Exclusive Formula Feeding Research Articles

889: Reasons socioeconomically disadvantaged (SED) women quit breastfeeding: can better targeted educational interventions improve breastfeeding ontinuation rates?

Most breastfeeding (BF) interventions for SED women focus on BF initiation, which does not necessarily correlate with BF continuation. We investigated reasons for quitting BF among SED women who initiated BF and the perceived usefulness of potential educational interventions in this population. This cross-sectional study occurred in 2016 at a single university-based tertiary care center, which is a Baby Friendly Hospital. SED women without a BF contraindication who delivered non-anomalous singletons were recruited at scheduled appointments within 6 months of delivery. Consenting women completed a validated BF survey. Outcomes included rates of BF with or without formula, perceived BF problems, and perceived usefulness of BF educational interventions. Among women who initiated BF, we compared outcomes between those who chose exclusive formula feeding and those who chose BF with formula supplementation on postpartum day #2 (PPD2). 149 women completed the survey. Though 129 (86.6%) initiated BF, by PPD2, 47 (31.5%) chose formula supplementation, and 51 (34.3%) chose exclusive formula feeding. The majority of women who chose exclusive formula feeding reported initiating BF (60.8%). Among those who initiated BF and added formula by PPD2, formula supplementation was associated with more perceived BF problems, ranging from latch difficulty to concern for low supply. Most women who chose exclusive formula feeding did not report any BF problems. On a 1-5 scale, with 1 denoting strong agreement, all patients initiating BF agreed that future educational interventions should include information on BF benefits, normal neonatal behavior, BF resources, and videos showing latch and BF holds. Women who chose formula supplementation were more likely to “strongly agree” with these proposed interventions than those who chose exclusive formula feeding. The majority of SED women who quit BF did so due to personal preference, not due to having problems with BF. To increase exclusive BF rates in this high-needs population, future educational interventions should focus on issues that the formula supplementation group identified as barriers to exclusive BF: BF benefits, normal neonatal behavior, and access to videos showing how to BF.

The Type of Feeding at Discharge of Very Preterm Infants: Neonatal Intensive Care Units Policies and Practices Make a Difference.

Objective: To assess the influence of neonatal intensive care units (NICUs) on feeding practices at discharge of Portuguese very preterm infants. Materials and Methods: We analyzed data from 580 very preterm infants (<32 gestational weeks) discharged home from NICUs of two Portuguese regions and enrolled during 2011-2012 in Effective Perinatal Intensive Care in Europe population-based cohort. Maternal and infant characteristics were abstracted from medical records, and heads of NICUs provided the units characteristics. Feeding at discharge was classified as exclusive formula, exclusive breast milk or mixed, and differences among NICUs were obtained by comparison with pooled geometric mean odds of all NICUs, using multinomial logistic regression. Median odds ratios (MOR) were calculated to quantify variability among NICUs using multilevel logistic regression. Results: At discharge, 25.2% very preterm infants were exclusively on breast milk, 34.1% exclusively on formula, and 40.7% had mixed feeding, with a wide variation among NICUs. Exclusive breast milk increased in NICUs that had higher numbers of admissions, provided parents eating facilities, and by having designated members to support mothers who were breastfeeding. The individual NICU odds of mixed versus exclusive formula feeding ranged from 0.36 to 2.07 and for exclusive breast milk versus exclusive formula ranged from 0.16 and 5.11. Adjusting for individual and unit characteristics, heterogeneity across NICUs remained evident, being the MOR 1.33 for mixed feeding and 1.35 for exclusive breast milk. Conclusions: NICUs influence feeding practices independently of individual characteristics, highlighting the importance of institution-based interventions to promote breast milk.

Comparison of the Prevalence of Helicobacter pylori Infection Between the Exclusively Breastfed and Formula- or Mixed-Fed Infants in the First Six Months of Life

