Ready-to-feed formula may prevent Cronobacter infection in babies

I love when I’m right. I mean, it happens so infrequently (at least according to Fearless Husband).

Even before the Cronobacter scare of 2011, I’d dramatically changed my tune about formula preparation and safety. The research I read surrounding bacterial infection in babies due to formula or bottle use made me see just how piss poor our education on bottle feeding truly is; this is what spurred my interest in starting some sort of pre or post-natal educational workshop/literature for bottle feeders, and also made me suspect that there was an astonishingly simple – albeit prohibitively expensive – solution to the bacteria problem.

Safety, thy name is Ready-To-Feed.

Until now I’ve merely been able to suggest that my personal belief is that ready-to-feed nursettes are the safest bet for newborns, and especially for late pre-term babies or those with any sort of compromised immune system. Now, a study published in Pediatrics gives scientific credit to my completely unscientific gut feeling.

I’d say squeeeand do a little dance of egotistical joy,

but unfortunately I can’t. Because we are talking about infant safety here, and the solution which this study is suggesting is not going to be feasible for many parents due to the cost involved. This is turning my happy ego dance into a sad waltz. Which sucks, because who doesn’t enjoy a good happy ego dance?

The study, Prevention of Invasive Cronobacter Infection in Young Infants Fed Powdered  Infant Formulas, looked at the records of 68 babies infected with invasive cronobacter between 1958-2003, and 30 babies between 2004-2010. A couple of things to note before we get into the nitty-gritty of the study:

1. Invasive Cronobacter infection is extremely rare, and usually affects pre-term babies and very young neonates (all of the infants reflected in these records were under two months old).

2. This study had some significant limitations, considering that it was conducted using records from a variety of international organizations (CDC, USDA, WHO, as well as “personal communications” and “publications”. Definitions might have varied, as well as the quality of the information. This might explain the shocking disparity between the cases reported in the older batch (1958-2003) and the newer batch (2004-2010).

Now that the caveats are out of the way, let’s continue. The study found very different statistics in the two chronological batches. In the older batch, only 24% of the babies were full term; out of the more recent cases, 58% were full term. That’s a radical leap. Plus, while in the 1958-2003 group only 21% became symptomatic at home, that percentage jumped to 52% between 2004-2010. This may have something to do with the fact that there were half the number of cases in the more modern group versus the older one; if bacterial contamination was becoming more rare, then perhaps we’re dealing with a newer or more virulent strain in the new millennium. But I also wonder if part of the disparity between the characteristics of the cases has to do with the lack of formula feeding guidance. The resurgence of breastfeeding since 2000 has led to many fantastic outcomes, but the downside, as we’ve discussed before, is a refusal to address the needs of formula feeding parents. Historically, concerns about bacterial infection were focused on NICUs; the tubing used to deliver food to the tiniest babies could easily become contaminated if the utmost care wasn’t taken, and given the fragile systems of premature or sick infants… well, it wasn’t a great combination of risk factors. But looking at the statistics used in this study, it seems that in the past 12 years, full-term babies in their parent’s care – at home – were equally at risk. I think it merits further reflection, at least, to consider if these cases might have been due to parents being given no guidance or support with formula feeding. We know from our numerous conversations here, and on the FFF Facebook page, that most of us were given ample education on breastfeeding (even if we didn’t get much practical support); very few of us were instructed on how to formula feed safely, sometimes with the excuse from more intolerant healthcare professionals that there was no “safe” way to formula feed.

Regardless, even if we were given better instruction on safe bottle feeding practices, very young infants fed powdered formula are at significantly higher risk of becoming ill from invasive cronobacter. The Pediatrics study found that out of all infected infants studied, 26% had received breastmilk, 23% had received RTF, and 90% had received either powdered infant formula or human milk fortifier (which is another caveat I forgot to mention – powdered human milk also posed a significant risk, not just powdered formula. Apparently Cronobacter loves powder of any sort).

Okay- just so we are crystal clear here – the lowest percentage of infected babies came in the group fed ready-to-feed formula only. It even beat breastmilk (not by much, but I think it should be mentioned, since it would be if it were the opposite). So it’s a no-brainer that the study’s author then recommends the following:

Invasive Cronobacter infection is extremely unusual in infants not fed powdered infant formula/Human Milk Fortifier. RTFs are commercially sterile, require minimal preparation, and are competitively priced. The exclusive use of breastmilk and/or RTF for infants <2 months old should be encouraged.

