I'm reading Margaret Wills' response on this thread.  Several years ago
WABA focused on the topic Saving One Million Lives as one of their WBW
themes, and Dr Arun Gupta was the one who was so enthusiastic about
adopting it.  Here is a synopsis of the Edmond research from Ghana showing
the life-saving effect of initiating breastfeeding within the first hour of
life.  What I'm not sure about is how they controlled for sick babies who
were too ill to breastfeed in the first hour.

*Edmond, Early IF practices, Am J Clin Nutr 2007 (synopsis)*



*First Time Epidemiological Evidence: Beginning Breastfeeding From First
Day of Life Reduces Infection Related Deaths in Newborns by 2.6 times.*
Enough scientific evidence is available for the benefits of exclusive
breastfeeding. This is the first epidemiologic evidence of such a causal
association between early breastfeeding and infection specific mortality in
the newborn infants. Edmonds at al, in the October 2007 issue of the
American Journal of Clinical Nutrition, (*Am J Clin Nutr* 2007;86: 1126
–31), show that those newborns in Ghana, who initiated breastfeeding within
1 hour were less likely to die of neonatal sepsis than those who didn't. It
is intuitively correct but this is the first time a study has demonstrated
this with good data and specifically infection specific mortality. In the
study period, 140 neonates died from day 2 to day 28; 93 died of infection
and 47 of non-infectious causes. Risk of infection deaths increased with
increasing delay in initiation of breastfeeding from 1 hour to day 7;
overall late initiation (after day 1) was associated with a 2.6-fold risk
[adjusted odds ratio (adj OR): 2.61; 95% CI: 1.68, 4.04]. Additionally,
partial breastfeeding during first month was associated with a 5.7-fold
adjusted risk of death as a result of infectious disease (adj OR: 5.73; 95%
CI: 2.75, 11.91) after adjusting with the effect of early breastfeeding.
That means early as well as exclusive breastfeeding both are significantly
associated with reduced infection-specific neonatal mortality in young
infants.


These findings have important implications for neonatal health programs and
policy. Authors have called for similar studies in other parts of the
world; and concluded that breastfeeding promotion programs that focus on
early initiation of breastfeeding and exclusive breastfeeding in the
neonatal period can significantly reduce the burden of infectious
disease-related mortality.


*Comment:* *This is an important addition to existing scientific evidence
on the role of breastfeeding in saving babies. Evidence is specific for
deaths related to neonatal infections and is good enough to be reflected in
policy and programs as majority of neonatal deaths  are due to infections.
It would be a challenge to see how programs can mainstream breastfeeding
counselling and support interventions to help women to succeed both in
early (within an hour or first day even) and exclusive breastfeeding (for
the first six months of life). Needless to say, doing this will
substantially reduce burden on health systems to treat newborn babies.
Newborn health programs should lay focus on ‘preventive care’ approach more
than the ‘treatment’ approach currently being followed.  *
* ------------------------------ *

Dr. Arun Gupta

National Coordinator, BPNI

Regional Coordinator, IBFAN-Asia


-----------------------

Among my clients in Harare were mother-baby pairs in the maternity units
who were struggling to breastfeed.  The paediatricians did not get excited
if the babies were not breastfeeding on the first day unless they became
jittery, when blood sugars would be taken and glucose given if the level
was below normal (I think 2.5). Some of those babies were mucousy and
retching.  For non-latching babies, I would suggest hand-expressing
colostrum on to a teaspoon and feeding it at intervals - this often calmed
down a hungry baby or perked up a sleepy baby sufficiently to enable us to
work on ways to get the baby on to the breast.  I hope this doesn't sound
careless - the policy was very much to promote exclusive breastfeeding for
all babies -  formula was simply not available for full-term healthy
babies;  if a baby was sick enough to need formula (assuming the mother
wasn't yet making 60ml/kg/day of breastmilk)  s/he was taken into the
Neonatal Unit, but this assessment was usually made at delivery, and very
rarely later.   The babies were usually discharged on Day 3, exclusively
breastfed.  In fact, they weren't discharged until they were breastfeeding
so mothers were highly motivated to get it going.


Pamela Morrison IBCLC

Rustington, England

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