>The next question regarding hep B and bf starts by >quoting the Red Book of
the
>AAP 's stance on hepatitis B and then goes on to >say:
 >Dr. Ryan states,..." Certainly, mothers in >developing countries where
>formula is not available should breast-feed.  In the >United states, a
mother
>who strongly desires to breastfeed her infant can >probably do so with
minimal
>or no risk. " ...
>And Dr. Mishell states,... "However, if there is any >chance that a
>potentially fatal disease could be transmitted to the >infant by
>breast-feeding, no matter how uncommon this >occurrence, I would recommend
>that a woman with hepatitis B utilize another source >of providing
nutrition
>to her infant."
>I spent two hours writing an e-mail to this journal,  if >any would like to
>further comment their e-mail address is >[log in to unmask]  This is
free
>monthly journal for  NP's that I receive.
>Sincerely,
> Christine Betzold  FNP, MSN, CLE

Christine,
This Dr Ryan/Dr Mishell debate sounds familiar. I Believe it is from a
journal called the Courtlandt Forum in which readers send questions to an
editorial board.
When the Hep B question was first asked, Dr Mishell an OB/GYN discouraged
breastfeeding.
I and other physicians wrote in and disagreed citing the Red Book.
Dr Ryan is Michael Ryan DO a pediatric infectious disease specialist who
also does a lot of general pediatrics.  Dr Ryan agrees with the Red Book
statement but it appears the Clinical Advisor didn't fully quote him.
I was going to write the Courlandt Forum again on this issue but you'll note
Dr Mishell said "another source" he didn't say formula.  Still maybe I
should have written again.
BTW Dr Ryan kind of "stole" me out of a FP residency and was my residency
advisor.
When I Emailed him that I was surprised my now weaned 2 y/o didn't get
rotavirus this year but  thought it might be b/c he had breastfed thought 3
rotavirus seasons Dr Ryan's response was: "Smart"
-Rob

Rob Cordes, DO ,FAAP, FACOP
Wilkes Barre, PA
mailto:[log in to unmask]

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