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Bre a stfe e ding : Disc la ime r I s it RE AL L Y wo rth a ll the e ffo rt? NE I T HE R T HE PUBL I SHE R NOR T HE AUT HORS ASSUME ANY L I ABI L I T Y F OR ANY I NJURY AND OR DAMAGE T O PE PE RSONS OR PROPE

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SLIDE 1

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Bre a stfe e ding :

I s it RE AL L Y wo rth a ll the e ffo rt?

1

Mic he lle G . Bre nne r, MD, IBCL C

E a ste rn Virg inia Me dic a l Sc ho o l Childre n’ s Ho spita l o f T he K ing ’ s Da ug hte rs No rfo lk, VA

Disc la ime r

  • NE

I T HE R T HE PUBL I SHE R NOR T HE AUT HORS ASSUME ANY L I ABI L I T Y F OR ANY I NJURY AND OR DAMAGE T O PE RSONS OR PROPE RT Y ARI SI NG F ROM

2

PE RSONS OR PROPE RT Y ARI SI NG F ROM T HI S WE BSI T E AND I T S CONT E NT .

F a c ulty Disc lo sure

  • I

n the pa st 12 mo nths, I ha ve no t ha d a sig nific a nt fina nc ia l inte re st o r o the r re la tio nship with the ma nufa c ture r(s) o f the pro duc t(s) o r pro vide r(s) o f the se rvic e (s) tha t will b e disc usse d in the pre se nta tio n.

3

  • T

his pre se nta tio n will no t inc lude disc ussio n

  • f pha rma c e utic a ls o r de vic e s tha t ha ve

no t b e e n a ppro ve d b y the F DA.

Ob je c tive s

  • Unde rsta nd the ro le o f BF

in:

– De c re a sing he a lth ine q uitie s – De c re a sing infa nt mo rb idity & mo rta lity I mpro ving he a lth & we llne ss

4

– I mpro ving he a lth & we llne ss

  • Co unse l ne w fa milie s o n b a sic s o f BF
  • Re c o g nize sig ns o f BF

suc c e ss o r strug g le

  • I

nte rve ne to ultima te ly suppo rt BF

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SLIDE 2

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5

PHYSICIAN AT T IT UDE S ABOUT Bre a stfe e ding

Ma ryAnn O’ Ha ra , Da vid Gro ssma n, a nd L

  • rna Rho de s

De spite physic ia ns’ se lf-re po rte d suppo rt fo r b re a stfe e ding , this study re ve a le d pe rva sive a mb iva le nc e a nd

6

p po te ntia lly c o unte rpro duc tive pra c tic e s.

Advances in Experimental Medicine and Biology, 2002

Surve y o f OB, F P, Pe ds Gra dua te s (2001-2005)

  • 100% a g re e d BF

e nha nc e s immune func tio n

  • Ye t o nly 38% b e lie ve d BF

b a b ie s a re

7

  • Ye t o nly 38% b e lie ve d BF

b a b ie s a re he a lthie r tha n fo rmula fe d b a b ie s

  • 42% sta te d b re a stmilk a nd fo rmula a re

e q ua lly a c c e pta b le

McCurdy & Brenner, unpublished data

Ag e nc y fo r He a lthc a re Re se a rc h a nd Qua lity, No . 153

8

U.S. De pt. o f He a lth a nd Huma n Se rvic e s U.S. Offic e o f Wo me n’ s He a lth

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SLIDE 3

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BF & Ma te rna l & I nfa nt He a lth Outc o me s E vide nc e Re po rt

  • 9000 a b stra c ts sc re e ne d

– 43 infa nt – 43 ma te rna l 29 syste ma tic re vie ws o r me ta a na lyse s

9

– 29 syste ma tic re vie ws o r me ta -a na lyse s

  • He a lth o utc o me s o nly

– No t e c o no mic sig nific a nc e , so c ia l o r e nviro nme nta l impa c t

April, 2007

Outc o me s fo r Mo ms

(Cle a r e vide nc e wo rth ta lking a b o ut!)

