Bre a stfe e ding : Disc la ime r I s it RE AL L Y wo rth a ll the e ffo rt? • NE I T HE R T HE PUBL I SHE R NOR T HE AUT HORS ASSUME ANY L I ABI L I T Y F OR ANY I NJURY AND OR DAMAGE T O PE PE RSONS OR PROPE RSONS OR PROPE RT RT Y ARI Y ARI SI SI NG F NG F ROM ROM T HI S WE BSI T E AND I T S CONT E NT . Mic he lle G . Bre nne r, MD, IBCL C E a ste rn Virg inia Me dic a l Sc ho o l Childre n’ s Ho spita l o f T he K ing ’ s Da ug hte rs No rfo lk, VA 1 2 F a c ulty Disc lo sure Ob je c tive s • I n the pa st 12 mo nths, I ha ve no t ha d a sig nific a nt fina nc ia l inte re st o r o the r • Unde rsta nd the ro le o f BF in: re la tio nship with the ma nufa c ture r(s) o f the – De c re a sing he a lth ine q uitie s pro duc t(s) o r pro vide r(s) o f the se rvic e (s) – De c re a sing infa nt mo rb idity & mo rta lity tha t will b e disc usse d in the pre se nta tio n. – I I mpro ving he a lth & we llne ss mpro ving he a lth & we llne ss • T his pre se nta tio n will no t inc lude disc ussio n • Co unse l ne w fa milie s o n b a sic s o f BF o f pha rma c e utic a ls o r de vic e s tha t ha ve • Re c o g nize sig ns o f BF suc c e ss o r strug g le no t b e e n a ppro ve d b y the F DA. • I nte rve ne to ultima te ly suppo rt BF 3 4 1
PHYSICIAN AT T IT UDE S ABOUT Bre a stfe e ding Ma ryAnn O’ Ha ra , Da vid Gro ssma n, a nd L o rna Rho de s De spite physic ia ns’ se lf-re po rte d suppo rt fo r b re a stfe e ding , this study re ve a le d pe rva sive a mb iva le nc e a nd p po te ntia lly c o unte rpro duc tive pra c tic e s. Advances in Experimental Medicine and Biology, 2002 5 6 Surve y o f OB, F P, Pe ds Ag e nc y fo r He a lthc a re Gra dua te s (2001-2005) Re se a rc h a nd Qua lity, No . 153 • 100% a g re e d BF e nha nc e s immune func tio n • Ye t o nly 38% b e lie ve d BF • Ye t o nly 38% b e lie ve d BF b a b ie s a re b a b ie s a re U.S. De pt. o f He a lth a nd Huma n Se rvic e s he a lthie r tha n fo rmula fe d b a b ie s U.S. Offic e o f Wo me n’ s He a lth • 42% sta te d b re a stmilk a nd fo rmula a re e q ua lly a c c e pta b le McCurdy & Brenner, unpublished data 7 8 2
BF & Ma te rna l & I nfa nt He a lth Outc o me s fo r Mo ms Outc o me s E vide nc e Re po rt (Cle a r e vide nc e wo rth ta lking a b o ut!) T ype I I DM (No hx o f g e st. DM), fo r e a c h ye a r o f BF : • 9000 a b stra c ts sc re e ne d • Co ho rt 1: 4% risk re duc tio n – 43 infa nt • Co ho rt 2: 12% risk re duc tio n (hig h q ua lity, lo ng itudina l study o f 150,000 wo me n) – 43 ma te rna l – 29 syste ma tic re vie ws o r me ta -a na lyse s 29 syste ma tic re vie ws o r me ta a na lyse s Bre a st Ca nc e r • Study 1: 4.3% risk re duc tio n fo r e a c h ye a r o f BF • Study 2: 28% risk re duc tio n fo r >12 mo nths o f BF • He a lth o utc o me s o nly – No t e c o no mic sig nific a nc e , so c ia l o r Ova ria n Ca nc e r e nviro nme nta l impa c t • 21% risk re duc tio n with >12 mo nths o f BF , c o mpa re d to ne ve r BF April, 2007 9 10 Ob ste tric s & Gyne c o lo g y: Ma y 2009 - Vo lume 113 - I ssue 5 – F ull T e rm I nfa nt Outc o me s-- pp 974-982 Sho w Me the Mo ne y!!!! Amo ng po stme no pa usa l wo me n, Condition “Amount” of BF Re duc tion in inc re a se d dura tio n o f la c ta tio n wa s Risk a sso c ia te d with a lo we r pre va le nc e o f a sso c ia te d with a lo we r pre va le nc e o f Ac ute OM E ve r BF vs E xc l F F 23% hype rte nsio n, diabe te s, E xc l BF 3-6 mo vs E xc l F F 50% ! hype rlipide mia, and c ardio vasc ular dise ase . 11 12 3
