More evidence that breastfeeding dramatically increases the risk of newborn hospital readmission


Another study has found exclusive breastfeeding dramatically increases the risk of newborn hospital readmission.

We’ve known for sometime that aggressive breastfeeding promotion has significant risks including hypernatremic neonatal dehydration and jaundice induced brain damage (kernicterus); indeed 90% of cases of kernicterus are associated with breastfeeding. Closing well baby nurseries in order to force infants to room in with mothers has additional harms: babies being smothered in or falling from mothers’ hospital beds.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Infants treated with phototherapy had a 72% reduction in risk of readmission. Infants allowed unrestricted access to formula had a 76% reduction in risk of readmission.[/pullquote]

In January I reported on Health Care Utilization in the First Month After Birth and Its Relationship to Newborn Weight Loss and Method of Feeding by Flaherman et al., which appears to be the first study to quantify the harms of aggressive breastfeeding promotion.

Exclusively breastfed newborns had higher readmission rates than those exclusively formula fed for both vaginal (4.3% compared to 2.1%) (p<0.001) and Cesarean deliveries (2.1% compared to 1.5%) (p=0.025). Those exclusively breastfed also had more neonatal outpatient visits compared to those exclusively formula fed for both vaginal (means of 3.0 and 2.3, p<0.001) and Cesarean deliveries (means of 2.8 and 2.2, p<0.001)

In addition to the pain and suffering of the newborns and anguish of the parents, a tremendous amount of money was spent.

…[S]ince the cost of a neonatal readmission has been estimated at $4548.27 a potential savings of $7.8 million might be realized for a cohort similar to ours if the readmission rate of exclusively breastfed newborns approximated that of newborns exclusively formula fed.

To put that in perspective, with 4 million births each year and more than 75% hospital breastfeeding rates, that means we should expect 60,000 excess newborn hospital admissions at a cost of more than $240,000,000 each and every year. And that doesn’t even count the downstream impact of brain injuries, a consequence that was beyond the purview of this study.

A new study Efficacy of Subthreshold Newborn Phototherapy During the Birth Hospitalization in Preventing Readmission for Phototherapy was undertaken to determine whether prophylactive phototherapy could reduce the risk of hospital readmission for severe neonatal jaundice.

As the authors explain:

To estimate the efficacy of subthreshold phototherapy for newborns with total serum bilirubin (TSB) levels from 0.1 to 3.0 mg/dL below the appropriate AAP phototherapy threshold during the birth hospitalization in preventing readmissions for phototherapy, and to identify predictors of readmission for phototherapy.

Phototherapy works! But the authors serendipitously found a far simpler intervention that also dramatically reduces the risk of readmission: formula!

Among 25 895 newborns with qualifying TSB [total serum bilirubin] levels from 0.1 to 3.0 mg/dL below the appropriate AAP phototherapy threshold, 4956 (19.1%) received subthreshold phototherapy and 241 of these (4.9%) were readmitted for phototherapy compared with 2690 of 20 939 untreated newborns (12.8%) (unadjusted odds ratio [OR], 0.35; 95% CI, 0.30-0.40). In a logistic regression model, adjustment for confounding variables, including gestational age, race/ethnicity, formula feedings per day, and the difference between the TSB level and the phototherapy threshold, strengthened the association (OR, 0.28; 95% CI, 0.19-0.40)… Subthreshold phototherapy was associated with a 22-hour longer length of stay (95% CI, 16-28 hours).

Formula supplementation was equally effective:

Newborns who received formula feedings had lower adjusted odds of readmission for phototherapy compared with exclusively breastfed newborns (OR, 0.58; 95% CI, 0.47-0.72 for >0 to to <2 formula feedings per day; OR, 0.24; 95% CI, 0.21-0.27 for 6 formula feedings per day).

Infants treated with phototherapy had a 72% reduction in risk of readmission. Infants allowed unrestricted access to formula had a 76% reduction in risk of readmission.

Contemporary pediatricians are rediscovering what our ancient foremothers learned long ago: supplementation in the days after birth improves outcomes.

Our ancient foremothers supplemented with prelacteal feeds. Prelacteal feeding — feeding babies supplements like water, tea and honey in the early days of breastfeeding — is common in indigenous and rural cultures around the world.

So why have lactivists, who promote breastfeeding as beneficial precisely because it was the practice of our foremothers, discarded this “ancient wisdom”? First, it doesn’t comport with their belief in the near magical properties breastfeeding. Second, studies have demonstrated that prelacteal feeding is associated with higher infant mortality.

That’s not surprising since the supplements are often contaminated with harmful bacteria, and therefore compare unfavorably with exclusive breastfeeding for women who produce enough breastmilk. But supplements probably compare favorably with death from insufficient breastmilk production. Since insufficient breastmilk in the early days after birth is relatively common, prelacteal feeding became a widespread practice the world over.

Are we actively and aggressively ignoring what indigenous mothers have known for centuries, that a significant proportion of babies cannot survive and thrive without initial supplementation?

Are we risking babies’ lives and brain function because lactivists and breastfeeding professionals have become obsessed with promoting the process of exclusive breastfeeding, privileging it over the outcome of healthy babies?

Sure, we could prophylactically treat large numbers of breastfed infants with phototherapy in order to reduce the risk of life threatening side effects of aggressive breastfeeding promotion: severe jaundice and hospital readmission. But as the authors note:

Phototherapy is generally considered a low-risk intervention. Still, it can cause physical separation of the mother and the newborn, potentially interfere with breastfeeding and bonding, increase inpatient hospitalization costs, and increase the hospital length of stay…

Or we could just allow babies unrestricted access to formula, an equally effective intervention that is far easier to employ, far less expensive, and would have the added bonus of treating newborn hunger, thus reducing suffering for both babies and mothers.