Background: Helicobacter pylori is a common gastrointestinal pathogen in human. The mechanism of its acquisition and transmission is unclear, although the most likely mode of transmission is fecal-oral or oral-oral. Most of infections occur in childhood. The current cohort assessed the prevalence of infection in infants with different feeding strategies (exclusive breastfeeding, formula, or mixed feeding). Methods: The current study was carried out in Vali-Asr hospital of Imam Khomeini hospital complex, Tehran, Iran, from 2012 to 2015.The study population included infants born in this hospital and registered in breastfeeding research center during the first 6 months of life. They were compared in 2 groups; exclusively breastfed, and formula or mixed fed. Mothers’ H. pylori infection was checked serologically using the enzyme-linked immunosorbent assay (ELISA) technique and those of infants by monoclonal antibody test using ELISA technique on stool samples at 1st and 6th month of life. Results: A total of 102 infants in 2 groups (54 exclusively breastfed and 48 formula or mixed fed) completed the study. Mothers’ serological assessments were positive in 68% of exclusively breast-fed subjects and 60% of formula or mixed fed subjects. All 1-month-old infants were negative for the infection and in the 6-month-old infants 10 cases (18.5%) were positive, 1 case was at borderline in the exclusively breastfed, and 13 cases (27%) were positive in formula- or mixed-fed subjects. This difference was not statistically significant (P = 0.302). The Mantel-Hanzel test was used to find a relationship in H. pylori positivity in mothers and infants during the first 6-month of life in each of the 2 groups. It was found that out of 37 serologically positive mothers in the breastfed group, 8 infants (22%) were H. pylori positive and in the formula and mixed-fed group, of 29 serologically positive mothers 10 infants (34%) were also H. pylori positive, but the difference between the groups was not statistically significant (P = 0.727). It meant that the prevalence of infantile H. pylori infection was similar in the 2 groups. Conclusions: The current study findings showed that exclusive breastfeeding had no role in protection or facilitation of H. pylori infection.

Effect of Dedicated Lactation Support Services on Breastfeeding Outcomes in Extremely-Low-Birth-Weight Neonates.

Breastfeeding is associated with major benefits for high-risk infants born prematurely, yet this population faces significant challenges to breastfeeding. Lactation services provide successful interventions, yet the impact of lactation services on breastfeeding outcomes in preterm infants is understudied. Research aim: The provision of full-time lactation support in the neonatal intensive care unit (NICU) will improve quantitative breastfeeding measures in premature infants. A longitudinal retrospective nonexperimental design was used. Data were collected from medical records of breastfeeding outcomes in patients 30 weeks' gestational age and under admitted to a level IV regional NICU over three epochs of varying levels of lactation services, from none to full time. Demographic, medical, and breastfeeding data were collected. Data analysis was performed using standard statistical tests and hierarchical regression analysis. A significant increase in the number of lactation consults was observed across epochs, and the number of infants who received human milk via feeding at the breast, as the first oral feeding, increased across epochs. After controlling for covariates, the odds of infants receiving any human milk compared with exclusive formula feeding increased across epochs. The provision of full-time dedicated NICU lactation support is associated with an increase in breastfeeding outcome measures for high-risk preterm infants.

Probiotics Prevent Late-Onset Sepsis in Human Milk-Fed, Very Low Birth Weight Preterm Infants: Systematic Review and Meta-Analysis.

Growing evidence supports the role of probiotics in reducing the risk of necrotizing enterocolitis, time to achieve full enteral feeding, and late-onset sepsis (LOS) in preterm infants. As reported for several neonatal clinical outcomes, recent data have suggested that nutrition might affect probiotics’ efficacy. Nevertheless, the currently available literature does not explore the relationship between LOS prevention and type of feeding in preterm infants receiving probiotics. Thus, the aim of this systematic review and meta-analysis was to evaluate the effect of probiotics for LOS prevention in preterm infants according to type of feeding (exclusive human milk (HM) vs. exclusive formula or mixed feeding). Randomized-controlled trials involving preterm infants receiving probiotics and reporting on LOS were included in the systematic review. Only trials reporting on outcome according to feeding type were included in the meta-analysis. Fixed-effects models were used and random-effects models were used when significant heterogeneity was found. The results were expressed as risk ratio (RR) with 95% confidence interval (CI). Twenty-five studies were included in the meta-analysis. Overall, probiotic supplementation resulted in a significantly lower incidence of LOS (RR 0.79 (95% CI 0.71–0.88), p < 0.0001). According to feeding type, the beneficial effect of probiotics was confirmed only in exclusively HM-fed preterm infants (RR 0.75 (95% CI 0.65–0.86), p < 0.0001). Among HM-fed infants, only probiotic mixtures, and not single-strain products, were effective in reducing LOS incidence (RR 0.68 (95% CI 0.57–0.80) p < 0.00001). The results of the present meta-analysis show that probiotics reduce LOS incidence in exclusively HM-fed preterm infants. Further efforts are required to clarify the relationship between probiotics supplementation, HM, and feeding practices in preterm infants.

