News Flash: WE HAVE BEEN HEARD.

 

I just received this email (see below) from Kat Shealy at the CDC, and spoke
with her at length a few minutes ago. CDC has been literally swamped with
feedback from LCs and others (much of which gets to Kat’s desk). They are
very grateful with the input and insightful feedback from the “real world”
of those who work directly with breastfeeding mothers. 

 

The good news is that many of our concerns were raised long ago by the BF
team at CDC, so our specific feedback is validating and helpful. Rational,
well-reasoned comments are especially welcome. 

 

(Note: RANTING IS NOT HELPFUL!)

 

There are some documents in the works waiting for final clearance that
should clarify the guidance even more (and I think/hope will be more
practical). Kat told me that the situation with H1N1 changes almost daily
and the guidance documents are NOT “set in stone.” She will circulate any
new documents as soon as they are cleared. 

 

I was shocked to hear the really bad news: most pregnant women who have
contracted H1N1 get very sick, very quickly. They’re hospitalized on
ventilators first, and most have died. Read that again: most have died.
[This week a mother in Columbus, Ohio came to the hospital in late pregnancy
with severe H1H1; a C/S was done to save the baby before the mother died.
Obviously she can’t breastfeed or even pump her milk.] 

 

[Personal comment from LJS: given the severity of this virus for young
women, I can better understand the fear of infectious disease experts. I am
eager to see the new documents for more guidance when they are released. And
I’m taking a mask with me on my next plane trip.]

 

So, what to do? 

1.	Read the email from Katherine Shealy that follows my signature
block. 
2.	Keep checking the CDC sites frequently for more news. Read the
existing documents cited below. You can sign up for daily email alerts at
www.cdc.gov/h1n1flu/ The August 28th webcast can be watched at
http://www.flu.gov/news/knowwhattodo.html#082709. The CDC Breastfeeding page
is www.cdc/gov/breastfeeding.  
3.	Know that the CDC’s breastfeeding experts ARE aware of our concerns
and ARE listening to (& reading) our constructive feedback. “They” are real
people, with deep knowledge of breastfeeding, and are consulting very
frequently with top experts in breastfeeding, infectious disease,
epidemiology, global pandemics and more. Kat’s email explains their process
even more.

 

Linda J. Smith, BSE, FACCE, IBCLC, FILCA

Bright Future Lactation Resource Centre, Ltd.

6540 Cedarview Ct, Dayton OH 45459

ph 937-438-9458 / fax 937-438-3229

www.BFLRC.com 

 

-----Original Message-----
From: Shealy, Katherine (CDC/CCHP/NCCDPHP) [mailto:[log in to unmask]] 
Sent: Friday, September 04, 2009 10:47 AM
To: [log in to unmask]
Subject: FW: H1N1 question

 

Dear ,

 

In total, there are 5 CDC guidance documents that include specific infant
feeding information:

*         Feeding Your Baby: What Parents Should Know
<http://www.cdc.gov/h1n1flu/infantfeeding.htm>
http://www.cdc.gov/h1n1flu/infantfeeding.htm

*         Considerations Regarding Novel H1N1 Flu Virus in Obstetric
Settings  <http://www.cdc.gov/h1n1flu/guidance/obstetric.htm>
http://www.cdc.gov/h1n1flu/guidance/obstetric.htm 

*         What Pregnant Women Should Know About H1N1 Virus
<http://www.cdc.gov/h1n1flu/guidance/pregnant.htm>
http://www.cdc.gov/h1n1flu/guidance/pregnant.htm 

*         Pregnant Women and Novel Influenza A (H1N1) Virus: Considerations
for Clinicians  <http://www.cdc.gov/h1n1flu/clinician_pregnant.htm>
http://www.cdc.gov/h1n1flu/clinician_pregnant.htm 

*         Interim Recommendations for Facemask and Respirator Use to Reduce
Novel Influenza A (H1N1) Virus Transmission
<http://www.cdc.gov/h1n1flu/masks.htm> http://www.cdc.gov/h1n1flu/masks.htm


The specific guidance related to infection control in obstetric settings
presents a conservative approach to preventing transmission of H1N1 virus
from a sick mother to her newborn and includes isolation of the newborn
until the risk of exposure is minimized.  All guidance documents are the
result of extensive consultation across CDC; in the case of the Obstetric
Settings guidance, external experts in pediatric infectious disease, human
lactation, and representatives of professional organizations of healthcare
providers also provided review, discussion, and submitted comments.   This
internal and external collaborative process yielded a thoughtful
deliberation of the many complex factors involved, based on the available
evidence in each expert’s field, and led to what is believed to be the most
prudent approach to preventing transmission of the virus to the newborn.  In
particular, we have been very fortunate to have consultation with Robert
Lawrence and Steven Buescher, both experts in management of lactation and
infectious disease.

 

The potential consequences of infection with novel H1N1 in the newborn were
considered. Little is currently known about novel H1N1 infection in newborns
or children. However, it has been documented that children less than one
year of age are at higher risk for complications associated with seasonal
human influenza virus and with previous influenza pandemic viruses. The risk
of complications is especially high for children less than 6 months of age.
Oseltamivir treatment of children under one year of age with novel H1N1
influenza A infection was recently approved under an Emergency Use
Authorization. Under this EUA, chemoprophylaxis is not recommended for
infants less than 3 months old unless the situation is judged to be
critical, because there is limited data on use in this age group. Therefore,
CDC guidance focuses on prevention of nH1N1 infection in the newborn whose
mother is acutely sick and contagious with nH1N1 infection.

 

All guidance from CDC on H1N1, regardless of its relationship to infant
feeding, should be considered interim and subject to change as new
information becomes available.  The guidance related to infant feeding and
isolation from the mother is under active review and reconsideration. CDC
now maintains a link to all H1N1 guidance that is related to infant feeding
on the CDC breastfeeding homepage so that our partners can more easily
access the most up-to-date recommendations.  The CDC breastfeeding homepage
is  <http://www.cdc.gov/breastfeeding>  <http://www.cdc.gov/breastfeeding >
www.cdc.gov/breastfeeding 

 

Please feel free to contact me directly if you have additional questions.

 

Sincerely,

Katherine

 

 

Katherine Shealy, MPH, IBCLC, RLC

Public Health Breastfeeding Specialist

National Center for Chronic Disease Prevention and Health Promotion

Centers for Disease Control and Prevention

Atlanta, GA 30341

 <mailto:[log in to unmask]> [log in to unmask] 

(770) 488 5449

www.cdc.gov/breastfeeding

www.cdc.gov/mpinc

 

 


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