Aims:To assess what is known about the risks associated with errors in reconstituting the present generation of infant formula feeds, and to examine which methods are likely to be safest. Methods: Systematic review, and examination of the range of infant formula products currently on sale in the UK. Studies from developed countries conducted after 1977 were included. All studies investigating the reconstitution of formula feeds for full term, healthy babies were eligible. Parameters studied were: measures of accuracy of feed reconstitution including fat, protein, total solids, energy content, and osmolality of feed; weight of powder in scoop; and reported method of preparing feed and measuring powder. Formula products were collected from one large UK supermarket in 2002. Number of different types of infant formula preparations available for sale were determined, together with scoop sizes for powdered preparations. Results: Only five studies were identified, none of adequate quality or size. All found errors in reconstitution, with a tendency to over-concentrate feeds; under-concentration also occurred. Thirty one different formula preparations were available for sale in one UK supermarket, with a range of scoop sizes. Some preparations had never been tested. Conclusions: There is a paucity of evidence available to inform the proper use of breast milk substitutes, and a large array of different preparations for sale. Given the impact incorrect reconstitution of formula feeds can have on the health of large numbers of babies, there is an important and urgent need to examine ways of minimising the risks of feed preparation. B reast feeding is the safest way to feed babies. For the majority of babies in all countries it is a perfect source of nutrition 1 and is available, ready-to-feed, via a clean delivery system. Breast feeding protects against infection, [2][3][4] and has benefits for health in childhood and beyond. [5][6][7] National and international agencies recognise the superiority of breast feeding and support it unequivocally.1 8 However, many babies in many countries are not breast fed.In the UK, in spite of initiatives to encourage more women to breast feed their babies, and to do so for longer, 9-11 over the past 20 years there has been no real change in the proportion of babies who are breast fed at birth. 12 In 2000, by 4-10 weeks of age (the first stage of the most recent national survey), 75% of babies were either exclusively fed on formula milks, or were receiving a combination of breast and formula feeds.12 These figures, which reflect infant feeding patterns in many westernised populations, highlight the fact that most babies in the UK are fed, wholly or in part, on breast milk substitutes. It is, therefore, important that while attempting to increase the prevalence and duration of breast feeding, 9 13-15 attempts should also be made to minimise the risks associated with artificial feeding.The most common breast milk substitutes are formula feeds manufactured as dried powders, reconstituted by ad...

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Background The Ugandan Maternal and Newborn Hub is a THET funded initiative focused on implementing Sustainable Volunteering Projects (SVPs) to improve maternal and newborn health. Annually, there are 2·65 million stillbirths worldwide and almost 90% occur in low-resource settings. Up to 70% of stillbirths occur in the intrapartum period; frequently these are associated with suboptimal care. Methods Through a SVP, from January to June 2012, we undertook a quality improvement project aiming to reduce intrapartum stillbirths at Mbarara Hospital in Uganda. Our quality improvements included regular audit presentations, implementation of a labour ward board and skills and drills training. We classified suboptimal care into types of delay using Thaddeus & Maine Three Delay Model. Results In this 6 months period, there were 102 intrapartum stillbirths. Most stillbirths were singleton pregnancies (99%) with a mean maternal age of 24 years and a mean parity of 2. 34% of women were unbooked. Suboptimal factors contributing to intrapartum stillbirths were identified in 86.4% of cases, 22% were related to care whilst admitted. Intrapartum stillbirths occurring after hospital admission reduced after introduction of quality improvement measures: see table. Abstract PP.26 Table Stillbirths Figures Mbarara Hospital 2012 Discussion Basic and comprehensive emergency obstetric care is an important intervention to reduce intrapartum stillbirths in the developing world. SVPs are an effective way of individualising quality improvement measures and improving outcomes.

Introduction SCD is associated with both maternal and fetal complications including pre-eclampsia, growth restriction and stillbirth together with an increased frequency of acute painful crises. Method This was a 6-year retrospective audit of 56 pregnant women with SCD: 22 HbSS & HbS-beta(0); 27 HbSC; 7 HbS-beta(+). Setting The women were all managed by the same multidisciplinary team, which included haematolgists, obstetricians and a specialist SCD midwife. Results There were few obstetric antepartum complications (2% pre-eclampsia, 2% antepartum haemorrhage). However, 35% were admitted with acute painful crises. 7 women underwent regular exchange transfusions for severe pre-existing maternal disease and significant obstetric history. There were no maternal deaths in this cohort.9% of women with SCD were delivered before 34 weeks. 64% of women were delivered by caesarean section (61% emergency, majority of which were for failure to progress).Out of the 56 pregnancies, there were 54 live births, 2 stillbirths (one unexplained at 40 weeks, one with severe growth restriction at 27 weeks), and 1 neonatal death (day 8 secondary to disseminated herpes simplex). Discussion The Green-top Guideline (No.61, 2011) suggests all those with SCD should be on low dose aspirin from 12 weeks, have appropriate management of painful crisis and undergo extra scanning with uterine artery dopplers.Most of these pregnancies predate this RCOG guideline. It would be interesting to note if further improvements in outcome will follow recent recommendations. SCD is the commonest and fastest growing single gene genetic disorder in the UK and these women benefit from specialised multidisciplinary care.