Protocol for a systematic review on health outcomes related to the age of introduction of complementary food for the scientific assessment of the appropriate age of introduction of complementary feeding into an infant's diet.

In 2016, the European Food Safety Authority (EFSA) received a mandate from the European Commission to update its 2009 opinion on the appropriate age for introduction of complementary feeding of infants. In order to retrieve data on health outcomes related to the age of introduction of complementary food, a systematic literature review will be conducted in line with the EFSA guidance on the application of systematic review methodology to food and feed safety assessments to support decision making. These data will be considered together with data on the nutritional adequacy of exclusive breastfeeding or formula feeding at different ages and with data on neuromuscular, gastrointestinal and renal development which may affect the capacity of the infant to introduce non‐milk foods in the diet as the basis for the scientific assessment. This protocol serves as a basis for conducting the systematic literature search aiming to retrieve data on health outcomes related to the age of introduction of complementary food. As EFSA wished to seek advice from stakeholders on the draft protocol for the systematic literature review, the NDA Panel endorsed the draft protocol for public consultation on 1 February 2017. The consultation was open from 16 February to 23 March 2017 (5 weeks).

Risk factors and clinical outcomes for carbapenem-resistant Gram-negative late-onset sepsis in a neonatal intensive care unit

Carbapenem-resistant (CR), Gram-negative (GN), late-onset sepsis (LOS) is a serious threat in the neonatal intensive care unit (NICU). To assess the prevalence of CR-GN-LOS in NICU patients and to identify the risk factors and outcomes associated with its acquisition. Neonates with carbapenem-susceptible (CS)-GN-LOS were compared with those with CR-GN-LOS in a two-year observational study. A total of 158 patients had GN-LOS; 100 infants had CS-GN-LOS and 58 infants had CR-GN-LOS. The incidence rate of CR-GN-LOS was 6.5 cases per 1000 patient-days. The most frequent bacterial strain in both groups was Klebsiella pneumoniae. The duration of total parenteral nutrition (TPN) (P=0.006) and prior carbapenem use (P=0.01) were independent risk factors for CR-GN-LOS acquisition. CR-GN-LOS was associated with higher mortality than CS-GN-LOS (P=0.04). Birth weight, small for gestational age, time to start enteral feeding, exclusive formula feeding, previous surgery, previous antifungal use, central venous device before onset, duration of central venous device, and infectious complications were identified as dependent risk factors for overall mortality. However, only male gender (P=0.04) and infectious complications (P < 0.001) were independent risk factors associated with mortality. Infectious complication rates, duration of mechanical ventilation, and length of hospital stay were significantly higher in infants with CR compared to CS-GN-LOS. The duration of TPN and carbapenem use were the independent predictors for CR-GN-LOS acquisition. CR-GN-LOS is associated with higher mortality, infectious complication rates, longer mechanical ventilation, and longer hospital stay. Male gender and infectious complications were the independent risk factors for mortality in neonates with GN-LOS.

Comparison of Breastfeeding and Exclusive Formula Feeding Rates 2-3 and 6-8 Weeks After Delivery Amongst Primiparas [21E

INTRODUCTION: Our study’s objective was to compare breastfeeding and exclusive formula feeding rates amongst primiparous women with an expressed intent to breastfeed during their admission for childbirth when randomized to either a 2-3 or 6-8 week follow up interval. METHODS: The data for this study was obtained as part of a randomized controlled trial that recruited term, primiparous women with an expressed intent to breastfeed to postpartum appointment intervals of either 2-3 or 6-8 weeks following childbirth. At the time of their postpartum encounter, their infant feeding method was categorized and compared using an odds ration with 95% CI. RESULTS: Of the 340 women enrolled in the study, 307 returned for a postpartum appointment where their infant feeding could be assessed. For 4 women in each group, infant feeding status was not denoted in their encounter record. Women randomized to the 2-3 week follow up interval were less likely to report exclusive formula feeding (OR 0.16, 95% CI 0.05-0.46, p &lt; 0.01) and more likely to report breastfeeding of any degree (OR 6.41, 95% CI 2.15-19.11, p &lt; 0.01). CONCLUSION: Amongst primiparous women with an expressed intent to breastfeed during their inpatient postpartum stay, our study demonstrated that women seen for earlier postpartum follow up were more likely to report breastfeeding to any degree and less likely to report exclusive formula feeding. Our findings suggest significant breastfeeding attrition may occur between 2-3 and 6-8 weeks after delivery. Understanding the timing for breastfeeding attrition may help us to target interventions to promote breastfeeding success and continuation.