I’ve been advising that newborns use RTF whenever possible for awhile now, but every time I do I feel like a classist a-hole. Because let’s be honest – the stuff is expensive. Even if you buy the 32-oz containers rather than the more costly (but sterile) nursettes, you’re still talking a major difference in cost for the recommended two months of use. And those first 2 months, there is a lot of wasted formula – babies are erratic, not on a schedule, parents are still figuring out hunger cues… it takes a few months before you know Junior will take exactly 4 oz every 4 hours. Powdered formula is significantly cheaper. And god help you if your baby ends up on a hypoallergenic – buying the RTF version of that stuff will seriously kill your bank account.

The big elephant in the room, of course, is that the formula typically given away in those controversial hospital swag bags is ready to feed – often in the form of sterile nursettes. Not that the amount in the bags would feed a baby for the entire two month window of risk, but the bags I received – generously “supplemented” by the maternity ward nurses since our breastfeeding-friendly hospital didn’t have many formula feeding mothers and there were plenty of leftover bags – gave me enough formula to get us through the first few weeks. Every little bit counts.

Now, I’m not naive enough to believe that the formula companies are giving away RTF out of the kindness of their hearts. But considering that the Ban the Bags movement has grown in popularity, and hospitals are going Baby-Friendly right and left – they are going to need an alternative way to market their products. Why couldn’t we set up a program which would give parents that have chosen to formula feed (or supplement) before leaving the maternity ward to request a “gift” of ready to feed formula? Formula companies could still reap the rewards of brand loyalty, and look somewhat altruistic in the meantime. The parents who receive these samples could be the same ones who already were forced to sign documentation which labeled them as formula feeders, so what would be the harm?

There needs to be a way to provide supplementing and exclusively formula-feeding parents with the safest breastfeeding substitutes possible. In the first two months of life, ready-to-feed formula is the safest commercial alternative. If the formula companies would be wiling to provide at least a few weeks of RTF to take the financial edge off, it might help parents afford RTF for the subsequent 6-7 weeks.

Seems like a no-brainer to me, but then again… you know what Fearless Husband says. I’m hardly ever right.

 

 

Christopher Martyn, I love you

Dear Christopher,

Can a person fall in love over the Internet? I’m sure the owners of Match.com think so, but I’m talking about another kind of love… a love that dares not speak its name. Yes, I’m talking about the love between an associate editor of a medical journal and a blogger who is guilty of the same thing he is so eloquently criticizing. But oh, Chris… I can’t help it. You are just pure awesome.

My love affair with Chris actually began as a love affair with his place of employment, the British Medical Journal (BMJ), when that publication printed the analysis article I talked about in my “British People Are Cool” post. You know, the one that said breastmilk alone may not be sufficient for a child over the age of 6 months? And dared to question the almighty WHO?

But then, I read the responses to the article that BMJ printed, and felt betrayed. It almost seemed like my new love was regretting publishing the article, as if the bravery they’d displayed by printing such heresy was just an embarrassing mistake, something they needed to cover up with a slew of outraged letters-to-the-editor. (I’ve since come to realize that these were just “rapid responses”, basically the equivalent of leaving a comment on a blog post, so the editors have little control over what is said. At the time though, I thought these were more like “letters to the editor” in standard form, and was disheartened.)

And then… hark! Here comes Christopher Martyn, with an editorial to end all editorials, completely renewing my faith in the medical research profession.

I’ve printed a few selections from his editorial below. I would print the whole thing, but it’s one of those you-gotta-pay-to-read-it things (like the majority of what appears in reputable medical journals today, unfortunately) so I think legally I’m not allowed to. I think this little snippet will suffice, though, in demonstrating why I am kvelling the way that I am…

