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A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. These guidelines are not intended to be all-inclusive, but to provide a basic framework for physician education regarding breastfeeding.

Background: The range of human milk docosahexaenoic acid (DHA) concentrations worldwide is much broader than the range explored in randomized clinical trials to date., Objective: The primary objective was to determine the effect of 4 amounts of DHA supplementation on the visual acuity of formula-fed infants at 12 mo of age. Secondary objectives were to evaluate visual acuity maturation, red blood cell fatty acids, tolerance, anthropometric measures, and adverse events., Design: This double-masked, randomized trial was conducted at 2 sites (Dallas and Kansas City). Three hundred forty-three healthy, term, formula-fed infants were enrolled at 1-9 d of age and were randomly assigned to be fed 1 of the following 4 infant formulas containing equivalent nutrient amounts, except for long-chain polyunsaturated fatty acids: control (0% DHA), 0.32% DHA, 0.64% DHA, or 0.96% DHA; DHA-supplemented formulas also provided 0.64% arachidonic acid. Visual acuity was measured by visual evoked potentials in 244 infants who completed the 12-mo primary outcome examination., Results: Infants fed control formula had significantly poorer visual evoked potential visual acuity at 12 mo of age than did infants who received any of the DHA-supplemented formulas (P < 0.001). There were no significant differences in visual evoked potential visual acuity between the 3 amounts of DHA supplementation for either site at any age tested., Conclusions: DHA supplementation of infant formula at 0.32% of total fatty acids improves visual acuity. Higher amounts of DHA supplementation were not associated with additional improvement of visual acuity. This trial was registered at clinicaltrials.gov as NCT00753818.

Purpose: To evaluate the effects on thermoregulation of bathing a healthy newborn within the first hour of life compared to bathing four to six hours after birth., Design: Quasi-experimental., Setting: Newborn nursery of a 30-bed obstetric unit in an urban university hospital., Sample: Fifty-one healthy term newborns with a minimum axillary temperature of 36.5 degrees C (97.7 degrees F)., Intervention: Newborns in an experimental group were bathed within the first hour of birth; those in a control group were bathed at the standard four to six hours of age., Main Outcome Variable: Axillary temperatures were measured before the bath, immediately after the bath, one hour later, and two hours later., Results: Axillary temperatures as measured at four different times did not differ significantly between infants bathed within one hour of birth and those bathed four to six hours after birth., Conclusions: A flexible bathing time is recommended according to the characteristics and stability of the newborn and to family desires.

Objective: To base permissible noise criteria for occupied, new nurseries on research findings., Study Design: An interdisciplinary group of clinicians reviewed the literature regarding the effect of sound on the fetus, newborn, and preterm infant and based recommended criteria on the best evidence. An external panel subsequently reviewed the criteria., Results: The recommended criteria: Patient bed areas and the spaces opening onto them shall be designed to produce minimal ambient noise and to contain and absorb much of the transient noise that arises within the nursery. The overall, continuous sound in any bed space or patient care area shall not exceed: (1) an hourly Leq of 50 dB and (2) an hourly L10 of 55 dB, both A-weighted, slow response. The 1-second duration Lmax shall not exceed 70 dB, A-weighted, slow response., Conclusion: The permissible noise criteria will protect sleep, support stable vital signs, and improve speech intelligibility for many infants most of the time.

Use of illicit and licit drugs during pregnancy is a major public health concern, as it can have adverse effects on the developing fetus. Infants born of women addicted to narcotics, cocaine, alcohol, or polydrugs often undergo a characteristic withdrawal syndrome and may have physical, behavioral, and/or neurological abnormalities. As it is not feasible to ascertain whether these functional changes in human infants are produced by abused substance(s) per se or by a combination of complex socioeconomic factors and polydrug use, researchers in recent years have developed and utilized various innovative animal models to assess drug-induced alterations and their biological mechanisms during the developmental period under a controlled environment. To promote interdisciplinary communications as well as to assess the progress and the future needs in this area, the National Institute on Drug Abuse (NIDA) held a technical review at which biomedical researchers discussed their current findings in various physiological systems. This report summarizes the major findings and the methodological and experimental issues discussed at the conference. The meeting was held in Washington, DC, on May 25 and 26, 1994.

This study examined the relationship between perinatal risk factors and developmental functioning for a referred population of 216 children. A canonical correlation analysis indicated that 31% of the variability in developmental information could be predicted from perinatal events. The results were interpreted as lending support to a multivariate link between perinatal complications and developmental functioning for referred children.