A Coordinated Cultural Shift Improves Breastfeeding Exclusivity in a Federally Qualified Health Center [16E

INTRODUCTION: Provider support for breastfeeding has been shown to have a positive impact on breastfeeding including initiation and continuation. This study attempts to determine if a coordinated cultural shift can influence breastfeeding rates among patients in a Federally Qualified Health Center (FQHC). METHODS: All staff at Eric B. Chandler Community Health Center, an FQHC located in an urban setting in New Jersey, were educated about the importance of breastfeeding and improved outcomes in breastfeeding mother-baby pairs. Additionally, key staff members were trained to assist with breastfeeding problems. Breastfeeding promotion was standardized within the obstetric program. A professional relationship with WIC was established. Data was collected and analyzed to determine if there was an impact on breastfeeding at the six-week postpartum visit comparing the six months prior to and six months after the cultural shift. RESULTS: Three hundred seventy-three women in the post intervention group were compared to 63 women in the baseline group. Exclusive breastfeeding at six weeks postpartum increased from 12/63 (19.1%) to 107/373 (28.7%), p less than 0.05. Combination feeding decreased from 31/63 (49.2%) to 159/373 (42.6%). Exclusive formula feeding remained unchanged 20/63 (31.7%) compared to 107/373 (28.7%). Mode of delivery had no influence on rates of breastfeeding. CONCLUSION: This study demonstrates that a coordinated cultural shift can increase the rate of breastfeeding exclusivity in a FQHC. Improvement in exclusivity, however, was a result of more breastfeeding women forgoing supplementation. There was no comparable increase in formula feeders choosing either combination feeding or exclusive breastfeeding.

Ethnic Disparities in Beverage Consumption for American Infants and Children

Beverages contribute nearly a quarter of the total daily calories for children in their first 5 years of life. With this large caloric contribution it's important to understand what additional nutrients these beverages contribute to the diet of American infants and children. Our hypothesis was that nutrient dense beverages, such as milk and 100% juice, provide a significant percentage of essential nutrients to the diets of infants and young children. Thus, the goal of this project was to examine beverage consumption in children (0–6 mo, 6–11 mo, 12–23 mo, 2–3 yrs, and 4–5 yrs), among varying ethnic groups (Non‐Hispanic White (NHW), Non‐Hispanic Black (NHB), Hispanic (H), and Asian (A)). Data from the dietary component of 2011–2014 National Health and Nutrition Examination Survey (NHANES) were used in this study (n=2,431). Beverages were broken down as follows; dairy (milk, flavored milk, milk shakes, dairy drinks, milk substitutes), 100% juice (citrus, apple, other fruit, vegetable, baby juice), diet beverages (soft drinks, sport drinks, energy drinks, other), sweetened beverages (soft drinks, fruit drinks, sport drinks, energy drinks, nutritional beverages), coffee &amp; tea, and water (tap, bottled, flavored, carbonated, enhanced, fortified, baby water). Results show that dietary recommendations of exclusive breastmilk or formula feeding for the first 6 mo are not always followed, with 12% of children 0–5 mo already consuming 100% juice, providing 1% of total calories for this age group. Additionally the recommendation of not drinking any milk before 1 yr of age is not always followed either as 22% of 6–11 mo children already drinking milk, providing 7% of total calories. As children get older, sweetened beverage consumption rapidly increases. For example, 60% of 4–5 yrs children consume sweetened beverages, providing 6% of their total calories, while only 55% drink water. Along with the increase in these energy dense, yet nutrient poor beverages the intake of nutrient dense beverages such as milk and 100% juice begin to decline at 2 yrs. Further, ethnic disparities exist among beverage intakes across the age groups examined. Throughout all ages, NHB children consume the least milk and the most sweetened beverages as well as 100% juice. During the second year of life NHB children consume nearly 2, 3, and 6 times as much sweetened beverages than H, NHW, and A toddlers, respectively. The decrease in nutrient dense beverage consumption is complemented by a decrease in the number of children who meet the EAR/AI for the nutrients of concern (e.g., vitamin D, calcium, potassium, and iron). Behaviors that are adopted in childhood tend to persist throughout adulthood, thus nutrition education to promote nutrient dense beverage consumption, such as milk and 100% juice, and also water, in place of sugar sweetened beverages can have a large and positive impact on overall childhood health, especially among NHB.Support or Funding InformationFunding provided by National Dairy Council

