Consensus on the matter, though, is lacking. The UNICEF-World Health Organization Baby-Friendly Initiative, for instance, recommends that pacifiers not be used.16 The AAP, however, advises that pacifiers can be used once breastfeeding is well established.17
The research is also mixed. On the one hand, new evidence indicates that pacifier use may decrease the incidence of sudden infant death syndrome.18 On the other hand, pacifier use for longer than 48 months has been linked to orthodontic problems and dental caries.19,20
Thus, while prolonged pacifier use may be harmful to dental hygiene, newer evidence allows that pacifiers may be acceptable in the first few years during breastfeeding.
BELIEF 8: Newborn emesis is an indication for a formula change
THE EVIDENCE: No literature supports the belief that it is appropriate to change an infant’s formula in response to emesis in the first 2 weeks of life (SOR: C).
The overwhelming majority of vomiting episodes in newborns have no accompanying medical problem.21 A 2002 study by Miyazawa et al that looked at more than 900 infants showed more than 47% of Japanese infants ≤1 month of age had daily occurrences of regurgitation or emesis without having an underlying medical disorder.22
Newborns vomit for any number of benign reasons, including swallowed maternal blood or overfeeding.21 Gastroesophageal reflux can be a manifestation of milk allergy. However, a newborn infant is too young to manifest an antibody response to the protein in the formula. Therefore, switching formula because of vomiting due to milk allergy is not prudent in the first 10 to 14 days of life, the length of time needed to mount an antibody response to an antigen23 and thus, the length of time needed to become allergic to an infant formula.
BELIEF 9: Umbilical cord care can prevent umbilical cord infections
THE EVIDENCE: There is no definitive evidence regarding the best method for preventing umbilical cord infections among babies living in developed countries (SOR: C).
In fact, there is no evidence that any topical preparation, be it a dye, an antiseptic, or an antibiotic, is any better at preventing umbilical cord infections than keeping the area clean and dry.24 Umbilical cord infections such as omphalitis or tetanus neonatorum are more common in developing countries than high-income countries.16 In developed countries, cord care with topical antimicrobial agents is frequently unnecessary.24
Infants who were delivered at home and those who room in with their mothers have no need of a topical antimicrobial therapy. If an infant is kept in a hospital nursery or intensive care unit, topical antimicrobial therapy to the cord may have some benefit in keeping down cord colonization with pathological bacteria such as methicillin-resistant Staphylococcus aureus.24
Umbilical cord infections sometimes occur even when the cord area is kept clean and dry,25 so healthcare providers must be attentive to signs of possible infection.16
BELIEF 10: It’s easy to spot when a newborn is jaundiced
THE EVIDENCE: Jaundice is actually difficult to detect in darkly pigmented babies,5 and in babies sent home within 24 hours of birth, because bilirubin levels reach maximum levels between the third and fourth days of life26 (SOR: C).
Years ago, when infants stayed longer in the nursery, doctors had the chance to see them when their bilirubin level was highest and when the babies were most jaundiced. The current emphasis on early discharge does not allow this practice.
The AAP recommends clinical assessment of a newborn’s state of jaundice and that a bilirubin level be obtained whenever a physician is in doubt about the degree of clinical jaundice. The AAP also recommends that physicians consider obtaining a routine screening bilirubin in all newborns at the time of hospital discharge even if, by clinical assessment, the child is not jaundiced.5 (The AAP stopped short, though, of saying that such a screening test is required.) The AAP made these recommendations because of an increasing concern that the incidence of kernicterus in America is rising.27
BELIEF 11: All infants who require phototherapy need IV fluids to prevent dehydration and enhance excretion of bilirubin
THE EVIDENCE: Unless the baby is clinically dehydrated, IV fluid therapy for infants under phototherapy is not needed28 (SOR: c).
Though IV fluid therapy is commonly used to increase the excretion of bilirubin and combat dehydration, the research tells us that IV fluids do not bring down bilirubin levels and that even with mild dehydration, the best fluid therapy is breast milk or formula because it inhibits the enterohepatic circulation of bilirubin.5 Intravenous fluid therapy should be reserved for jaundiced newborns with moderate to severe dehydration, or those with mild dehydration5 who are not able to take fluid by mouth.