Medications And More Newsletter Volume 35, October 2008


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Medications And More Newsletter Volume 35, October 2008

  1. 1. Medications and More NEWSLETTER Volume 35 • October, 2008 Hale Publishing Melamine and Breastfeeding Contents Notes from Dr. Hale by Thomas W. Hale, PhD Guest Author Notes from the Editor Melamine contamination of infant formulas is of great Affiliate Program interest today, following the report of thousands of PubMed Section Chinese infants who have fallen ill with exposure to 1 Breastfeeding in the News this product in formula. I was recently asked about What’s New melamine exposure in the mother and how much Book Shelf melamine would transfer into human milk. Hartmann/Hale Human Lactation Research Conference Melamine is a small organic base used in the synthesis of plastics. Because it appears in tests to act like protein, it has been used illicitly to increase the protein content of foods. In China, it was added to milk to increase the test results for protein, even though it is not a protein. It has a molecular weight of 126 Daltons and is quite polar or water soluble. Although we have no data on its transfer into human milk, just chemical characteristics alone would suggest that milk levels are probably going to be quite low. It has a pKa of 5.66 and LogP (pH 7.0) of -1.37. When ingested, it is primarily retained in body water, failing to enter most compartments due to a very poor lipid solubility. Using a mathematical formula to estimate milk levels, Dr. Ken Ilett has estimated that the Milk/ Plasma ratio will range from 0.15 to 0.86, depending on protein binding (which we don’t know). From its chemistry alone, we can estimate that the protein binding will be less than 50%. In addition, rodent studies suggest that its plasma half-life is brief, with 90% excreted in 24 hours. At this time we cannot really estimate an accurate dose that is transferred into human milk because we Notes from the Editor: simply do not have data on human plasma levels, nor protein binding following exposure. However, a October 1-3 - ILCA - A Worldwide View on good guess is that the relative infant dose of melamine Breastfeeding - Vienna Austria in human milk is likely to be quite small, and any risk October 11 - Breastfeeding Challenge to the breastfeeding infant is low. Editor: Janet Rourke Medications and More Newsletter is a free monthly e-newsletter publication of Hale Publishing LP, Amarillo, TX.
  2. 2. Guest Author With commercial discharge bags being distributed through approximately 90% of US birthing hospitals, the hospital itself has morphed into the marketing arm of the infant formula industry. Merewood and colleagues (2008) Formula Company Discharge Bags: describe the pervasiveness of formula gift bag distribution, Hale Publishing The Wolf in Sheep’s Clothing noting that 94% of hospitals in 21 eastern states and the District of Columbia dispense these bags. This is in spite of by Marsha Walker RN, IBCLC the condemnation of this practice by the US Office on Women’s Health, the Centers for Disease Control and What could be happier than the birth of a baby? Prevention, the American Academy of Pediatrics, the Unfortunately, that cute little infant and his mother American College of Obstetricians and Gynecologists, and are viewed as marketing targets by the infant the Government Accountability Office. formula industry. Hospitals do not distribute these bags as a charitable 2 Stalked throughout her pregnancy, a mother is endeavor. They are paid (bribed) to do so by formula the recipient of cans of formula, coupons, emails, companies who addict hospitals with gifts of cash, supplies, and invitations to join baby formula clubs. This equipment, and continuing education for staff, until the crushing commercial pressure to feed her baby hospital becomes so dependent on this influx of “good will” formula continues after the birth of her baby with that it turns a blind eye to the conflict of interest it is the formula company discharge bag given to her engaged in. when she leaves the hospital. The bags are not free, nor are any other items provided Research has demonstrated that the receipt of to the hospital or staff. Mothers who purchase these commercial formula company discharge bags results premium formula brands pay for the marketing tricks. in shorter durations of breastfeeding, especially Fancy dinners in expensive restaurants are provided to exclusive breastfeeding. This, of course, is precisely physicians and nurses as a lure to listen to marketing the outcome desired by the industry from this form packaged as “education.” Most of the mothers who purchase of sampling. In order to sell more formula, they the high-priced formula cannot afford the meals that their need to “sell” less breastmilk. health providers are lavished with in an attempt to buy Rosenberg, Eastham, Kasehagen, and Sandoval goodwill and recommendation of the company’s product. (2008) demonstrated, yet again, the association Clinicians may enjoy the gifts and attention paid to between commercial discharge