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Re: Inappropriate Cover illustration

Dear Editor,

The cover illustration of the September 2007 issue of the Fetal and Neonatal edition of the Archives Disease in Childhood, shows a severely jaundiced infant with a nasogastric tube in situ being bottlefed. If the message of the picture is to make a wake-up call to prevent kernicterus, then there is no need to promote a bottle feeding picture in the front page of this esteemed journal. The results of the prospective surveillance study of severe hyperbilirubinemia in the newborn in the UK and Ireland by Manning and colleagues should cause concern for all (1).

The Baby Friendly Hospital Initiative (BFHI) recommends the use of cup feeding for infants intending to breastfeed, so that no artificial nipples are introduced to these infants (2). The answer to lack of breast milk jaundice is not to take the baby off the breast or to give bottle feeds. The safety and advantages of cup feeding as a method of providing supplemental feedings to breastfed infants is supported by several studies.Cup feeding is a simple procedure, early positive body and eye contact is fostered and the infant receives positive tactile and olfactory stimulation. The cardio-respiratory and oxygen saturation can be maintained and minimal energy is expended. The infant controls the feed and can pace the intake and the total volume of milk taken, and there is minimal risk of aspiration.

The randomized clinical trial of pacifier use and bottle feeding or cup feeding and their effect on breastfeeding by Cynthia R. Howard and colleagues found detrimental effects from pacifier use begun in the first week of life on exclusive breastfeeding at 1 month and on overall breastfeeding duration (3). This study supports the BFHI recommendations to use cup feeding as the method of choice when providing supplemental feedings and hence any message promoting bottle feeding is not welcome.

References:

1) Manning D, Todd P, Maxwell M, Jane Platt M. Prospective surveillance study of severe hyperbilirubinaemia in the newborn in the UK and Ireland. Arch Dis Child Fetal Neonatal Ed. 2007;92:F342-6.

2) World Health Organization, United Nations Children’s Fund. Baby Friendly Hospital Initiative, Part III, Assessor’s Manual. Geneva, Switzerland: WHO; 1992:10–11.