Mary Fewtrell and her colleagues probably thought that they had been careful in the way that they phrased their analysis article published in the BMJ a fortnight ago (BMJ 2011;342:c5955). They had…asked whether it might be better to abandon the current recommendation to breast feed exclusively for six months in favour of introducing solids earlier.. In the hope of forestalling any misunderstanding they had put in a sentence saying that the evidence for breast feeding itself was extensive and that it wasn’t their intention to question it.
…But that didn’t prevent the inhabitants of planet Blog seizing the wrong end of the stick and then complaining that their hands were dirty. Breastfeeding websites vary from the twee (boobiemunchkins.blogspot.com) to the overexplicit (theleakyboob.com). Many are vehicles for groups of people with a fundamentalist conviction about the virtue of breast feeding, and these worked up a sense of outrage over the study. Lactivist.net called on its readers to email the editor of the BMJ demanding another press release. A blog called Dispelling Breastfeeding Myths worried that “fragile nursing relationships have been undermined by these reports”. The Analytical Armadillo guessed that “many people with a young infant coming up to solids age will now be absolutely bewildered about when they should be thinking about solids!” It also quoted the author of a book, Baby-Led Weaning, whose view was that “this is pure speculation and scare-mongering”…
It almost seemed that some of the people contributing to these websites were looking for a fight. Gurgle.com posted a calm and balanced piece, explaining the BMJ article well, only to receive complaints that it had been  irresponsible…
…The websites and blogs that I’ve been writing about may do all sorts of good things to support women and encourage breast feeding, but there’s no getting away from the fact that they don’t contribute much to scientific debate on infant nutrition. Reading them felt like being caught up in a demonstration march. It’s not that the protesters are bad or wicked or unable to discuss other points of view, but if you’re among them there’s just no way of going in the opposite direction.

Swoon.

I vote we all start an email campaign of our own, letting BMJ and Christopher know that not all “mommy blogs” are angrily stabbing his voodoo doll with safety pins; to thank him and BMJ for finally exposing the craziness for what it is. You can reach him at cmartyn@bmj.com.

And if, when I start this campaign with my own email, I use the subject line SWAK…Shh. Don’t tell Fearless Husband.

A new take on the benefits of breastfeeding

Thanks to FFF Jen for sending me this article about a study out of the Norwegian University of Science and Technology claiming that “the association between breastfeeding and healthy children is not as strong as has previously been believed.” This is obviously HUGE news, but being the pop science freak that I am, I found the reasons behind this statement even more fascinating than that revolutionary soundbite:

“It is true that breastfed infants are slightly healthier than bottle-fed babies. But apparently it is not the milk that makes the difference. Instead, the baby’s overall health is all determined before he or she is born. So why do so many studies associate breastfeeding with better health for young babies. The answer is simple: If a mother is able to breastfeed, and does so, this ability is essentially proof that the baby has already had an optimal life inside the womb.”

The article then describes how certain hormones are related to both breastfeeding problems and less-than-ideal conditions in utero. As someone who suffered from a growth restriction (or to be more clear, the mother of someone who suffered from a growth restriction; I didn’t have much trouble growing considering I gained 35 pounds during my pregnancy. Unfortunately, this considerable bulk didn’t do much to nourish my poor little baby who stopped growing around 33 weeks. So he was the restricted one…ahh, semantics) I am intrigued by this.

It seems like the hormones in question are associated more with PCOS and certain lifestyle factors than what I was dealing with, but I wonder if further studies would expand upon this theory even further to include other types of fertility issues. For example – I probably couldn’t have carried a baby to term were it not for modern medical science. That’s part of the reason the evolutionary argument for breastfeeding kind of puzzles me – fertility is a huge industry these days. Yes, breastfeeding is natural, but that doesn’t mean everyone has the ability to do it. Having babies is natural too, but societal, environmental and evolutionary factors have made conception difficult for a large portion of the baby-making population – yet, this doesn’t stop us from seeking ways to have the experience of motherhood. And just like many of us need medical assistance to have babies in the first place, maybe it’s okay to rely on science to feed those babies when our bodies don’t function correctly.

Anyway. It’s an interesting read… and I have to say, I feel a wave coming; one that will wash away pressure and guilt when it comes to infant feeding decisions. Hannah Rosin, Joan Wolf, and now this… so hang in there, fearless formula feeders. I believe a day will come – hopefully by the time our daughters are having babies – when those who can easily breastfeed (and have the desire to) will be able to do so freely and proudly, and those who can’t (or don’t have the desire to) will be able to formula feed just as freely and proudly.The times, they are a-changin…

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