Predictors of Breastfeeding Intention in Malaysia

Breastfeeding is linked to a number of health related benefits among infants. Breastfeeding provides the ideal nutrition for infants, by promoting a higher IQ and protecting against childhood and adult diseases. Despite these health benefits, the rates of exclusive breastfeeding are still low in Malaysia. Intention to breastfeed is closely related to early initiation to breastfeed and could also be a predictor of longer duration of breastfeeding. The objectives of this study are to provide a descriptive analysis of the sociodemographic characteristics, breastfeeding intention and breastfeeding attitudes and determine predictors affecting breastfeeding intention among low-to-middle income women. A prospective cohort study was undertaken of mothers attending eight antenatal clinics run by the Ministry of Health in Selangor, Malaysia. Mothers were recruited during the antenatal period and followed up until six months postpartum to document breastfeeding outcomes. Among 652 mothers in our study, exclusive breastfeeding, mixed feeding, and exclusive formula feeding intentions were 49.6%, 46.3%, and 9.0%, respectively. Age, maternal employment, maternal education, parity, pre-pregnancy body mass index (BMI), breastfeeding attitude, spouse’s preference, grandmother’s preference and breastfeeding experience had significant relationship with breastfeeding intention (p&amp;lt; 0.05). However, further analysis showed that breastfeeding intention was associated with positive breastfeeding attitudes, older age, greater years of education, being housewives, having partner and family support for breastfeeding and grandmothers’ breastfeeding experience. These findings suggest that by providing breastfeeding initiatives towards less educated, young mothers who lack breastfeeding support from their loved ones may improve breastfeeding rates.Keywords: Exclusive breastfeeding; Maternal obesity; Breastfeeding intention; Breastfeeding attitudeISSN: 2398-4287© 2017. The Authors. Published for AMER ABRA by e-International Publishing House, Ltd., UK. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer–review under responsibility of AMER (Association of Malaysian Environment-Behaviour Researchers), ABRA (Association of Behavioural Researchers on Asians) and cE-Bs (Centre for Environment-Behaviour Studies), Faculty of Architecture, Planning &amp; Surveying, Universiti Teknologi MARA, Malaysia.

Risk factors of infant anemia in the perinatal period.

Infants are at particular risk of iron-deficiency anemia. We investigated changes in the blood count of the mother and infant as well as the relationship between them and the relationship between infant nutrition method and infant anemia. This retrospective cohort study included healthy neonates born between August 2011 and July 2014 at St Luke's International Hospital, Tokyo, Japan. Data from maternal blood samples obtained during late pregnancy and those of infants obtained at birth and at the age of 3, 6, and 9 months were analyzed. Using multivariate logistic regression, we investigated nutrition methods, maternal anemia, and other clinically relevant parameters that were potential risk factors for infant anemia. In total, data for 3472 infants and their mothers were analyzed. Nutrition method was the most significant risk factor for infant anemia, with risk of future anemia decreasing in the following order: exclusive breast-feeding, partial breast-feeding, and formula feeding. Furthermore, low umbilical cord blood hemoglobin led to a tendency toward anemia in the child. Infant nutrition method was the most significant factor related to anemia in late infancy. Infants with low umbilical cord blood hemoglobin are more likely to develop anemia in late infancy.

Effect of breastfeeding versus infant formula on iron status of infants with beta thalassemia major

BackgroundThalassemia major or Cooley’s anemia is the most severe form of beta thalassemia in which the complete lack of beta protein in the hemoglobin causes a life-threatening anemia requiring regular blood transfusions and extensive ongoing medical care. These extensive, lifelong blood transfusions lead to iron-overload that must be treated with chelation therapy to prevent early death from organ failure. We compared serum iron and ferritin levels amongst infants aged up to one year with beta thalassemia major according to their feeding types, including exclusively breastfed, exclusively formula fed and combined (both breast and formula) fed types.MethodsSixty out of 176 screened infants with transfusion dependant beta thalassemia major were recruited from the outpatient clinic of thalassemia at Zagazig University Hospital in Egypt, between 2007 and 2014. Patients were classified into three groups (20 patients per group) according to type of feeding. Group 1: exclusive breastfeeding, around 6–8 feeds per day; group 2: exclusive infant formula feeding, 120–150 ml of formula per kilogram of body weight per day divided into 6–8 feeds and group 3: combined breastfeeding and formula per day.ResultsSerum iron and ferritin levels were lower in group 1 compared to groups 2 and 3. The mean serum iron for group 1 was 73, 87 and 96 ug/dl at 6, 9 and 12 months respectively, while that for group 2 was 85, 99 and 112 ug/dl at 6, 9 and 12 months respectively and for group 3 was 78, 92 and 99 ug/dl at 6, 9 and 12 months respectively. The mean serum ferritin for group 1 was 283, 327 and 497 ng/ml at 6, 9 and 12 months respectively, while that for group 2 was 310, 389 and 591 ng/ml at 6, 9 and 12 months respectively and for group 3 was 291, 345 and 515 ng/ml at 6, 9 and 12 months respectively. The differences were not statistically significant.ConclusionsBreastfed infants with beta thalassemia major may accumulate less iron than infants fed iron fortified formula anticipating later onset of iron overload in the breastfed infants. Larger studies are needed to support these findings.