T ype I I DM (No hx o f g e st. DM), fo r e a c h ye a r o f BF :

  • Co ho rt 1: 4% risk re duc tio n
  • Co ho rt 2: 12% risk re duc tio n

(hig h q ua lity, lo ng itudina l study o f 150,000 wo me n)

10

Bre a st Ca nc e r

  • Study 1: 4.3% risk re duc tio n fo r e a c h ye a r o f BF
  • Study 2: 28% risk re duc tio n fo r >12 mo nths o f BF

Ova ria n Ca nc e r

  • 21% risk re duc tio n with >12 mo nths o f BF

, c o mpa re d to ne ve r BF

Ob ste tric s & Gyne c o lo g y: Ma y 2009 - Vo lume 113 - I ssue 5 – pp 974-982 Amo ng po stme no pa usa l wo me n, inc re a se d dura tio n o f la c ta tio n wa s a sso c ia te d with a lo we r pre va le nc e o f

11

a sso c ia te d with a lo we r pre va le nc e o f

hype rte nsio n, diabe te s, hype rlipide mia, and c ardio vasc ular dise ase .

Condition “Amount” of BF Re duc tion in Risk

F ull T e rm I nfa nt Outc o me s-- Sho w Me the Mo ne y!!!!

12

Ac ute OM E ve r BF vs E xc l F F E xc l BF 3-6 mo vs E xc l F F 23% 50% !

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SLIDE 4

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Condition “Amount” of BF Re duc tion in Risk

F ull T e rm I nfa nt Outc o me s-- Sho w Me the Mo ne y!!!!

13

Ac ute OM E ve r BF vs E xc l F F E xc l BF 3-6 mo vs E xc l F F 23% 50% ! GI I nfe c tio ns BF vs no t BF 64%!!

Condition “Amount” of BF Re duc tion in Risk

F ull T e rm I nfa nt Outc o me s-- Sho w Me the Mo ne y!!!!

14

Ac ute OM E ve r BF vs E xc l F F E xc l BF 3-6 mo vs E xc l F F 23% 50% ! GI I nfe c tio ns BF vs no t BF 64%!! L

  • we r Re sp I

nf E xc l BF > 4 mo s 72%!!!

Condition “Amount” of BF Re duc tion in Risk

F ull T e rm I nfa nt Outc o me s-- Sho w Me the Mo ne y!!!!

15

Ac ute OM E ve r BF vs E xc l F F E xc l BF 3-6 mo vs E xc l F F 23% 50% ! GI I nfe c tio ns BF vs no t BF 64%!! L

  • we r Re sp I

nf E xc l BF > 4 mo s 72%!!! Ato pic De rm w/ F Hx BF >3 mo vs <3 mo 42% Asthma E xc l BF 3 mo s 27%, 40% w/ F Hx

Condition “Amount” of BF Re duc tion in Risk

T ype I DM T ype I I a s a dult BF 3 mo s BF in infa nc y 19-27% 39% L e uke mia BF 6 mo s AL L 19%:AML 15% SI DS Hx o f BF 36% F ull T e rm I nfa nt Outc o me s

16

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SLIDE 5

5

Numb e r Ne e de d to T re a t

Dise a se NNT

NSAI Ds fo r Arthritis 2

17

Meyers BF Med, 2009

Numb e r Ne e de d to T re a t

Dise a se NNT

NSAI Ds fo r Arthritis 2 St ti f MI 70

18

Meyers BF Med, 2009

Sta tins fo r MI 70

Numb e r Ne e de d to T re a t

Dise a se NNT

NSAI Ds fo r Arthritis 2 St ti f MI 70

19

Meyers BF Med, 2009

Sta tins fo r MI 70 Co lo no sc o py 1500 to pre ve nt 1 de a th

Numb e r Ne e de d to T re a t

Dise a se NNT

NSAI Ds fo r Arthritis 2 St ti f MI 70

20

Meyers BF Med, 2009

Sta tins fo r MI 70 Co lo no sc o py 1500 to pre ve nt 1 de a th Ma mmo g ra phy 2300-5000 to pre ve nt 1 de a th

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SLIDE 6

6

Numb e r Ne e de d to T re a t

Dise a se NNT

Otitis Me dia 6

21

Meyers BF Med, 2009

Numb e r Ne e de d to T re a t

Dise a se NNT

Otitis Me dia 6 Ga stro e nte ritis 2.5

22

Meyers BF Med, 2009

1 9 9 9

Obesity Trends* Am ong U.S. Adults BRFSS, 1 9 9 0 , 1 9 9 9 , 2 0 0 9

( * BMI 3 0 , or about 3 0 lbs. overw eight for 5 ’4 ” person) 1 9 9 0

23

2 0 0 9 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Psyc ho lo g ic a l Be ne fits

Bre a stfe e ding fo ste rs ho rmo na l, se nso ry, physio lo g ic , immuno lo g ic , a nd b e ha vio ra l me c ha nisms whic h:

