Intussusception & bf

[Irish Marie]

Hi all
I was reading through the 'Breast is Best' book and came across a section in
it that outline 'some' reasons that might put you off bf. Mostly they are
fairly daft and easily overcome but there is one that has alarm bells in my
head.
It mentions that Intussesception is more common in breastfed babies. My DS
who is now 3.5 had a bout of intussusception when he was 3 months old, I bf
him for about 4 days and then he was formula fed.
My main questions/worries is that it can run in families, and if this baby
does have more likelihood of getting it, am I sealing his/her fate to get it
by bf?

--
Marie/possibly being irrational
Mum to DD5, DS3 and due #3 July '03

[Larry McMahan]

Irish Marie > writes:
: Hi all
: I was reading through the 'Breast is Best' book and came across a section in
: it that outline 'some' reasons that might put you off bf. Mostly they are
: fairly daft and easily overcome but there is one that has alarm bells in my
: head.
: It mentions that Intussesception is more common in breastfed babies. My DS
: who is now 3.5 had a bout of intussusception when he was 3 months old, I bf
: him for about 4 days and then he was formula fed.
: My main questions/worries is that it can run in families, and if this baby
: does have more likelihood of getting it, am I sealing his/her fate to get it
: by bf?

: --
: Marie/possibly being irrational
: Mum to DD5, DS3 and due #3 July '03

I had never heard of intussesception until I read your post, so I went out and
did an internet search. Here is a good example of what I found:

Background: Intussusception is the telescoping or prolapse of one
portion of the bowel into an immediately adjacent segment. Contrast
enema can reduce the intussusception in approximately 75% of cases.


Pathophysiology: Intussusception most commonly occurs at the terminal
ileum (ie, ileocolic). The telescoping proximal portion of bowel (ie,
intussusceptum) invaginates into the adjacent distal bowel (ie,
intussuscipiens).

The mesentery of the intussusceptum is compressed, and the ensuing
swelling of the bowel wall quickly leads to obstruction. Venous
engorgement and ischemia of the intestinal mucosa cause bleeding and an
outpouring of mucous, which results in the classic description of red
currant jelly stool.

Most cases (90%) are idiopathic, with no identifiable lesion acting as
the lead point or pathological apex of the intussusceptum.


Frequency:


In the US: Intussusception is the predominate cause of intestinal
obstruction in persons aged 3 months to 6 years. The estimated
incidence is 1-4 per 1000 live births. Mortality/Morbidity: Most
patients recover if treated within 24 hours.

Mortality with treatment is 1-3%. If left untreated, this condition is
uniformly fatal in 2-5 days. Recurrence is observed in 3-11% of cases.
Most recurrences involve intussusceptions that were reduced with
contrast enema. Sex:

Overall, the male-to-female ratio is approximately 3:1. With advancing
age, gender difference becomes marked; in patients older than 4 years,
the male-to-female ratio is 8:1. Age: Intussusception is most common
in infants aged 3-12 months, with an average age of 7-8 months.

Two thirds of the cases occur before the patient's first birthday.
Intussusception occurrence is rare in persons younger than 3 months, and
it becomes less common in persons older than 36 months.

***** end of quoted material *******************

I was able to find NO information associating it with bf. I was able
to find associations with rotavirus vaccine, tumors, and some antibiotics.

Larry

[Irish Marie]