Self-reported breast feeding practices and the Baby Friendly Hospital Initiative in Riyadh, Saudi Arabia: prospective cohort study

BackgroundThe Baby Friendly Hospital Initiative (BFHI) is a practice guideline for healthcare providers to promote breastfeeding and increase breastfeeding rates.ObjectiveThis study aimed to examine reported experiences and views on breastfeeding...

Breastfeeding practices on postnatal wards in urban and rural areas of the Deyang region, Sichuan province of China.

BackgroundDespite the efforts that have been made to promote breastfeeding in China since the 1990s, there is still a very low prevalence of exclusive breastfeeding. The objective of this study was to assess the current situation of infant feeding practices during the postpartum hospital stay in urban and rural areas of the Deyang region.MethodsCross-sectional sampling was used in two urban hospitals and five rural clinics in the Deyang region of southwestern China. Interviews with mothers after delivery (urban n = 102, rural n = 99) were conducted before discharge and five focus group discussions were held.ResultsThe prevalence of Caesarean section was high in both urban and rural areas (63.9 % urban vs. 68.4 % rural). After birth, nearly all mothers (98.0 % urban vs. 99.0 % rural) initiated breastfeeding. One week after delivery, the prevalence of exclusive breastfeeding was 8.0 % (9.8 % urban vs. 6.1 % rural), almost exclusive breastfeeding 34.5 % (29.4 % urban vs. 39.8 % rural), mixed feeding 56.0 % (58.8 % urban vs. 53.1 % rural), and exclusive formula feeding 1.5 % (2.0 % urban vs. 1.0 % rural).Breastfeeding initiation (≤ two days after birth) was positively associated (Odds Ratio [OR] 1.97, 95 % Confidence Interval [CI] 1.11, 3.50) with exclusive and almost exclusive breastfeeding, whereas birth length under 50 cm (OR 0.48, 95 % CI 0.26, 0.87), mother’s education > 12 years (OR 0.46, 95 % CI 0.24, 0.88) and mother’s lack of knowledge about the importance of colostrum (OR 0.35, 95 % CI 0.14, 0.86) were negatively associated with almost exclusive breastfeeding.ConclusionAlthough disparities between urban and rural areas exist, the situation of infant feeding is inadequate in both settings. The high prevalence of Caesarean section, the mothers’ poor knowledge of the physiology of breast milk production, the mothers’ lack of breastfeeding confidence, the widespread advertising of breast milk substitutes, and the changing perception of the function of breasts, may influence the unfavorable breastfeeding behavior observed in the study area.

Prevalence and Predictors of Exclusive Breastfeeding in Late Preterm Infants at 12 Weeks

Purpose: The purpose of this study was to identify breastfeeding practice with late preterm infants (LPIs), and to determine predictors of exclusive breastfeeding at the 12th week after discharge. Methods: The participants were 106 mothers of LPIs hospitalized in neonatal intensive care units at two university hospitals. Data were collected between February and October, 2013. Questionnaires included characteristics of LPIs, their mothers, and feeding-related characteristics. Feeding methods were exclusive breastfeeding, mixed feeding, and formula feeding. Results: Exclusive breastfeeding steadily increased from 5.7% at the 1st week to 19.8% at the 12th week, as did formula feeding from 27.3% to 67.9%. Contrarily, mixed feeding decreased from 67.0% at the 1st week to 12.3% at the 12th week. The ratio of formula feeding was higher than that of exclusive breastfeeding over time. Predictors for exclusive breastfeeding were the following: type of delivery (OR=2.96, 95%CI=1.07-8.14), feeding intolerance (OR=3.03, 95%CI=1.26-7.25) and feeding method during hospitalization (OR=7.84, 95%CI=3.15-19.53). Conclusion: In order to increase breastfeeding opportunities for LPIs, educational programs for gestational age-appropriate breastfeeding should be developed. The focus of breastfeeding education needs to be on mothers who delivered their LPIs through Cesarean-section and LPIs who had feeding intolerance or were fed only formula during hospitalization.