24

– E nha nc e s a tta c hme nt – F

  • ste rs nurturing ro le ,

– I mpro ve s se lf-e ste e m – De c re a se s c rying b e ha vio rs – De c re a se s a b a ndo nme nt o r a b use

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SLIDE 7

7

25

Pre va le nc e o f Bre a stfe e ding I nitia tio n a nd Dura tio n

T e nne sse e

  • No. of

r e sponde nts Initia tion 6 months 12 months

Hispa nic 241 68.6 38.8 20.1 White , no n- Hispa nic 1,617 66.2 33.5 15.2

26

Hispa nic Bla c k, no n- Hispa nic 467 45.4 21.1 8.1 National Immunization Survey, United States, 2004--2008

I nte ntio n to Bre a stfe e d in a Rura l Appa la c hia n Sa mple : Ro le s o f Smo king a nd So c io de mo g ra phic s

  • 821 de live rie s
  • Bre a stfe e ding initia tio n ra te o f 46% (na tio na l

a ve ra g e =70%)

27

  • No n-smo ke rs we re ne a rly twic e a s like ly

b re a stfe e d (56%) a s smo ke rs (30%).

Prima ry Ca re Re se a rc h Da y, Se pte mb e r 2008 Wrig ht HN, Ba ile y BA, De pa rtme nt o f F a mily Me dic ine E a st T e nne sse e Sta te Unive rsity

BF in Rura l Co mmunitie s

  • E

thno g ra phic da ta sug g e st ma ny wo me n:

– Ne ve r e ve n c o nside re d b re a stfe e ding o r disc o ntinue d b re a stfe e ding due to :

28

disc o ntinue d b re a stfe e ding due to :

  • Smo king
  • Pa in
  • E

mb a rra ssme nt

  • L

a c k o f a ssista nc e

Flower, Matern Child Health J. 2008 May

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SLIDE 8

8

I nc re a sing BF in Rura l Co mmunitie s

  • E

nha nc ing wo rkpla c e suppo rt

  • Ma ximizing the ro le o f WI

C

29

  • I

nc re a sing ho spita l BF a ssista nc e

  • Cre a te a so c ia l e nviro nme nt in whic h

BF is no rma tive Pa tie nt Pro te c tio n a nd Affo rda b le Ca re Ac t -- Ma rc h 23, 2010 E mplo ye rs must pro vide :

  • Re a so na b le b re a k time to e xpre ss

b re a st milk fo r 1 ye a r

30

b re a st milk fo r 1 ye a r

  • A pla c e , o the r tha n a b a thro o m, tha t

is shie lde d fro m vie w, fre e fro m intrusio n fro m c o wo rke rs a nd the pub lic

Huma n Milk—so wha t’ s in this stuff, a nywa y? ? ?

31

Huma n Milk is:

  • Huma n Spe c ific
  • Dyna mic !!
  • Nutrie nt a nd no n-nutrie nt sig na ls

32

  • I

nfe c tio n pro te c tio n

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SLIDE 9

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Co lo strum— L e a rning Milk

  • Ye llo w, thic k liq uid
  • Hig h in a ntib o die s, pro te in, WBCs
  • Hig h in Vita min A, B12, D, E

, Zinc Sma ll q ua ntitie s

33

  • Sma ll q ua ntitie s—

– 3 T . o n Da y 1 – 13 T . b y Da y 2

  • E

xc e lle nt la xa tive

  • T

he pe rfe c t pra c tic e fo o d!!

Ma jo r Nutrie nts in Huma n Milk

  • Prote ins—sI

g A, I g M, I g G, la c to fe rrin, lyso zyme , a lpha la c ta lb umin, c a se in

  • Ca rbohydra te s—la c to se ,
  • lig o sa c c ha ride s g lyc o c o njua te s

34

  • lig o sa c c ha ride s, g lyc o c o njua te s
  • F

a ts—T

G, L C-PUF A, F F A

Hamosh M. Pediaric Clin No Amer 2001;48-69.

Pro te c tive Co mpo ne nts

  • sI

g A, G, M, D, E

  • Ma jo r nutrie nts & mino r nutrie nts

– Nuc le o tide s, vita mins—A,C,E

  • E

nzyme s—lipa se , c a ta la se , g luta thio ne id PAF

35

pe ro xida se , PAF

  • Ho rmo ne s—pro la c tin, c o rtiso ne , thyro xine ,

insulin, g ro wth fa c to rs

  • Ce lls—ma c ro pha g e s, PMNs, lympho c yte s
  • Cyto kine s—I

L 1,3,4,5,6,8,10,12, I F Ns

Hamosh M. Pediaric Clin No Amer 2001;48-69.

