Recent public health efforts focus on reducing formula use for breastfed infants during the birth hospitalization. No previous randomized trials report the effects of brief early formula use. The objective of the study was to determine if small formula volumes before the onset of mature milk production might reduce formula use at 1 week and improve breastfeeding at 3 months for newborns at risk for breastfeeding problems.
We randomly assigned 40 exclusively breastfeeding term infants, 24 to 48 hours old, who had lost ≥5% birth weight to early limited formula (ELF) intervention (10 mL formula by syringe after each breastfeeding and discontinued when mature milk production began) or control (continued exclusive breastfeeding). Our outcomes were breastfeeding and formula use at 1 week and 1, 2, and 3 months.
Among infants randomly assigned to ELF during the birth hospitalization, 2 (10%) of 20 used formula at 1 week of age, compared with 9 (47%) of 19 control infants assigned during the birth hospitalization to continue exclusive breastfeeding (P = .01). At 3 months, 15 (79%) of 19 infants assigned to ELF during the birth hospitalization were breastfeeding exclusively, compared with 8 (42%) of 19 controls (P = .02).
Early limited formula may reduce longer-term formula use at 1 week and increase breastfeeding at 3 months for some infants. ELF may be a successful temporary coping strategy for mothers to support breastfeeding newborns with early weight loss. ELF has the potential for increasing rates of longer-term breastfeeding without supplementation based on findings from this RCT.
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Re:Effect of Early Limited Formula Supplementation on Duration and Exclusivity of Breastfeeding
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Effect of Early Limited Formula Supplementation on Duration and Exclusivity of Breastfeeding
This paper makes it sound like it is okay to give newborns small amounts of formula for a weight loss, and raises many questions.
Maternal IV load is correlated with newborn weight loss (Pediatrics 2011: 127), with some authors ( Noel-Weiss et al Int BF J 2011) suggesting that newborn weights are accurate 24 hours after being born, after the baby has had time for diuresis. There is no mention in this article about maternal IV loads.
Formula use before gut closure alters the pH of the newborn gut which leads to a different microbiome, with the potential for serious impact on health over the course of a life. This is true when even if small amounts of formula are used.
All mothers come to the hospital with milk in their breasts. A local hospital has a policy called Code White, which gives a mother half an hour to either hand express or breastfeed for babies in need of supplementation. Giving donor human milk is another option.
Sometimes infant symptoms (weight loss, low blood sugar, and hyperbilirubinemia) result from hospital practices that prevent mother and baby from breastfeeding. A BabyFriendly hospital is a facility that implements best practices so that mother and baby are together for frequent breastfeeding and where maternity staff are trained to help mothers breastfeed. (A hospital does not have to be BabyFriendly to implement best practices.)
Exclusive breastfeeding means that the newborn receives nothing by mouth but human milk, (unless some medicine or vitamins are prescribed). This is a global public health recommendation. Giving formula, even a little bit, in a vulnerable time when the new mother and baby are learning about each other, carries unnecessary risks.
When I read that one of the authors has served as a paid consultant to major formula companies, suddenly the intent of this article made sense. Thank goodness for disclosure!
sincerely, Nikki Lee RN, BSN, MS, IBCLC, ANLC
Conflict of Interest:
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