Impact of Breastfeeding on the Nutritional Status of Infants with Cystic Fibrosis (CF) in the First Year of Life‐Results of the FIRST STUDY

Optimizing nutritional status is critical in CF infants. The 2009 CF Foundation guidelines call for breast milk(BM) as the initial type of feeding, but do not address appropriateness of exclusive or prolonged breastfeeding(BF) for CF patients with meconium ileus and/or pancreatic insufficiency. There are no recommendations for fortification of BM or formula to increase caloric and nutrient density.Objectives1)Determine growth patterns and nutritional status in infants with CF in the first year of life &amp; relate this to feeding type 2)Assess the potential longer term benefits and risks of early exclusive breastfeeding in infants with CF on nutritional status &amp; pulmonary disease status at 2 y –6 y of age.MethodsThe FIRST Study is an ongoing US multi‐centered prospective observational study to determine optimal feedings for infants with CF. Study endpoints include growth patterns (weight (W), length(L), W/L ratio), prevalence of anemia, and fatty acid &amp; vitamins A,E,D status. Infants were evaluated monthly after study enrollment when feeding information was collected.Results115/160 infants have been enrolled to date, 96 of whom have completed 12 mo of the study and are included in this preliminary analysis. Infants were diagnosed at 0.8 ± 0.7 mo and enrolled at 1.6 ± 0.9 mo. Infants self selected into 1 of 3 feeding groups: exclusive BF (ExBF), exclusive formula feeding (ExFF), &amp; mixed feeding(MF). 63% initiated ExBF,decreasing to 31% at 4 wk, 18% at 4 mo, and 15% at 6 mo. 26% initiated ExFF, increasing to 45% at 4 mo and 56% at 6 mo. 11% initiated MF which increased to 37% at 4 mo &amp; declined to 29% by 6 mo. WHO W and L z‐scores were normal at birth and fell below normal by 2 mo regardless of feeding type. W but not L z‐scores recovered by 12 mo, but growth patterns differed significantly by feeding type. Increasing duration of ExBF was associated with lower increases in both W &amp; L z‐scores. 40% of infants were unable to achieve 25‐OH Vit D levels ≥ 75 nmol/L despite early and sustained supplementation with a median intake of 400 IU Vit D (400–2500 IU/d). Highest rate of deficiency occurred at 4 mos. Vit A and Vit E status did not differ by feeding group. Median Vit A intake was 5751 IU (750–11,502 IU/d) and median Vit E intake was 50 IU (range 5–100 IU/d). Low vit A level ( α‐tocopherol &lt; 5 mg/L) was observed in 14% of infants. Prevalence of low vit E (retinol &lt; 0.2 mg/L) was very low. Hemoglobin was assessed in 70% of infants between 6 &amp;12 mo and 33% were anemic, more prevalent (50%)in the ExBF infants who were not routinely supplemented with Fe. 83% of ExBF had iron intakes less than the RDA. Abnormal essential fatty acid status (EFA) was common before age 3 mo; 36% of infants were deficient or insufficient (triene‐tetraene &gt; 0.01). In addition, the concentrations of the principle EFA, linoleic acid was lower in BF compared to FF infants, but no difference in DHA was noted. The prevalence of Pseudomonas aeruginosa infections did not differ between BF and FF infant.ConclusionsOur data indicate that duration of exclusive breastfeeding in CF infants during the first year of life has a potential negative impact on growth patterns and on various measures of nutritional status including growth and prevalence of Fe, vit D,and EFA deficiencies.Support or Funding InformationSupported by NIH‐RO1DK072126, R56DK109692, UL1TR000427, CFF‐LAI14A0

Factors Associated with Supplemental Formula Feeding of Breastfeeding Infants During Postpartum Hospital Stay.