bags and the them by formula company salespeople, but serve only as a decreased amount of exclusive breastfeeding seen in means to an end. An old Ross Laboratories’ training manual the presence of these bags. Mothers think they are emphasizes the importance of hospital staff: receiving a free gift, one that is safe and sanctioned Ross Hospital Feeding System is designed to provide by the hospital. A mother believes that her an early and convenient means of getting infants healthcare providers have her and her baby’s best started on Similac…and ultimately sent home with interest in mind, not realizing that these bags will instructions that they continue to use Similac. diminish her chances of breastfeeding exclusively. The giving of this bag is actually a form of “Never underestimate the importance of nurses. If they marketing, defined as such by Health Information are sold and serviced properly, they can be strong allies. A Privacy and Protection Act (HIPPA), and so nurse who supports Ross is like an extra salesperson”. effective that it is used as an example in marketing While infant formula marketing preys upon consumer textbooks. Market research has shown that mothers vulnerability, healthcare professionals are inundated with almost always purchase the same formula that was food and gifts by formula company salespeople. Food and used in the hospital. Sampling gets the product into gifts, under the guise of friendship are designed to remove the hands of the consumer, provides for its easy use professional barriers between salespeople and clinicians at the first sign of breastfeeding roadblocks, and with the expectation of reciprocity in the form of looking starts the process of early weaning—the perfect set- favorably upon the formula company’s product. There is a up for creating a market where none existed before. tendency for people to be much more receptive to
  3. 3. information when it is presented while eating enjoyable Guest Author food. This is why formula salespeople offer food at every opportunity. When salespeople combine food with flattery, recipients tend to like them more, regardless of what it is they have to say. The positive feelings associated with good Hale Publishing food are projected onto the people providing it as well as the Merewood A, Fonrose R, Singleton M, Grossman X, messages being presented while eating. Navidi T, Cook JT, Pomales T. From Maine to The bags are not only a hazard to breastfeeding but pose Mississippi: Hospital distribution of formula sample packs among the eastern seaboard. Arch Pediatr other risks as well. Powdered infant formula is not sterile Adolesc Med. 2008;162:823-827. and if included in the bag, increases the risk of an infant being fed a contaminated product. The formula in these Rosenberg KD, Eastham CA, Kasehagen LJ, Sandoval AP. Marketing infant formula through hospitals: bags can--and has--sickened infants. Since most hospitals the impact of commercial hospital discharge packs lack any stock control procedures, there is no way to inform on breastfeeding. Am J Public Health. 2008;98:290- 3 mothers when there is a recall of the formula in the bags 295. such as happened in 2006. Many Risk Management departments in hospitals have been unwilling to accept such liability and have requested that their respective hospital cease doling out these bags. Marsha Walker is a registered nurse and IBCLC. She is a published author, international speaker, a current Following an unsuccessful attempt at removing the bags member of the board of directors of the Massachusetts through mandates in the Massachusetts state perinatal Breastfeeding Coalition and Baby Friendly USA, and regulations, the Massachusetts Breastfeeding Coalition past president of ILCA. Watch for her newest created the Ban the Bags campaign. Help is available at the monograph from Hale Publishing, Breastfeeding the campaign’s website at Despite the Preterm Infant, available Summer, 2009. odds of eliminating the bags, there are more than 300 birthing hospitals that have done so. If your hospital has rid itself of commercial gift bags, be sure to report it on the website so we can keep track of hospitals that have made an ethical commitment to breastfeeding. When a hospital has eliminated the discharge bags, we have seen a tendency for formula gift packs to show up in the special care nursery or NICU, in physician offices, and in clinics. Make sure to check on other portals of entry for formula marketing and ask that these be discontinued so that your breastfeeding promotion and support efforts are not sabotaged. While there are often objections to eliminating the bags, mostly from nurses, we have never seen mothers leaving one hospital for another because they cannot get their free formula bag. Mothers and infants deserve our unbiased support for breastfeeding and the ethical practice of our respective professions. Healthcare providers should not be in the business of promoting pricey products. The health and lives of our most precious assets depend on this. As the tag line for the Ban the Bags campaign says, “Give the bags the boot!”