Clinic a l E vide nc e of Huma n Milk Prote c tion

Otitis media J Pediatr 126:696-702, 1995 Clin Infect Dis 22:1079-1083, 1996 Infect Dis 160:83-94, 1989 Pneumonia Pediatrics 101:837-844, 1998 Pediatrics 93:977-985, 1994 Upper respiratory infection Perinatol 22:354-359, 2002 VLBW sepsis Arch Pediatr Adolesc Med 157:66-71, 2003 UTI Acta Paediatr 93:164-168,2004 J Pediatr 120:87-89, 1992 Gastroenteritis Pediatrics 101:837-844, 1998

36

Gastrointestinal infection Am J Clin Nutr 78:291-295, 2003 Gastrointestinal illness Am J Dis Child 138:629-632, 1984 Death from diarrhea BMJ 323:1-5, 2001 Am J Epidemiol 129:1032-1041,1989 Salmonella Am J Dis Child 134:147-152, 1980 Clin Infect Dis 38 Suppl 3:S262-S270, 2004 Acta Paediatr 85:804-808, 1996 Rotavirus J Hosp Infect 50:13-17, 2002 Campylobacter diarrhea J Pediatr 116:707-713, 1990 Severe rotavirus infection Pediatrics 92:680-685, 1993 Giardia Scand J Infect Dis 35:322-325, 2003 Am J Trop Med Hyg 65:257-260,2001 Pediatrics 93:28-31, 1994 J Pediatr 121:363-370, 1992

slide-10
SLIDE 10

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Clinic a l E vide nc e of Huma n Milk Prote c tion

Cholera N Engl J Med 308:1389-1392, 1983 Severe shigellosis Am J Epidemiol 123:710-720, 1986 Pediatrics 90:406-411, 1992 Ascaris infection Indian J Pediatr 50:493-495, 1983 Persistent diarrhea Int J Epidemiol 20:1064-1072, 1991 Diarrhea J Nutr 127:436-443, 1997 Pediatrics 86:874-882, 1990 Gastrointestinal infections J Pediatr 126:191-197, 1995 Acute Respiratory infection Saudi Med J 22:347-350, 2001

37

Infections J Hum Lact 12:27-30, 1996 Acute respiratory infections J Nutr 127:436-443, 1997 Invasive H. Influenzae Int J Epidemiol 26:443-450, 1997 Pneumonia / bronchiolitis Acta Paediatr 83:714-718, 1994 Parainfluenza bronchiolitis Am J Dis Child 140:34-40, 1986 Respiratory infection Int J Epidemiol 13:447-453, 1984 Infant respiratory infection Am J Epidemiol 147:863-870, 1998 Respiratory infections J Pediatr 126:191-197, 1995 All infections J Pediatr 126:191-197, 1995 VLBW infant infections Pediatrics 102:E38, 1998

MULTIPLE MULTIPLE AGENTS, SITES, & PATHOPHYSIOLOGIES

Sta rt a t the ve ry b e g inning …

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T a lk I t Up!!!!!

  • 78% o f fe e ding de c isio ns

ma de pre -pre g na nc y o r during 1st trime ste r

39

  • Do n’ t unde re stima te the po we r o f yo ur

e ndo rse me nt o f b re a stfe e ding

  • Disc uss BF

with pa tie nts, pa rtne rs, a nd ma te rna l g ra ndmo the rs

Pe dia tric s 106: e 67, 2000 J Hum L a c t 15: p27-34,1999

Ge t b re a stfe e ding in the ma instre a m…..

40

www.b e stfo rb a b e s.o rg

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SLIDE 11

11

T he T e n Ste ps T

  • Suc c e ssful Bre a stfe e ding
  • 1. Ha ve a writte n BF

polic y tha t is ro utine ly c o mmunic a te d to he a lth

c a re sta ff. 2.

T ra in a ll he a lth c a re sta ff in skills ne c e ssa ry to imple me nt this po lic y.

3.

Inform a ll pre g na nt wo me n a b o ut b e ne fits & ma na g e me nt o f BF

  • 4. He lp mo the rs initia te BF

within 1hour o f b irth.