To determine reasons potentially amenable to interventions that mothers choose to supplement breastfeeding with formula in the immediate postpartum period. We distributed surveys to all mothers in the postpartum unit who delivered a live newborn on day of maternal discharge to assess feeding behaviors during their inpatient admission. We evaluated, when applicable, their reasons for supplementation and examined cultural and demographic information to uncover trends for formula use and potential areas for provider intervention. Seven hundred twelve of 1,400 mothers responded, of which 478 (65%) reported supplementing breastfeeding with formula (BF+F). The most common reasons for formula supplementation were perception of inadequate milk supply (36.4%), desire for sleep (35.4%), and a plan to breast and bottle feed (35.2%). Exclusive breastfeeding (EBF) was associated with primiparous status (OR 1.95; 95% CI 1.3-3.0), higher education level (OR 2.6; 95% CI 1.7-3.9), and having been breastfed as an infant (OR 1.54; 95% CI 1-2.37). Mothers who experienced skin-to-skin contact also had higher rates of EBF (29.5% versus 19.9%). Factors associated with exclusive formula feeding included single marital status, birth of mother in the United States, Catholic religion, multiparity, and cesarean delivery. Religious and cultural factors also played important roles in maternal feeding behaviors. Clinicians can anticipate risk factors for formula use in mothers who plan to breastfeed and tailor counseling appropriately to increase EBF rates.

Association of Cesarean Delivery and Formula Supplementation With the Intestinal Microbiome of 6-Week-Old Infants.

The intestinal microbiome plays a critical role in infant development, and delivery mode and feeding method (breast milk vs formula) are determinants of its composition. However, the importance of delivery mode beyond the first days of life is unknown, and studies of associations between infant feeding and microbiome composition have been generally limited to comparisons between exclusively breastfed and formula-fed infants, with little consideration given to combination feeding of both breast milk and formula. To examine the associations of delivery mode and feeding method with infant intestinal microbiome composition at approximately 6 weeks of life. Prospective observational study of 102 infants followed up as part of a US pregnancy cohort study. Delivery mode was abstracted from delivery medical records, and feeding method prior to the time of stool collection was ascertained through detailed questionnaires. Stool microbiome composition was characterized using next-generation sequencing of the 16S rRNA gene. There were 102 infants (mean gestational age, 39.7 weeks; range, 37.1-41.9 weeks) included in this study, of whom 70 were delivered vaginally and 32 by cesarean delivery. In the first 6 weeks of life, 70 were exclusively breastfed, 26 received combination feeding, and 6 were exclusively formula fed. We identified independent associations between microbial community composition and both delivery mode (P< .001; Q < .001) and feeding method (P = .01; Q < .001). Differences in microbial community composition between vaginally delivered infants and infants delivered by cesarean birth were equivalent to or significantly larger than those between feeding groups (P = .003). Bacterial communities associated with combination feeding were more similar to those associated with exclusive formula feeding than exclusive breastfeeding (P = .002). We identified 6 individual bacterial genera that were differentially abundant between delivery mode and feeding groups. The infant intestinal microbiome at approximately 6 weeks of age is significantly associated with both delivery mode and feeding method, and the supplementation of breast milk feeding with formula is associated with a microbiome composition that resembles that of infants who are exclusively formula fed. These results may inform feeding choices and shed light on the mechanisms behind the lifelong health consequences of delivery and infant feeding modalities.

Committee Opinion No. 658: Optimizing Support for Breastfeeding as Part of Obstetric Practice.

Although most women in the United States initiate breastfeeding, more than one half wean earlier than they desire. As reproductive health experts and advocates for women's health who work in conjunction with other obstetric and pediatric health care providers, obstetrician-gynecologists are uniquely positioned to enable women to achieve their infant feeding goals. The American College of Obstetricians and Gynecologists recommends exclusive breastfeeding for the first 6 months of life, with continued breastfeeding as complementary foods are introduced through the infant's first year of life, or longer as mutually desired by the woman and her infant. Because lactation is an integral part of reproductive physiology, all obstetrician-gynecologists and other obstetric care providers should develop and maintain knowledge and skills in anticipatory guidance, physical assessment and support for normal breastfeeding physiology, and management of common complications of lactation. Obstetrician-gynecologists and other obstetric care providers should support each woman's informed decision about whether to initiate or continue breastfeeding, recognizing that she is uniquely qualified to decide whether exclusive breastfeeding, mixed feeding, or formula feeding is optimal for her and her infant. Obstetrician-gynecologists and other obstetric care providers should support women in integrating breastfeeding into their daily lives in the community and in the workplace. The offices of obstetrician-gynecologists and other obstetric care providers should be a resource for breastfeeding women through the infant's first year of life, and for those who continue beyond the first year.