  4. 4. Affiliate Program Do you want to earn extra Hale Publishing money? Become an affiliate! The Hale Publishing Affiliate Program is free – there are no sign-up or membership fees. All you have to do is place banner ads for any of our books on your website with a special link back to our site. If someone visits your site, clicks on the book ad, and makes a purchase on our site, you earn an 8% 4 commission. It’s easy to earn extra money! For more information, click here. Do you have an idea for a book, monograph, or other publication? If you have an idea, we’d love to hear about it. Hale Publishing is a small, but growing, independent publisher looking for titles in breastfeeding, perinatal and women’s health. The two most common formats for our publications are monographs (about 100 pages double-spaced) or books (200-300 pages double-spaced). We have also published shorter books, educational materials, and continuing education modules. If you have an idea, we can help you develop it into a finished product. For more information on how you can join our list of prestigious authors, please see our guidelines for prospective authors click here. To find out what you need to do to write a book proposal, click here. And if you need further information, contact Kathleen Kendall-Tackett (, our Acquisitions Editor. See you in print!
  5. 5. Allergies/AsthmA PubMed Approach to milk protein allergy in infants. Breastfeeding and allergies: time for a change in paradigm? Breastfeeding and prevalence of allergic diseases in Japanese Getting bone health right from the start! Pregnancy, lactation and weaning. Hale Publishing university students. Maternal tolerance achieved during pregnancy is transferred Growth pattern of exclusively breastfed infants in to the offspring via breast milk and persistently protects the first six months of life: a study of babies the offspring from allergic asthma. delivered at the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria. Infant feeding and weight in the first year of life BiochemicAl in babies of women with eating disorders. Identification of N-linked glycoproteins in human milk by Infant growth and child cognition at 3 years of hydrophilic interaction liquid chromatography and mass 5 age. spectrometry. Minerals and trace elements in commercial infant IgA1 levels in milk and serum samples from intestinal food. parasite-infected or normal puerperae. Neonatal jaundice: a critical review of the role and Using interphase fluorescence in situ hybridization (i-fish) practice of bilirubin analysis. to detect the transfer of infant cells during Staphylococcus epidermidis: a differential trait of breastfeeding. the fecal microbiota of breast-fed infants. Treatment of neonatal hypoglycaemia: more hiV/AiDs frequent latching onto the breast versus A feeding education program to prevent mother-to-child supplementary feeding with formula; transmission of HIV in Haiti. retrospective study of patient files Feeding and nutritional characteristics of infants on pmtct programs. mAternAl issues Maternal immune status influences HIV-specific immune Changes in breast hemodynamics in breastfeeding responses in pups after DNA prime protein boost using mothers. mucosal adjuvant. Exposure assessment of French women and their newborns to tetrabromobisphenol-A: infAnt/chilD issues Occurrence measurements in maternal [A case of hypernatremic dehydration due to breast- adipose tissue, serum, breast milk and cord feeding.] serum. Associations of maternal fish intake during pregnancy and Gestational diabetes mellitus: postpartum breastfeeding duration with attainment of opportunities for the diagnosis and prevention developmental milestones in early childhood: a study of type 2 diabetes mellitus. from the Danish National Birth Cohort. Influence of oxytocin or epidural analgesia on Breastfeeding or oral sucrose solution in term neonates personality profile in breastfeeding women: a receiving heel lance: a randomized, controlled trial. comparative study. Case definition, aetiology and risk assessment of early Management of postpartum loss of libido. childhood caries (ecc): a revisited review. Occurrence of lactational mastitis and medical Clinical approach of ankyloglossia in babies: report of two management: A prospective cohort study in cases. Glasgow. Cytomegalovirus seroprevalence and childhood sources of Offspring-exposure reduces depressive-like infection: A population-based study among pre- behaviour in the parturient female rat. adolescents in the United States. Research summaries for normal birth.