  • 5. Sho w mo the rs how to BF

& how to ma inta in la c ta tion, e ve n if the y a re

41

  • 5. Sho w mo the rs how to BF

& how to ma inta in la c ta tion, e ve n if the y a re

se pa ra te d fro m the ir infa nts.

  • 6. Give ne wb o rn infa nts no food or drink o the r tha n b re a stmilk, unle ss

me dic ally indic a te d.

  • 7. Pra c tic e “rooming in”- - a llo w mo the rs & infa nts to re ma in to g e the r 24

hrs/ da y.

  • 8. E

nc o ura g e BF

  • n de ma nd.
  • 9. Give no pa c ifie rs o r a rtific ia l nipple s to BF

infa nts.

  • 10. F
  • ste r the e sta b lishme nt o f BF

support g roups & re fe r mo the rs to the m

  • n disc ha rg e

WHO/ UNICE F 1989 HMHB 1994

Optimizing Bre a stfe e ding

  • He lp fa milie s ma ke info rme d de c isio ns
  • S

e t up e xpe c tatio n to :

42

S e t up e xpe c tatio n to : Bre astfe e d E arly & Ofte n!

  • E

xc lusive b re a stfe e ding fo r first 6 mo nths

  • Co ntinua tio n fo r a t le a st 1st ye a r with

c o mple me nta ry fo o ds a t 6 mo nths

F e e ding F re q ue nc y

  • Ge ne ra l Guide line s

– 8-12 fe e ding s/ 24 hrs – Atte mpt fe e d e ve ry 2-3 hrs (skin to skin)

43

Atte mpt fe e d e ve ry 2 3 hrs (skin to skin) – E a rly Hung e r Cue s: stirring in sle e p, suc king fist, sta rting to sq uirm – L a te sig n o f hung e r: Crying 

No rma l Gro wth in the Bre a stfe d I nfa nt is Ro b ust

  • T

a rg e t >7% loss a s a n infa nt a t risk

44

  • T

a rg e t >7% loss a s a n infa nt a t risk

  • Wt. lo ss e nds b y Da y 3-4, a s milk inc re a se s
  • We ig ht g a in g o a l = 20-30g pe r da y
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SLIDE 12

12

Go o d L a tc h Po o r L a tc h

45

Pro b le ms with L a tc h - a fe w tric ks

  • Cro ss-c ra dle ho ld
  • L

ine up no se & nipple

  • “T

a c o ” o r U-ho ld o f b re a st W it f id th

46

  • Wa it fo r wide mo uth
  • Pull b a b y o n fa st
  • Che c k lips fla ng e d
  • T

uc k b o tto m in to de c o mpre ss no se

“Ho w do e s yo ur b o dy kno w ho w muc h milk to ma ke ? ? ”

47

“Wet nurses fed as often as 34 times per day, producing up to 5 quarts of milk.”

Supply & De ma nd

  • Milk re mova l re sults in mo re milk

48

Milk re mova l re sults in mo re milk

pro duc tio n

  • De c re a se d re mo va l = “le fto ve rs” sig na l

to do wn re g ula te supply

  • F

e e db a c k inhib ito r o f la c ta tio n (F I L )

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SLIDE 13

13

Supply & De ma nd— “Ha nds-o n” Appro a c h

  • Milk re mova l ma na g e s milk pro duc tio n
  • I

mpro ve milk re mo va l b y a dding c o mpre ssio n, ha nd e xpre ssio n o r ha nds-o n pumping

49

J Pe rina to l 29: 757–764, 2009 Vide o s a t http:/ / ne wb o rns.sta nfo rd.e du/ Bre a stfe e ding /

Ho w Do Yo u K no w I t’ s E no ug h?

  • Minimum o f 8-12 fe e ds/ da y
  • 4 Stools BY Da y 4 with

i f i

50

c le a ring o f me c o nium

  • Urine dia pe rs = # o f

da ys o ld

  • Re la xe d & c o nte nt b a b y

a fte r fe e d

51

Ne wb o rn Che c k-ups: I n 20 minute s o r le ss…

  • Pa r

e nta l Conc e r ns

  • Birth histo ry/ re vie w o f pa pe rwo rk
  • Ne wb o rn nurse ry c o urse
  • Ma te rna l se ro lo g ie s
  • He pa titis se ro lo g y & va c c ina tio n
  • Blo o d type s a nd ABO inc o mpa tibility
  • Ja undic e
  • Bir

th me a sur e me nts

  • T
  • da y's me a sur

e me nts

  • F

e e ding , sto o ling , vo iding

  • F

e e ding Hx

  • He a ring sc re e n
  • Sc re e n fo r ma te rna l de pre ssio n, illne ss
  • So c ial suppo rt syste ms
  • Smo ke e xpo sure / c e ssa tio n
  • We ig ht lo ss c a lc ula tio n

