PC14 THRIVING OF MALNOURISHED BREASTFED INFANTS AFTER ADDITIONAL FORMULA MILK FEEDING

Abstract

Introduction: Breastfeeding is the ideal way of nutrition for infants, especially during the first six months of life. Inadequate breastfeeding may result in critical infant failure to thrive. In such infants it is often necessary to implement nutritional intervention. We studied the efficiency of addition of formula milk to exclusively breastfed infants with failure to thrive, with formula offered after each breastfeeding. We aimed at a) catch up infant growth and b) preservation of breastfeeding as much as possible. Methods: 33 full-term (≥ 37. gestation wk, normal gestation wt) breast-fed, malnourished, otherwise healthy infants, aged from 28 to 99 days, participated in the study. Insufficient weight gain was defined as ≤40% expected weight gain for age (600 g/mnth) and/or body weight ≤10. percentile for age (Eurogrowth, 2000). After each breastfeeding, formula milk was offered to the infants at libitum, and strategies to preserve breastfeeding were explained to the mother by a paediatrician. Human milk intakes during the first three and the last three days of the study were monitored with the test weighting method. Formula milk intake was registered during the whole study period. Contribution of breastfeeding to total milk intake (CBF, %) was calculated as human milk / (human milk + formula milk intake) ×100. Anthropometric data of the infants were analyzed using Euro Growth program. Results: Mean (+ SD) weight, length and head circumference gains during 31 days of nutritional intervention were 1282 + 355 g, 4.0 + 0.9 cm and 2.2 + 0.9 cm. Absolute human milk intakes (mean + SD) decreased from 476 + 163 g/day (days 1–3) to 362 + 282 g/day (days 28–31) (p <0.01). CBF (mean + SD) decreased from 63 + 19 % (study days 1–3) to 42 + 35 % (study days 28–31) (p <0.001). Mean daily energy intake (human + formula milk) decreased from 140 ± 27 to 120 ± 24 kcal/kg. In the subgroup of 9 breastfeeding women with the highest contribution of breast-feeding to total milk intake (> 75%) at the beginning of the study, breastfeeding tendency increased in 7 out of 9 women (100% sensitivity, 96% specificity). Conclusion: The addition of formula milk to term malnourished breastfed infants improved their thriving. CBF decreased from 64 to 44% within the 31 days of additional formula feeding, but in children with > 75% of breast milk at baseline, the introduction of formula milk preserved or even increased breast milk intake.