  6. 6. PubMed Determinants of infant-feeding choice among young women in Hilo, Hawaii. Factors Associated With Exclusive Breastfeeding at 3 Months Postpartum in Valdivia, Chile. The influence of psychological factors on Health professionals’ advice for breastfeeding problems: Hale Publishing Hale Publishing breastfeeding duration. Not good enough! Incorrect advice: the most significant negative determinant meDicAtion on breast feeding in Malta. Azathioprine treatment during lactation. Inclusion of Fathers in an Intervention to Promote Breastfeeding: Impact on Breastfeeding Rates. Breastfeeding and drug management in connective tissue and rheumatic diseases. Infant feeding in Sweden: socio-demographic determinants and associations with adiposity in childhood and GF120918 as a chemical Abcg2 knockout model to 6 adolescence. study nitrofurantoin transfer into milk. Make or break. Mothers’ experiences of returning to paid Olanzapine and breast-feeding: changes of plasma employment and breastfeeding: a New Zealand study. concentrations of olanzapine in a breast-fed infant over a period of 5 months. Misperceptions and misuse of Bear Brand coffee creamer as infant food: national cross sectional survey of Pharmacogenetic insights into codeine analgesia: consumers and paediatricians in Laos. implications to pediatric codeine use. Prenatal breastfeeding education and breastfeeding Pharmacological management of panic disorder. outcomes. Providing responsive nursing care to new mothers with oBesity high and low confidence. Alternative regression models to assess increase in Socioeconomic status and rates of breastfeeding in childhood BMI. Australia: evidence from three recent national health An ecological systems approach to examining risk surveys. factors for early childhood overweight: findings Understanding maternal breastfeeding confidence: a from the UK Millennium Cohort Study. Gadamerian hermeneutic analysis of women’s stories. Do Differences in Childhood Diet Explain the Who supports breastfeeding? Reduced Overweight Risk in Breastfed Children? Survey of Mothers’ Sleep & Fatigue Dr. Thomas Hale and Dr. Kathleen Kendall- Promotion Tackett are conducting an on-line survey of Attempted breastfeeding before hospital discharge mothers’ sleep and fatigue. on both sides of the US-Mexico border, 2005: Your help is needed in referring new mothers the Brownsville-Matamoros Sister City Project to complete this survey! Please tell the mothers for Women’s Health. you work with about the study and encourage them Breastfeeding: factors that cause early weaning. to participate. The more mothers who complete Breastfeeding duration in families with type 1 the survey, the more valid the findings will be. diabetes compared to non-affected families: The survey takes 20 to 30 minutes to complete results from BABYDIAB and DONALD and is confidential. It has been approved by the studies in Germany. Institutional Review Board at Texas Tech Breastfeeding duration related to practised University Health Sciences Center, Amarillo, contraception in the Netherlands. Texas. Breastfeeding Practices in Duzce, Turkey. The link for the survey is:
  7. 7. September 21, 2008 – GMANews.TV reports that the BF in the NEWS Manila, Philippines Department of Health is encouraging mothers to “go back” to breastfeeding in response to the Chinese melamine-contaminated baby milk products September 11, 2008 – Red Orbit reports on an scare. article in the Israeli Journal of Psychiatry and Hale Publishing September 21, 2008 – Shanghaiist reports that an Related Sciences that found that 30% of newborn enterprising Chengdu mother has offered her breastfeeding infants exposed to SSRIs during pregnancy may services for the reportedly princely sum of RMB300 per present with neonatal abstinence syndrome (NAS) day to moms worried about giving their babies Chinese during the first days after birth. NAS includes a formula. The mother is breastfeeding a 3-month-old son. wide spectrum of symptoms divided into 4 She says she has so much extra milk she could easily categories: central nervous system, gastrointestinal, breastfeed up to two additional babies. autonomie, and respiratory. SSRI-exposed newborns should be monitored for NAS 7 September 