Wilde Vera K
Methods, Ethics, and Technology, Independent Researcher, Berlin, DEU.
Cureus. 2021 Oct 4;13(10):e18478. doi: 10.7759/cureus.18478. eCollection 2021 Oct.
Insufficient milk intake in breastfed neonates is common, frequently missed, and causes preventable hospitalizations for jaundice/hyperbilirubinemia, hypernatremia/dehydration, and hypoglycemia - accounting for most U.S. neonatal readmissions. These and other consequences of neonatal starvation and deprivation may substantially contribute to fully preventable morbidity and mortality in previously healthy neonates worldwide. Previous advanced civilizations recognized this problem of breastfeeding insufficiencies and had an infrastructure to solve it: Wetnursing, shared nursing, and prelacteal feeding traditions used to be well-organized and widespread. Modern societies accidentally destroyed that infrastructure. Then, modern reformers missing a few generations of direct knowledge transmission about safe breastfeeding invented a new, historically anomalous conception of breastfeeding defined in terms of exclusivity. As that new intervention has become increasingly widespread, so too have researchers widely reported associated possible harms of the longer neonatal starvation/deprivation and later infant under-nutrition periods that it creates when breastfeeding is insufficient. Early insufficient nutrition/hydration has possible long-term effects including neurodevelopmental consequences such as attention deficit hyperactivity disorder, autism, cerebral palsy, cognitive and developmental delay, epilepsy, hearing impairment, kernicterus, language disorder, mood disorders, lower IQ, and specific learning disorder. Current early infant feeding guidelines conflict with the available evidence. Recent reform efforts have tended to focus on using more technology and measurement to harm fewer neonates instead of proposing the indicated paradigm shift in early infant feeding to prevent more harm. The scientific evidence is already sufficient to mandate application of the precautionary principle to feed neonates early, adequate, and often milk before mothers' milk comes in and whenever signs of hunger persist, mitigating possible risks including death or disability. In most contexts, the formula is the best supplementary milk for infants at risk from breastfeeding insufficiencies. National-level reviews of scientific evidence, health policy, and research methods and ethics are needed to initiate the early infant feeding paradigm shift that the data already support. Policy experiments and related legislative initiatives might also contribute to the shift, as insurers might decline or be required by law to decline reimbursing hospitals for costs of this type of preventable hospitalization, which otherwise generates profit.
母乳喂养的新生儿奶量摄入不足很常见，常常被忽视，会导致因黄疸/高胆红素血症、高钠血症/脱水和低血糖而住院，而这些情况是可以预防的——这占了美国新生儿再次入院的大部分原因。新生儿饥饿和营养缺乏的这些及其他后果可能在很大程度上导致全球此前健康的新生儿出现完全可预防的发病和死亡情况。以前的先进文明认识到母乳喂养不足的这个问题，并拥有解决该问题的基础设施：乳母喂养、共享哺乳以及开奶前喂养的传统曾经组织完善且广泛存在。现代社会意外地破坏了那个基础设施。然后，几代人缺乏关于安全母乳喂养的直接知识传承的现代改革者发明了一种新的、在历史上异常的母乳喂养观念，其定义为排他性。随着这种新干预措施越来越普遍，研究人员也广泛报告了母乳喂养不足时所造成的新生儿长期饥饿/营养缺乏以及随后婴儿营养不良期可能带来的相关危害。早期营养/水分摄入不足可能产生长期影响，包括神经发育方面的后果，如注意力缺陷多动障碍、自闭症、脑瘫、认知和发育迟缓、癫痫、听力障碍、核黄疸、语言障碍、情绪障碍、智商较低以及特定学习障碍。当前的早期婴儿喂养指南与现有证据相冲突。最近的改革努力往往侧重于使用更多技术和测量手段以减少对新生儿的伤害，而不是提出早期婴儿喂养方面所需的范式转变以预防更多伤害。科学证据已经足以要求应用预防原则，在母乳分泌之前以及饥饿迹象持续存在时尽早、足量且频繁地用奶喂养新生儿，减轻包括死亡或残疾在内的可能风险。在大多数情况下，配方奶是面临母乳喂养不足风险的婴儿的最佳补充奶。需要在国家层面审查科学证据、卫生政策以及研究方法和伦理，以启动数据已经支持的早期婴儿喂养范式转变。政策试验和相关立法举措也可能有助于这种转变，因为保险公司可能拒绝或依法被要求拒绝为这类可预防住院的费用向医院报销，否则医院会从中获利。
