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Small formula doses may prolong breast-feeding

Monday May 13, 2013
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For infants experiencing high levels of weight loss in the first few days of life, giving small amounts of formula may actually increase the length of time their mothers end up breast-feeding, according to a study.

"Until now, we havenít explored if it is possible to identify babies who might benefit from early formula use," Valerie Flaherman, MD, MPH, the studyís lead author and an assistant professor of pediatrics and epidemiology and biostatistics at the University of California, San Francisco, said in a news release.

"This study provides the first evidence that early limited formula can provide important benefits to some newborns. Based on our findings, clinicians may wish to consider recommending the temporary use of small amounts of formula to new moms whose babies are experiencing significant early weight loss."

Recent public health efforts have focused extensively on reducing the amount of formula babies are given in the hospital after birth.

"Formula use has the potential to be a slippery slope to breast-feeding discontinuation, but early limited formula [ELF] is a different way to envision using it," said Flaherman, a pediatrician at UCSF Benioff Childrenís Hospital. "Rather than giving full bottles of formula that make it hard for the baby to return to the breast, ELF is a small amount of supplementation with a clear end point that alleviates some of the stress new mothers feel about producing enough milk."

Breast-feeding is known to offer wide-ranging preventive health benefits for babies, reducing their risk of infections and allergies and providing a balance of nutrients to help them grow into strong and healthy toddlers. Mothers and infants should breast-feed exclusively for the first six months for maximum health benefits, according to American Academy of Pediatrics guidelines.

Women do not immediately produce high volumes of milk after childbirth. Instead mothers initially secrete small amounts of colostrum, which contains high concentrations of nutrients and antibodies for the baby. During this period, babies often lose weight, and new mothers may be concerned that their babies appear fussy or hungry.

"Many mothers develop concerns about their milk supply, which is the most common reason they stop breast-feeding in the first three months," Flaherman said. "But this study suggests that giving those babies a little early formula may ease those concerns and enable them to feel confident continuing to breast-feed."

The study, published May 13 on the website of the journal Pediatrics, enrolled 40 full-term newborns who were 24 to 48 hours old and had lost more than 5% of their birth weight. The babies were randomly assigned either to receive early limited formula (ELF), which consisted of a third of an ounce of infant formula by syringe following each breast-feeding, or to continue with their mothersí intention to breast-feed exclusively.

So as not to interfere with breast-feeding eight to 12 times a day, the ELF babies were given only small amounts of formula. The syringe was used to help babies avoid developing nipple confusion, which is when a baby develops a preference for a bottle nipple over the breast. The ELF babies stopped the formula when their mothers began producing mature milk, approximately two to five days after birth.

At the one-week assessment, all the babies in both groups were still breast-feeding. However, only 10% of the ELF babies had received formula in the last 24 hours, compared with 47% of the control group.

After three months, 79% of the babies in the study who received early limited formula in the first days of life were still breast-feeding, compared with 42% of the babies who did not receive early limited formula. Additionally, 95% of the babies who received limited formula in the first few days were breast-feeding to some extent at three months, compared with 68% of the babies who did not receive early limited formula.

Although impressed with the results of this small study, the authors urged caution in interpreting their results. "It will be important to see whether these results can be confirmed in future, larger studies and in other populations," said Thomas Newman, MD, MPH, a professor of pediatrics and epidemiology and biostatistics at UCSF and a pediatrician at USCF Benioff Childrenís Hospital.

Read the study abstract: http://pediatrics.aappublications.org/content/early/2013/05/08/peds.2012-2809.abstract.


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