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Post-publication Peer Reviews to:
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![[Read P3R]](/icons/misc/sectionDOWN.gif){kind=icon}
Filtering Out Failures Prior Final Analysis
Untitled
Answer to Dr.Graham A. Barden
Repley to Lyn Dolby
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Graham A Barden, Pediatrician, General
Send letter to journal:
GBARDEN{at}NCFREEDOM.NET Graham A Barden
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I am concerned that this paper appears to be a case of "arranging" a study to yield the desired result. Specifically, how can one split out the "failures" of the breast fed group, put it in a third group called "supplemental", and then say that only supplemental feeding is associated with jaundice? This paper took two original groups, Breast Fed and Formula Fed, and implied that it was going to determine if a relationship exists between either of the two groups and neonatal jaundice. The paper then took all of the "failures" (breast fed infants who in the judgement of their parents and physicians were failing BF and needed supplementation with formula to maintain health) and put them in another group. The paper then concluded that supplementation was associated with jaundice, not breast feeding! I think patients should be placed in their respective groups at the start of a study, not self-selected to a new group withing the study. Whereas the rest of the paper seemed appropriate, I think the only conclusion that could be made is something generic like, "Babies who fail breast-feeding are more likely to be jaundiced". What I'd like to see is a paper showing a group of breast-feeding mothers divided into two groups with varying interventions, and then show us wich steps work best to keep moms breast feeding and successful! -Graham Barden MD |
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Lyn Dolby, Sn.Lecturer:Midwifery University of Hertfordshire. UK
Send letter to journal:
L.Dolby{at}herts.ac.uk Lyn Dolby
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I read the above article with interest, as in Britain I find that sometimes healthcare professional have an expectation that breasfed infants are more likely to become jaundiced. In my knowledge, the opposite should be true, due to the action of the constituents of colostrum on the gastro-intestinal tract. One point that I found particularly interesting, was that 'breastfeeding' was termed as 'demand feeding', although infants were 'generally' fed 10 minutes on each breast. I wonder if you have considered your research in the light of unrestricted feeding on one breast followed by feeding on the other side if the infant still wishes? The '10 minutes on each breast' would generally be considered as restricted feeding in Britain. In such circumstances the usual result is an infant who is not able to take a 'full' feed. This type of scenario can impact on the infant's rate of growth and development. As you discuss the possible adverse outcome of fasting and/or dehydration within your study, I just wondered if 'restricted' feeding might have an impact, particularly for those infant's who already have a higher bilirubin level? |
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Giovanna Bertini, Professor of pediatrics University of Florence School of Medicine, F F Rubaltelli
Send letter to journal:
rubaltelli{at}unifi.it Giovanna Bertini, et al.
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From its planning stages, the study considered three original groups, not two. It is well known in fact that, with few exceptions, it's almost impossible to predict which mothers will successfully breast-feed their babies. Failure of breast-feeding was judged not by the parents but by the neonatologists on the basis of infants' weight loss. This also appears evident in the observation that weight loss in the "supplemental" group, in spite of supplementation, is greater that that of formula-fed and breast-fed groups. There is no great difference between saying that unsuccessful breast-feeding, as opposed to supplementation, is associated with jaundice! What appears very clear from this study is the fact that breast-feeding per se is not responsible for an increased number of jaundiced newborns, but rather that the failure of successfully breast- feeding is responsible for an increased number of infants with significant (>12.9 mg/dL) early neonatal jaundice (as shown by our study), as well as very severe jaundice in breast-fed infants who become dehydrated and lose too much weight (1). 1. Hansen TWR. Acute management of extreme neonatal jaundice - the potential benefits of intensified phototherapy and interruption of enterohepatic bilirubin circulation. Acta Paediatr 1997;86:843-6 |
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Giovanna Bertini, Pediatrician University of Florence School of Medicine
Send letter to journal:
gioenna{at}yahoo.it Giovanna Bertini
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In our hospital setting, we work with the concept of "demand feeding". The mothers always have their babies nearby and can therefore feed them whenever the infant so desires or needs. Regarding the length of each feeding, 10 minutes per breast is generally the minimum amount of time suggested so that the infant can be fed sufficiently without tiring himself excessively. Because of this, I would therefore not consider it "restricted" feeding. I agree with you that "restricted" feeding, which is more frequent in nurseries where non rooming-in is performed, is likely to be responsible for excessive weight loss and higher bilirubin levels. Increasing the amount of milk assumed by the newborn infant, as well as the frequency of feedings, is, in my opinion, extremely important in the prevention and treatment of nonhaemolithic jaundice. In connection with this, you can check the reference reported in the response to Dr. Barden. |
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