52 We ig ht lo ss c a lc ula tio n

  • Gro wth c ha rts
  • Physic a l E

xa mina tion

  • Cong e nita l he a r

t dise a se

  • De ve lopme ntal dysplasia of the hip
  • Pro b le m lists
  • Me dic a tio n lists
  • Ca r se a ts
  • Skin c a re , c o rd c a re , c irc c a re
  • Ba c k to sle e p
  • Smo ke a la rms
  • Wa te r sa fe ty
  • Sibling riva lry
  • WIC
  • F

e ve r/ illne ss sig ns/ Sx

  • F
  • llo w-up a ppo intme nts
  • Pre sc riptio ns
  • T

ra nspo rta tio n

slide-14
SLIDE 14

14

Dia pe r/ BF Dia ry

  • Pro vide s o b je c tive do c ume nta tio n
  • E

nc o ura g e s fre q ue nt fe e ds N t id d t l

53

  • No te s vo ids a nd sto o ls
  • Re info rc e s tha t “o utput” is a me a sure
  • f the a de q ua c y o f “input”
  • F

a c ilita te s fo llo w-up, no t re lying o n pa re nta l re c a ll

Whe n Do Mo ms Give Up? ? ?

54

Me a n a g e o f b re a stfe e ding c e ssa tio n = 5.4 da ys.

Ha ll, 2002

Mo ms Ne e d to K no w:

  • YOUT

HI NK I T I S WORT H I T T O CONT I NUE

  • Yo u think the y a re do ing a g re a t jo b
  • T

he y will suc c e e d with the rig ht he lp

55

  • Yo u c a n he lp the m o r yo u kno w

so me o ne who c a n

  • T

he y ha ve suppo rt a t ho me whe re it is the ha rde st

  • YOUT

HI NK I T I S WORT H I T T O CONT I NUE

Wha t if thing s do n’ t g o smo o thly? ?

T he “Rule s”

  • 1. F

e e d the b a b y! (E BM o r fo rmula )

56

  • 2. Pro te c t the b re a stmilk supply!!
  • 3. Pro te c t the o ptio n to b re a stfe e d:

ke e p “so me thing

so me thing happe ning happe ning ” a t

b re a st during the inte rve ntio n pe rio d

slide-15
SLIDE 15

15

Whe n will yo u se e ne wb o rns in the

  • ffic e ?

57

Ac a de my o f BF Me dic ine Pro to c o ls

  • Hypo g lyc e mia
  • Supple me nta tio n
  • Ma stitis
  • Huma n Milk Sto ra g e
  • Ga la c to g o g ue s
  • BF

the ne a r-te rm infa nt

58

  • Pe ripa rtum BF

Mg mt

  • Co -sle e ping a nd BF
  • Ne o na ta l

Ankylo g lo ssia BF the ne a r te rm infa nt

  • Mo de l Ho spita l Po lic y
  • Go ing ho me / disc ha rg e
  • NI

CU to Ho me

www.bfmed.org

59

http://toxnet.nlm.nih.gov/

E a rlie r Disc ussio ns Ab o ut Bre a stfe e ding

  • T

a lk it up!

  • Pre c onc e ptiona l c a re
  • E

ve ry pre na ta l visit

  • L
  • b b y insura nc e

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  • L
  • b b y insura nc e

c o mpa nie s to c o ve r BF re la te d se rvic e s

  • Pra ise de c isio n
  • Che e rle a d to c o ntinue
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SLIDE 16

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T ha nks….fo r a ll yo u do !!!

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Ne ws He a dline s !!

Washington, D.C. - March 27, 2010 – The world-wide biopharmaceutical giant Klim-Ekam-I announced today the release of a proprietary anti-infectious bio-technology, developed for use in infants and children, that is active against multiple classes of infectious agents. In an unanticipated marketing move, the corporation announced that they would make their new product available to women world-wide at no cost. In extensive clinical testing, the new

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world wide at no cost. In extensive clinical testing, the new product is safe and effective in infants and small children. In addition, unexpected benefits to other family members have also been reported. The U. S. Government is looking into allegations that truth in advertising regulations may have been violated by the announcement.

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