 61 3 9537 2640
"Taking paths of least resistance is what makes rivers - and people -
crooked." poster in Palmerston North NZ bookshop...

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