F ull T e rm I nfa nt Outc o me s-- F ull T e rm I nfa nt Outc o me s-- Sho w Me the Mo ne y!!!! Sho w Me the Mo ne y!!!! Condition “Amount” of BF Re duc tion in Condition “Amount” of BF Re duc tion in Risk Risk Ac ute OM E ve r BF vs E xc l F F 23% Ac ute OM E ve r BF vs E xc l F F 23% E xc l BF 3-6 mo vs E xc l F F 50% ! E xc l BF 3-6 mo vs E xc l F F 50% ! GI I nfe c tio ns BF vs no t BF 64%!! GI I nfe c tio ns BF vs no t BF 64%!! L o we r Re sp I nf E xc l BF > 4 mo s 72%!!! 13 14 F ull T e rm I nfa nt Outc o me s F ull T e rm I nfa nt Outc o me s-- Condition “Amount” of BF Re duc tion in Risk Sho w Me the Mo ne y!!!! T ype I DM BF 3 mo s 19-27% T ype I I a s a dult BF in infa nc y 39% L e uke mia BF 6 mo s AL L 19%:AML 15% Condition “Amount” of BF Re duc tion in Risk SI DS Hx o f BF 36% Ac ute OM E ve r BF vs E xc l F F 23% E xc l BF 3-6 mo vs E xc l F F 50% ! GI I nfe c tio ns BF vs no t BF 64%!! L o we r Re sp I nf E xc l BF > 4 mo s 72%!!! Ato pic De rm BF >3 mo vs <3 mo 42% w/ F Hx Asthma E xc l BF 3 mo s 27%, 40% w/ F Hx 15 16 4
Numb e r Ne e de d to T re a t Numb e r Ne e de d to T re a t Dise a se NNT Dise a se NNT NSAI Ds fo r Arthritis 2 NSAI Ds fo r Arthritis 2 Sta tins fo r MI St ti f MI 70 70 Meyers BF Med, 2009 Meyers BF Med, 2009 17 18 Numb e r Ne e de d to T re a t Numb e r Ne e de d to T re a t Dise a se NNT Dise a se NNT NSAI Ds fo r Arthritis 2 NSAI Ds fo r Arthritis 2 Sta tins fo r MI St ti f MI 70 70 St ti Sta tins fo r MI f MI 70 70 Co lo no sc o py 1500 to pre ve nt 1 de a th Co lo no sc o py 1500 to pre ve nt 1 de a th Ma mmo g ra phy 2300-5000 to pre ve nt 1 de a th Meyers BF Med, 2009 Meyers BF Med, 2009 19 20 5
Numb e r Ne e de d to T re a t Numb e r Ne e de d to T re a t Dise a se NNT Dise a se NNT Otitis Me dia 6 Otitis Me dia 6 Ga stro e nte ritis 2.5 Meyers BF Med, 2009 Meyers BF Med, 2009 21 22 Obesity Trends* Am ong U.S. Adults Psyc ho lo g ic a l Be ne fits BRFSS, 1 9 9 0 , 1 9 9 9 , 2 0 0 9 ( * BMI 3 0 , or about 3 0 lbs. overw eight for 5 ’4 ” person) Bre a stfe e ding fo ste rs ho rmo na l, se nso ry, 1 9 9 0 1 9 9 9 physio lo g ic , immuno lo g ic , a nd b e ha vio ra l me c ha nisms whic h: 2 0 0 9 – E nha nc e s a tta c hme nt – F o ste rs nurturing ro le , – I mpro ve s se lf-e ste e m – De c re a se s c rying b e ha vio rs – De c re a se s a b a ndo nme nt o r a b use No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥ 30% 23 24 6
Pre va le nc e o f Bre a stfe e ding I nitia tio n a nd Dura tio n No. of T e nne sse e Initia tion 6 months 12 months r e sponde nts Hispa nic 241 68.6 38.8 20.1 White , no n- 1,617 66.2 33.5 15.2 Hispa nic Hispa nic Bla c k, no n- 467 45.4 21.1 8.1 Hispa nic National Immunization Survey, United States, 2004--2008 25 26 I nte ntio n to Bre a stfe e d in a Rura l BF in Rura l Co mmunitie s Appa la c hia n Sa mple : Ro le s o f Smo king a nd So c io de mo g ra phic s • E thno g ra phic da ta sug g e st ma ny • 821 de live rie s wo me n: • Bre a stfe e ding initia tio n ra te o f 46% (na tio na l – Ne ve r e ve n c o nside re d b re a stfe e ding o r a ve ra g e =70%) disc o ntinue d b re a stfe e ding due to : disc o ntinue d b re a stfe e ding due to : • No n-smo ke rs we re ne a rly twic e a s like ly • Smo king b re a stfe e d (56%) a s smo ke rs (30%). • Pa in • E mb a rra ssme nt Prima ry Ca re Re se a rc h Da y, Se pte mb e r 2008 • L a c k o f a ssista nc e Wrig ht HN, Ba ile y BA, De pa rtme nt o f F a mily Me dic ine E a st T e nne sse e Sta te Unive rsity Flower, Matern Child Health J. 2008 May 27 28 7
Pa tie nt Pro te c tio n a nd Affo rda b le Ca re I nc re a sing BF in Rura l Ac t -- Ma rc h 23, 2010 Co mmunitie s E mplo ye rs must pro vide : • E nha nc ing wo rkpla c e suppo rt • Re a so na b le b re a k time to e xpre ss • Ma ximizing the ro le o f WI C b re a st milk fo r 1 ye a r b re a st milk fo r 1 ye a r • I nc re a sing ho spita l BF a ssista nc e • A pla c e , o the r tha n a b a thro o m, tha t • Cre a te a so c ia l e nviro nme nt in whic h is shie lde d fro m vie w, fre e fro m BF is no rma tive intrusio n fro m c o wo rke rs a nd the pub lic 29 30 Huma n Milk—so wha t’ s in this Huma n Milk is: stuff, a nywa y? ? ? • Huma n Spe c ific • Dyna mic !! • Nutrie nt a nd no n-nutrie nt sig na ls • I nfe c tio n pro te c tio n 31 32 8
Recommend
More recommend
