Friday, September 07, 2012

Canada looks to Japan's low NEC rate and use of only human milk in the NICU

Earlier this year Canadians for Health Research featured Dr. Shoo Lee as their researcher of the month. Dr. Lee is the head paediatrician behind the research into donor human milk use in the NICU in Toronto. Take a look at the full article to learn more about Dr. Lee's efforts - he's the founder of the Canadian Neonatal Network which unites neonatal researchers across Canada, and he's been instrumental in encouraging NICUs to adopt evidence-based practices in neonatal care, which is a factor in the resurgence of interest in the use of donor human milk in the NICU. Dr. Lee was at UBC and the University of Alberta before moving to Toronto. Of note is Dr. Lee's exploration into why Japan has succeeded in reducing the rate of necrotizing enterocolitis in premature babies - in Japan only human milk is allowed in the neonatal nursery. Japan's NEC rate is 0.5%.

Dr. Shoo Lee | Canadians for Health Research | Les Canadiens pour la recherche medicale
Scientific Director, CIHR Institute of Human Development, Child and Youth Health Professor of Pediatrics, Obstetrics and Gynecology - University of Toronto
Researcher of the month:
Leading the Vanguard in Neonatal CareOver the last 20 years, Canada has slipped from the top 5 in lowest infant mortality rate to rank 40th in the world.
“That’s unacceptable to me,” says Dr. Shoo Lee, a neonatologist and health economist, recently appointed as Scientific Director of the Canadian Institutes for Health Research (CIHR)’s Institute of Human Development, Child and Youth Health. “Canada is a rich country. Why are so many other poorer countries ahead of us? Not only that, in native communities, the infant mortality rate is 3 times higher than in the general population.”
Infant mortality isn’t the only problem that Dr. Lee wants to tackle in his new job. “We’ve had a 30% rise in prematurity rates in this country over the last 20 years. We need to pay attention and develop ways to deal with this problem.”
Breast vs cow’s milk in the NICUAbout 7% of very-low-birth-weight infants weighing less than 1500 grams at birth worldwide suffer from necrotizing enterocolitis (NEC). This intestinal infection is one of the single biggest killers of premature babies. In Canada, neonatal death rates from NEC have risen as high as 33%. The only country that has succeeded in reducing NEC is Japan, which currently has an incidence of 0.5%.
“Japan does not do evidence-based research, so we sent a delegation there to watch,” explains Dr Lee. “One of the things that impressed us was that they do not allow cow’s milk in the neonatal nursery. Only human milk is allowed. If the baby’s mother cannot produce milk, they use donor milk from another mother.”
By 7 to 10 days, every infant has been converted from intravenous fluid or parenteral feedings to full feedings of human milk. Conversion rates are typically slower in Canada. 
Projects were started in Vancouver and at Sunnybrook Health Sciences Centre in Toronto to feed only human milk to premature babies, unless mothers objected. Within 2 years, the incidence of NEC had dropped from 10% to 2% in Vancouver and from 8% to 1% at Sunnybrook.
“To me, this is good enough proof,” says Dr. Lee. “We are working to build human milk banks in the rest of the country and to supply all the babies who need it.”...more

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