"Larry McMahan" > wrote in message
...
> Irish Marie > writes:
> : Hi all
> : I was reading through the 'Breast is Best' book and came across a
section in
> : it that outline 'some' reasons that might put you off bf. Mostly they
are
> : fairly daft and easily overcome but there is one that has alarm bells in
my
> : head.
> : It mentions that Intussesception is more common in breastfed babies. My
DS
> : who is now 3.5 had a bout of intussusception when he was 3 months old, I
bf
> : him for about 4 days and then he was formula fed.
> : My main questions/worries is that it can run in families, and if this
baby
> : does have more likelihood of getting it, am I sealing his/her fate to
get it
> : by bf?
>
> : --
> : Marie/possibly being irrational
> : Mum to DD5, DS3 and due #3 July '03
>
> I had never heard of intussesception until I read your post, so I went out
and
> did an internet search. Here is a good example of what I found:
>
> Background: Intussusception is the telescoping or prolapse of one
> portion of the bowel into an immediately adjacent segment. Contrast
> enema can reduce the intussusception in approximately 75% of cases.
>
>
> Pathophysiology: Intussusception most commonly occurs at the terminal
> ileum (ie, ileocolic). The telescoping proximal portion of bowel (ie,
> intussusceptum) invaginates into the adjacent distal bowel (ie,
> intussuscipiens).
>
> The mesentery of the intussusceptum is compressed, and the ensuing
> swelling of the bowel wall quickly leads to obstruction. Venous
> engorgement and ischemia of the intestinal mucosa cause bleeding and an
> outpouring of mucous, which results in the classic description of red
> currant jelly stool.
>
> Most cases (90%) are idiopathic, with no identifiable lesion acting as
> the lead point or pathological apex of the intussusceptum.
>
>
> Frequency:
>
>
> In the US: Intussusception is the predominate cause of intestinal
> obstruction in persons aged 3 months to 6 years. The estimated
> incidence is 1-4 per 1000 live births. Mortality/Morbidity: Most
> patients recover if treated within 24 hours.
>
> Mortality with treatment is 1-3%. If left untreated, this condition is
> uniformly fatal in 2-5 days. Recurrence is observed in 3-11% of cases.
> Most recurrences involve intussusceptions that were reduced with
> contrast enema. Sex:
>
> Overall, the male-to-female ratio is approximately 3:1. With advancing
> age, gender difference becomes marked; in patients older than 4 years,
> the male-to-female ratio is 8:1. Age: Intussusception is most common
> in infants aged 3-12 months, with an average age of 7-8 months.
>
> Two thirds of the cases occur before the patient's first birthday.
> Intussusception occurrence is rare in persons younger than 3 months, and
> it becomes less common in persons older than 36 months.
>
> ***** end of quoted material *******************
>
Larry thanks for taking the time to post an explanation as to what
intussusception is, I should have done that myself.

> I was able to find NO information associating it with bf. I was able
> to find associations with rotavirus vaccine, tumors, and some antibiotics.
>
That's all I could find too so that's why I thought I might have more luck
asking here.
In fact I would have thought that FF would cause greater incidence and was
looking on Google only last week to back that thought in the back of my head
up, but I came up with nothing. But then I read that chapter in Breast is
Best which really surprised me, but have found no mention of it anywhere
since.
I wonder if I contact the children's hospital that treated DS could they
have any more enlightening information?
Marie

[Plissken]

"Irish Marie" > wrote in message
...
> Hi all
> I was reading through the 'Breast is Best' book and came across a section
in
> it that outline 'some' reasons that might put you off bf. Mostly they are
> fairly daft and easily overcome but there is one that has alarm bells in
my
> head.
> It mentions that Intussesception is more common in breastfed babies. My
DS
> who is now 3.5 had a bout of intussusception when he was 3 months old, I
bf
> him for about 4 days and then he was formula fed.
> My main questions/worries is that it can run in families, and if this baby
> does have more likelihood of getting it, am I sealing his/her fate to get
it
> by bf?
>
> --
> Marie/possibly being irrational
> Mum to DD5, DS3 and due #3 July '03
>

Marie, out of curiosity I did an online search regarding this subject and
did indeed come up with a site which stated that intussesception is more
common in breastfed babies. FYI here is the link and the quote from it:

Link:
http://pediatrics.aappublications.org/cgi/content/full/108/2/e37

Quote from above link
"Pisacane et al(25) performed a case-control study of infants 12 months of
age and younger to determine whether breastfeeding might have a protective
effect on development of intussusception. This study found that
participating infants who were exclusively breastfed had a sixfold increased
risk, whereas partially breastfed children had a two- to threefold increased
risk when compared with children who had never been fed with human milk.
These data suggest that exclusive breastfeeding might be a risk factor for
intussusception in infancy although no clear mechanisms by which this might
occur is evident at this time. Additional analysis of the CDC's case-control
and cohort study data may provide more insight into the relationship between
intussusception and diet and nutritional status. "

