EARLY FEEDING OF COW'S MILK FORMULA - A RISK FOR COW'S MILK ALLERGY

Abstract

Feeding of cow's milk formula during neonatal life, particularly in delivery hospitals, has been incriminated as a major factor in the development of cow's milk allergy (CMA), the proof being, however, defective and coincidental. We examined prospectively, in a double-blind fashion, the effects of different feeding regimens given in delivery wards on the development of CMA in a large unselected group of newborn infants. Altogether 6211 healthy, term infants of mothers, who volunteered to the study within 12 hours from the delivery, in three delivery hospitals entered the study. In addition to breastfeeding, 5236 (84%) infants were given supplemental milk at hospital. Three different supplementary feeds were used. They were coded and changed every month; different delivery hospital used different supplements each months. The three study supplements were: pasteurized, pooled, human milk (HM), adapted, liquid cow's milk formula (AF; Tutteli, Valio, Finland) or whey hydrolysate formula (HF; Pepti-Junior, Nutricia Fennica, The Netherlands). Exact time and dose of every feed of the infants in the study was recorded in the delivery ward. The control group consisted of exclusively breast-fed infants. The mothers recorded the feeding regimen of the infants daily during the first 8 weeks. Family history of atopy was recorded during the stay at the hospital. If the child presented with symptoms suggestive to CMA, a milk challenge test was performed after 2-4-week elimination period in the hospital in a carefully scrutinized way during one day, the challenge continued at home, all infants were seen five days after the beginning of the challenge test. Out of 248 cow's milk challenges performed, 118 (48%), were positive, giving an incidence of 1.9% of CMA in the whole study group. In the feeding groups the results were: Table The group on AF had higher incidence of CMA than those in the other three groups (p=0.02). The difference was significant also between AF group and combined HF and HM groups; 2.6% vs 1.6% (p=0.02). Infants with CMA were equally often breast-fed exclusively for the first eight weeks in the three study groups (42% in AF, 42% in HF and 48% in HM groups). In the control group the percentage was significantly larger (94%). The incidence of allergy in family members of infants in different groups was similar. The study proves that adapted cow's milk formula given to a newborn infant during the first few days increases the risk for CMA. Hydrolysed whey formula and pasteurized human milk were as safe as exclusive breast-feeding during the first days of life. On the other hand. the exclusive breast-feeding during the first eight weeks did not protect from the CMA.