The Question of Whether to Use Supplementation in Infants

Abstract

The Academy of Breastfeeding Medicine’s protocol on supplementation states that weight loss is not an automatic marker for the need for supplementation in infants but is an indicator for additional evaluation. Excessive weight loss may be an indication of inadequate milk transfer or low milk production, but before automatically ordering formula supplementation, a thorough evaluation of the feeding session should be completed. Feeding issues need to be addressed as soon as possible because formula supplementation is not always medically indicated. Conversely, if formula supplementation is needed, it should be provided. The Newborn Weight Tool (NEWT) was created to allow health care providers plot a newborn’s weight and compare it with a large sample of newborns during the first days of life. It is a visual indicator of feeding success. Use the NEWT for any infant identified as having excess weight loss before ordering formula supplementation. The NEWT was initially implemented during daily interdisciplinary patient care rounds as a decision-making tool offering evidence to guide the plan of care. The team plots the weights on the tool and proposes a feeding plan based on results. Use of the NEWT has evolved, moving from the conference room during rounds to the bedside, becoming a collaborative and informed decision-making process between parents and the care team. Between Fiscal Years 2018 and 2019, breastfeeding exclusivity rates increased from 55% to 62%. We attribute this improvement in part to use of the NEWT. After implementation of the NEWT, the number of infants medically supplemented with formula for weight loss decreased to an average of 3 per month. We continue to use the NEWT and collect data related to those infants who are medically supplemented with formula to reverse weight loss. Implementing this innovative way to evaluate breastfeeding success has led to autonomy in nursing practice and empowers nurses with evidence to drive best newborn feeding practices. It has also led to earlier interventions for feeding issues that can affect length of stay as well as readmission rates for dehydration.