This is just to show you that the book did not pull this out of the air and
there has indeed been a study. That said, I did not want to post this and
have you scared of of breastfeeding so I sent of an email to Dr. Jack Newman
a renowned breastfeeding expert (author of Dr. Jack Newman's Guide to
Breastfeeding, a GREAT book) and luckily he was VERY quick with his reply
and this is what he had to say:

"I have read this study before, but I don't remember all the details. The
study does have weaknesses in being retrospective. But even assuming there
is a higher risk of intussusception in breastfed babies, I hardly find this
a compelling argument not to breastfeed, even where there is a family
history. Very few babies get intussusception, but every baby has a brain.
And I would be very worried about the negative effects of not breastfeeding
on the developing brain. Also more common is diabetes, whose incidence is
increased in babies not breastfed. If you weigh all the pros and cons, the
question of intussusception as a reason not to breastfeed is very weak.

Jack Newman, MD, FRCPC"

He also sent an attachment titled "the risks of formula" if you would like
this attachment let me know and I will email it to you (is your email
correct?). I strongly encourage you to buy his book and have a read of it!
Hope this helps you out.

Nadene

[Hillary Israeli]

In >,
Larry McMahan > wrote:

*I had never heard of intussesception until I read your post, so I went out and
*did an internet search. Here is a good example of what I found:
[snip quoted material explaining what intussusceptions are]
*I was able to find NO information associating it with bf. I was able
*to find associations with rotavirus vaccine, tumors, and some antibiotics.

Well, I guess you didn't search the right place, Larry :)

J Pediatr. 1993 Oct;123(4):593-5.

Infant feeding and idiopathic intussusception.

Pisacane A, Caracciolo G, de Luca U, Grillo G, Simeone C, Impagliazzo N,
Mazzarella G.

Dipartimento di Pediatria, Universita di Napoli, Italy.

A case-control study showed that, compared with infants who had never been
fed human milk, breast-fed infants had a relative risk of intussusception
of 6.0 (95% confidence interval, 1.8 to 20.4) when breast-feeding at
admission was exclusive and of 2.3 (95% confidence interval, 0.8 to 6.6)
when it was partial. Exclusive breast-feeding may be a risk factor for
intussusception in infancy.

[end abstract]

Weird. But that's the ONLY article Medline has on the subject. Honestly, I
think the benefits of BF far outweigh the tiny risk of intussusception on
a case by case basis. I've never heard of intussusceptions being familial.
Of course the ones I see are usually secondary to severe diarrhea caused
by intestinal parasites or GI viruses (parvovirus, coronavirus) rather
than being truly idiopathic.

--
hillary israeli vmd http://www.hillary.net
"uber vaccae in quattuor partes divisum est."
not-so-newly minted veterinarian-at-large :)

[Irish Marie]

