In a bid to promote breastfeeding, hospitals push to reduce formula feeding in infants in the days following their birth. But in a new study, the first to carry out a randomized trial, researchers show that giving small amounts of formula to newborns who lose a lot of weight in their first few days of life, can actually help prolong breastfeeding in the long term.
Lead author Valerie J. Flaherman of the University of California – San Francisco (UCSF), and colleagues, write about their findings in the 13 May online issue of the journal Pediatrics.
Because of its perfectly balanced nutritients for healthy growth and wide-ranging protective benefits, such as reducing infection and allergy risk, breastfeeding is widely promoted by public health bodies.
For example, the American Academy of Pediatrics recommends that for maximum health benefits, infants should breastfeed exclusively for the first six months of their lives, as long as mother and baby are in good health.
In a press statement, Flaherman, an assistant professor of pediatrics and epidemiology and biostatistics at UCSF and a pediatrician at the University’s Benioff Children’s Hospital, says until now, there hasn’t been much investigation of whether it is possible to pick out the infants who might benefit from early formula use.
“This study provides the first evidence that early limited formula (ELF) can provide important benefits to some newborns,” she adds, explaining that based on these 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.”
While using formula can be a “slippery slope” to stopping breastfeeding altogether, ELF can be seen as a different way to use it, says Flaherman.
The point of ELF is to supplement breastfeeding with small amounts of formula, to alleviate the stress that not having enough milk can produce in new mothers.
This is a different approach to giving babies full bottles of formula that then make it hard for them to return to the breast.
In the first few days after birth, the mother’s breasts tend to produce small amounts of colostrum, which contains high levels of nutrients and antibodies for the baby. Sometimes, this means milk production is delayed for a few days, and in the meantime the baby has lost weight, and may appear fretful and hungry, which naturally distresses to the mother.
“Many mothers develop concerns about their milk supply, which is the most common reason they stop breastfeeding in the first three months,” says Flaherman.
But this study suggests giving just small supplements of formula may alleviate that concern and help mothers carry on breastfeeding.
For the trial, Flaherman and colleagues recruited 40 full-term newborns. The infants were between 1 and 2 days old and had lost more than 5% of their birth weight.
They randomly assigned the babies to one of two groups: an ELF group and a breastfeeding only group.
In the ELF group, the babies received one-third of an ounce of infant formula by syringe after each breastfeed, while in the breastfeeding only group (the controls), the babies received no supplementation and were assigned to be fed only via the breast.
The idea of the intervention was to cause minimum interference with breastfeeding, which occurred up to 12 times a day. ELF was in small amounts, at the end of each breastfeeding session.
They used a syringe so as not cause confusion about nipples: sometimes when babies are given a bottle as well as the breast, they can end up preferring the bottle nipple.
ELF was stopped as soon as the mother were producing enough mature milk: this was between 2 and 5 days after birth.
One week after birth, all the babies in both groups were still breastfeeding. But in the ELF group, only 10% of the babies had been given formula in the previous 24 hours compared to 47% of the breastfeeding only group.
Three months after birth, 79% of the ELF babies were still breastfeeding exclusively, compared to 42% of the controls.
Also at the three-month assessment, researchers found that 98% of the ELF babies were breastfeeding to some extent, compared to only 68% of the controls.
Although the results seem impressive, the authors point out this is the first study of its kind, with a small number of participants, and now needs to be confirmed with larger trials in other populations.
James Taylor, medical director for the University of Washington Medical Center’s Newborn Nursery, was not involved with the research. He says the results are “provocative and challenge conventional wisdom”.
“It is crucial that we have more randomized controlled trials on interventions to increase breastfeeding rather than relying on heavily confounded observational studies or biased expert opinion,” he urges.
A recent report from the US Centers for Disease Control and Prevention (CDC) shows that more American mothers are breastfeeding, and a record number are still breastfeeding at six months.
Written by Catharine Paddock PhD