20, 2008 – The Peterborough Examiner symptoms. Commonly seen symptoms include: reports that WHO has designated the Peterborough irritability, jitteriness, abnormal crying, altered County-City Health Unit as a “baby-friendly community behavior, sleep abnormalities, poor feeding, health service” for its efforts to promote breastfeeding in vomiting, hypotonia, hypertonia, respiratory the community. distress, and increased reflexes. September 17, 2008 – OneNews reports that new September 10, 2008 – Medical News Today research from the University of Georgia in Athens found reports that a Danish study linked higher fish that mothers who exclusively breastfed lost more weight consumption and longer breastfeeding than their mixed feeding counterparts. Researchers (independently beneficial) to better physical and followed 24 new mothers, 17 exclusively breastfeeding and cognitive development in infants. The article 9 mixed feedings their infants, for 12 weeks after delivery. appears in the September issue of the American When the researchers compared post-pregnancy weight Journal of Clinical Nutrition. These findings loss to pre-pregnancy weight, exclusively breastfeeding provide additional proof that the omega-3s found mothers lost more weight from 2-12 weeks than mixed in fish and breastmilk are beneficial to infant feeding mothers . The trend in percent body fat loss was development. statistically significant among the exclusively breastfeeding mothers. These findings were reported in the International September 9, 2008 – reports Breastfeeding Journal. on a new study published in the September issue of the Archives of Pediatrics & Adolescent Medicine. September 17, 2008 – The Huffington Post reports that Researchers surveyed 1,295 hospitals in 21 Professor Sarah Rubenstein-Gillis surveyed 150 films from Eastern states and the District of Columbia. They the last few decades that contain scenes of nursing mothers found that 1,215 hospitals still distribute formula or plot lines that refer to nursing. She found that sample packs to at least some new mothers. Out Hollywood reflects much of the ambivalence about nursing of the 80 hospitals that were sample-free, 20 found in society today. In an article published in the eliminated the practice before 2000 and 60 have October issue of Mothering magazine, Rubenstein-Gillis eliminated the practice since 2000, indicating this suggests that moviemakers should consider taking a public practice is changing significantly. health stand by being more mindful of how they portray breastfeeding.
  8. 8. What’s New Textbook of Human Lactation Hale Publishing Independent Study Modules The Histology and Cytology of the Human Mammary Gland Human Milk Fat Composition - Fat 8 Hormonal Control of the Lactation Cycle Mammary Gland: Past, Present, and Future Gross Anatomy of the Lactating Breast Human Milk Composition - Carbohydrates Molecular Aspects of Mammary Gland Development Oxytocin: Milk Ejection and Maternal-Infant Well- Being The Role of Breastfeeding in the Defense of the Infant Human Milk and Infectious Diseases Human Milk, Breastfeeding, and the Preterm Infant Hyperbilirubinemia and Breastfeeding Mother-Infant Cosleeping Breastfeeding, Birth Spacing, and Family Planning Reproductive Bioenergetics, Infertility, and Ovulation Induction Polycystic Ovary Syndrome Management of Lactation in the Puerperium Nutrition in Lactation Hale 1712 N Forest St. • Amarillo, TX 79106 • 806-376-9900 • 800-378-1317 Publishing To order, go to
  9. 9. Now Available Book Shelf Best Medicine: Medications and Human Milk Hale Publishing Mothers’ Milk 2008 in the NICU 13th Edition Nancy E. Wight MD, IBCLC Thomas W. Hale, PhD Jane A. Morton MD, and Jae H. Kim MD, PhD A must-have revised edition for lactation consultants, nurses, 9 physicians, and nursing Best Medicine discusses the use of human milk and the mothers. A worldwide, support of breastfeeding for the premature infant and best-selling reference for all NICU infants. The authors provide both the for anyone seeking “why” and the “how” to enable healthcare providers to knowledge on the transfer of medications into take full advantage of human milk, and the evidence to human milk, with over 100 new drugs. $34.95 empower