"Plissken" > wrote in message
. ca...
> "Irish Marie" > wrote in message
> ...
> > Hi all
> > I was reading through the 'Breast is Best' book and came across a
section
> in
> > it that outline 'some' reasons that might put you off bf. Mostly they
are
> > fairly daft and easily overcome but there is one that has alarm bells in
> my
> > head.
> > It mentions that Intussesception is more common in breastfed babies. My
> DS
> > who is now 3.5 had a bout of intussusception when he was 3 months old, I
> bf
> > him for about 4 days and then he was formula fed.
> > My main questions/worries is that it can run in families, and if this
baby
> > does have more likelihood of getting it, am I sealing his/her fate to
get
> it
> > by bf?
> >
> > --
> > Marie/possibly being irrational
> > Mum to DD5, DS3 and due #3 July '03
> >
>
> Marie, out of curiosity I did an online search regarding this subject and
> did indeed come up with a site which stated that intussesception is more
> common in breastfed babies. FYI here is the link and the quote from it:
>
> Link:
> http://pediatrics.aappublications.org/cgi/content/full/108/2/e37
>
> Quote from above link
> "Pisacane et al(25) performed a case-control study of infants 12 months of
> age and younger to determine whether breastfeeding might have a protective
> effect on development of intussusception. This study found that
> participating infants who were exclusively breastfed had a sixfold
increased
> risk, whereas partially breastfed children had a two- to threefold
increased
> risk when compared with children who had never been fed with human milk.
> These data suggest that exclusive breastfeeding might be a risk factor for
> intussusception in infancy although no clear mechanisms by which this
might
> occur is evident at this time. Additional analysis of the CDC's
case-control
> and cohort study data may provide more insight into the relationship
between
> intussusception and diet and nutritional status. "
>
> This is just to show you that the book did not pull this out of the air
and
> there has indeed been a study. That said, I did not want to post this and
> have you scared of of breastfeeding so I sent of an email to Dr. Jack
Newman
> a renowned breastfeeding expert (author of Dr. Jack Newman's Guide to
> Breastfeeding, a GREAT book) and luckily he was VERY quick with his reply
> and this is what he had to say:
>
> "I have read this study before, but I don't remember all the details. The
> study does have weaknesses in being retrospective. But even assuming
there
> is a higher risk of intussusception in breastfed babies, I hardly find
this
> a compelling argument not to breastfeed, even where there is a family
> history. Very few babies get intussusception, but every baby has a brain.
> And I would be very worried about the negative effects of not
breastfeeding
> on the developing brain. Also more common is diabetes, whose incidence is
> increased in babies not breastfed. If you weigh all the pros and cons,
the
> question of intussusception as a reason not to breastfeed is very weak.
>
> Jack Newman, MD, FRCPC"
>
> He also sent an attachment titled "the risks of formula" if you would like
> this attachment let me know and I will email it to you (is your email
> correct?). I strongly encourage you to buy his book and have a read of it!
> Hope this helps you out.
>
> Nadene
>
Thank you so much for that Nadene.
I know it is a longer shot for my baby to get intussusception than to
develop problems due to FF and I am certainly not going to use this study as
an excuse not to bf but it was a scary experience with DS and I really hope
it doesn't happen again.
It is curious though isn't it!!
Marie

[Irish Marie]

"Hillary Israeli" > wrote in message
...
> In >,
> Larry McMahan > wrote:
>
> *I had never heard of intussesception until I read your post, so I went
out and
> *did an internet search. Here is a good example of what I found:
> [snip quoted material explaining what intussusceptions are]
> *I was able to find NO information associating it with bf. I was able
> *to find associations with rotavirus vaccine, tumors, and some
antibiotics.
>
> Well, I guess you didn't search the right place, Larry :)
>
> J Pediatr. 1993 Oct;123(4):593-5.
>
> Infant feeding and idiopathic intussusception.
>
> Pisacane A, Caracciolo G, de Luca U, Grillo G, Simeone C, Impagliazzo N,
> Mazzarella G.
>
> Dipartimento di Pediatria, Universita di Napoli, Italy.
>
> A case-control study showed that, compared with infants who had never been
> fed human milk, breast-fed infants had a relative risk of intussusception
> of 6.0 (95% confidence interval, 1.8 to 20.4) when breast-feeding at
> admission was exclusive and of 2.3 (95% confidence interval, 0.8 to 6.6)
> when it was partial. Exclusive breast-feeding may be a risk factor for
> intussusception in infancy.
>
> [end abstract]
>
> Weird. But that's the ONLY article Medline has on the subject. Honestly, I
> think the benefits of BF far outweigh the tiny risk of intussusception on
> a case by case basis. I've never heard of intussusceptions being familial.
> Of course the ones I see are usually secondary to severe diarrhea caused
> by intestinal parasites or GI viruses (parvovirus, coronavirus) rather
> than being truly idiopathic.
>
I do agree with you that this is not good enough reason for me not to bf, I
am just nervous after the scary experience with DS when he got it.
Thanks for looking into it.
Marie