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Fact Vs. Fiction: Calling Out a Misleading FIB, Part 2

August 29, 2018

We at Baby-Friendly USA believe it is our responsibility to continue calling out misinformation publicized about the Baby-Friendly Hospital Initiative (BFHI). We owe it to the public and we owe it to the hospitals who have worked so hard to earn the Baby-Friendly designation.

On August 2nd, we posted a statement about one of many inaccurate assertions frequently promoted by the Fed Is Best Foundation. This organization has repeatedly claimed that the Academy of Breastfeeding Medicine’s (ABM’s) 2010 Jaundice Protocol states that “10-18% of babies experience starvation jaundice from insufficient milk intake,” when in fact, the protocol stated that “as many as 10-18% of exclusively breastfed U.S. newborns lose more than 10% of birth weight.” What’s more, this organization continues to reference this “finding” while the ABM has since published a 2017 revision to the Protocol which no longer even contains the “10-18%” statement and emphasizes individualized care that encourages early initiation and management of exclusive breastfeeding, education on early feeding cues, identification of at-risk mothers and babies, and formula supplementation if medically indicated.

The reactions to our statement from those involved in implementing the BFHI have been overwhelmingly supportive. Not surprisingly, the responses from Fed Is Best in social media and on their website have been quite the opposite and are once again riddled with inaccuracies and misleading interpretations.

We genuinely believe BFUSA and this organization share the same goal – healthy babies and healthy mothers. However, we strongly disagree on how to achieve this goal and as long as this organization continues to use divisive tactics for whatever reason and continues to base its arguments on falsehoods and misinterpretation of science, we will continue to call these out. For the sake of babies and mothers everywhere, we will not let these false claims go unchallenged.

Below are the many inaccurate statements included in their responses to BFUSA’s August 2nd statement, along with our corrections:

                             FIB                                        FACTS

“BFUSA has attempted to minimize their previous statements about the risk of starvation jaundice in exclusively breastfed newborns. Yet their own medical director’s lecture on brain injury caused by the same condition tells a very different story.”

- From Twitter, August 2

  • The person referenced here is Lawrence Gartner, MD. He is a member of BFUSA’s Board of Directors, not BFUSA’s “medical director.” The slides from Dr. Gartner’s lecture were posted without his permission, a gross violation of accepted professional protocol.
  • The “very different story” conclusion is based on a single bullet point from a single slide taken out of context from the rest of Dr. Gartner’s lecture. Dr. Gartner’s primary message in the entire lecture was that physicians and nurses need to recognize and correct inadequate intake of calories in sick infants and those with excessively rising serum bilirubin levels that are approaching potentially toxic levels, whether formula feeding or breastfeeding.
  • We have never disputed the fact that breastfed babies are at a higher risk for weight loss which contributes to the risk of jaundice. Individualized care requires health professionals to recognize conditions that merit further assessment and close follow-up with the mother and infant.

“More recent estimates of excessive jaundice in a Baby-Friendly-certified hospital system, Kaiser Permanente Northern California, which has among the highest EBFing rates at discharge, was published in JAMA Pediatrics in 2016, which showed that 12-20% of newborns developed hyperbilirubinemia of >15 mg/dL.”

- From their “Official Response” originally posted on Facebook and subsequently posted on their website

  • Baby-Friendly USA does not designate systems; we designate individual hospitals within systems. Most of the hospitals in the Northern California Kaiser system never participated in the BFHI, so the claim that these findings are representative of Baby-Friendly is not accurate.
  • The referenced study was designed to test the clinical effects of recalibration of the bilirubin testing instrument, not to assess hyperbilirubinemia levels across a population.
  • The results contrast hyperbilirubinemia levels “before” and “after” recalibration of the testing instrument. A reasonable assumption is that the “after” datapoint (12%) most closely reflects the “true” level for this population, as this figure was acquired via the improved methodology. The whole point of this study was to demonstrate that improved measurement results in bilirubin rates that are not as high as previously reported, yet Fed Is Best includes the “before” and “after range (12-20%) in its interpretation because this helps exaggerate the result to better support its message.

“To BFUSA’s request: We stand corrected. The most current estimate of newborn jaundice among exclusively breastfed newborns is not 10-18%, it is 12-20%.”

- From their “Official Response”

  • Again, the 12-20% figure is a misrepresentation of the findings in this study (see above).
  • This comment completely misses the point of BFUSA’s August 2nd statement. Our point was not that the 10-18% was misleadingly high (although it was), but rather that this was one of many examples where this organization manipulates scientific data to support a campaign of misinformation. Ironically, they attempt to distract from this inaccuracy by drawing attention to still another inaccuracy.
  • If they "stand corrected," why have they not yet removed the many references on their website to the erroneous 10-18% statistic?

“The study also reported than an astonishing 17% of babies developed pathological hyperbilirubinemia of greater than 15 mg/dL in the study period.”

- From an article on their website referenced in their “Official Response”

  • This figure is “astonishing” because it is a weighted average of the “before” and “after” percentages calculated by Fed is Best, not by the authors. Again, they have failed to recognize that the higher rate was found before the improved bilirubin measurement methodology was implemented and have falsely manipulated the data to exaggerate their incorrect conclusion and misleading message.

“In addition, among healthy, term EBF newborns, 10% of vaginally-delivered newborns and 25% of cesarean-delivered newborns in this same hospital system lost >10% of their birth weight. In contrast, none of the formula-fed newborns lost >10%.”

- From their “Official Response”

  • This claim references two articles. The first article states: “Almost 5% of vaginally delivered newborns and almost 10% of those delivered by cesarean had lost ≥10% of their birth weight by 48 hours. By 72 hours of age, >25% of newborns delivered by cesarean had lost ≥10% of their birth weight.” So the claim that “10% of vaginally-delivered newborns lost >10% of their body weight is blatantly untrue. That figure is correctly stated as 5%, which means 95% of exclusively breastfed infants lose <10% of their birthweight.
  • The second article states that there were 7 formula-fed infants in the study with >10% weight loss. So, while it is true that formula-fed babies experienced a lower rate of weight loss, it is a complete fabrication to say that “none” in this study lost >10%.

 

Any one of these inaccuracies by itself could be justified as a simple mistake. But when seen as a whole, a clear pattern of data manipulation and misrepresentation emerges. And it’s important to remember that these are the just the issues we found in the postings from the past few weeks. There are many more where these came from.

We would rather not spend our time “fact checking” this organization, but we will continue to do so if that’s what is necessary to ensure mothers and families get accurate information. We consider the constant drum-beat of these falsehoods to be reckless and negligent behavior and once again call on this organization to be more responsible in providing the public accurate and scientifically-grounded data.

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