mothers of NICU infants to access needed assistance. $32.95 History and Non-Prescription Assessment: Drugs for the It’s All in the Details Breastfeeding Denise Altman, RN, IBCLC, LCCE Mother Frank J. Nice This monograph discusses the information that RPh,CPA,CPHP should be obtained during $19.95 the history taking part of the patient interview and This book offers guidelines to help the breastfeeding shows how this information offers triggers for close mother make safe decisions concerning the use of the observation during the physical assessment that most commonly used nonprescription drugs. help the healthcare provider identify breastfeeding problems. $18.95 Special Surprise This book is a scientific testament to the amazing Immunobiology of components in breastmilk. Dr. Hanson has been Human Milk: How studying the immunobiology of breastmilk since 1955, publishing 650 scientific papers and editing/ Breastfeeding contributing to 19 books. He is one of the most Protects Babies highly respected immunobiologists/pediatricians in Lars Hanson, MD, PhD the world. SALE PRICE $3.95
  10. 10. Book Shelf Hale & Breastfeeding Hartmann’s and Diseases Hale Publishing Textbook of A Reference Guide Human E. Stephen Buescher, MD & Lactation Susan Hatcher, RN, IBCLC Breastfeeding and Diseases is a unique compilation of Written by many of the world’s leading experts, this 10 evidence-based knowledge first edition of Textbook of Human Lactation addresses and practical information the most current evidence-based scientific knowledge on breastfeeding in medically complicated in this rapidly developing field. $89.95 situations. $24.95 Study Guide for Non Pharmacologic Hale & Treatments for Hartmann’s Depression in Textbook of New Mothers Human Kathleen Kendall -Tackett, Lactation PhD, IBCLC Pregnant and postpartum women are at increased risk for depression, As important as it is to The Study Guide is designed to be used in promptly treat depression, some are voicing concern over whether the risks of antidepressant conjunction with Hale & Hartmann’s Textbook of medications outweigh the benefits. The good Human Lactation. It can be used by instructors to news is that there are safe and effective test the knowledge of their students or by individuals alternatives to medications that can alleviate to deepen their understanding of the information in even major depression. $18.95 each chapter. $34.95 Monograph by Diana West and Elliot Hirsch Breastfeeding after Do you work with pregnant or breastfeeding mothers who have had breast surgeries or other breast Breast and Nipple procedures? Breastfeeding after breast surgery can be Procedures challenging. Breastfeeding expert Diana West and Diana West , BA, IBCLC plastic surgery resident Dr. Elliot Hirsch have teamed and Elliot Hirsch, MD up to write Breastfeeding after Breast and Nipple Procedures: A Guide for Healthcare Professionals. $18.95
  11. 11. Conference S ave this date Featured speakers: Hartmann & Hale’s Hale Publishing Thomas Hale Peter Hartmann Julie Mennella James McKenna Human Donna Geddes Sue Cox Lactation 11 Lee Gettler Kathleen Kendall-Tackett Research Click to register for conference Featured evening activity: Dinner & Show Conference BIG TEXAN STEAK DINNER & TEXAS - a musical drama set in Palo Duro Canyon, the nation’s second largest canyon. Nestled in a natural June 4-6, 2009 In beautiful scenic Amarillo, TX, USA basin in majestic Palo Duro Canyon, the show’s fictional characters bring to life the stories, struggles, and triumphs of early settlers of the Texas Panhandle. With song, dance, and good ole Texas humor, this play includes spellbinding lighting, special effects, and fireworks, too. Don’t miss this majestic, fun-filled evening - an evening you will long remember! The dinner & show is included in your registration. TEXAS - a musical drama set in Palo Duro Canyon Newsletter Design: Dolly Moore Click here to subscribe. Contact: Medications and More is a monthly newsletter. If you would like to be removed from our newsletter mailing list, click here to unsubscribe. If you enjoyed this newsletter, please tell your friends about it. Hale 1712 N Forest St. • Amarillo, TX 79106 • 806-376-9900 • 800-378-1317 Publishing To order, go to