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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Article

Effect of Early Limited Formula on Duration and Exclusivity of Breastfeeding in At-Risk Infants: An RCT

Valerie J. Flaherman, Janelle Aby, Anthony E. Burgos, Kathryn A. Lee, Michael D. Cabana and Thomas B. Newman
Pediatrics June 2013, 131 (6) 1059-1065; DOI: https://doi.org/10.1542/peds.2012-2809
Valerie J. Flaherman
Departments of aPediatrics,
bEpidemiology and Biostatistics, School of Medicine, and
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Janelle Aby
cDepartment of Pediatrics, Stanford University, Stanford, California; and
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Anthony E. Burgos
dDepartment of Pediatrics, Kaiser Permanente Medical Center, Downey, California
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Kathryn A. Lee
eFamily and Community Nursing, School of Nursing, University of California, San Francisco, California;
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Michael D. Cabana
Departments of aPediatrics,
bEpidemiology and Biostatistics, School of Medicine, and
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Thomas B. Newman
Departments of aPediatrics,
bEpidemiology and Biostatistics, School of Medicine, and
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Abstract

BACKGROUND AND OBJECTIVES: Recent public health efforts focus on reducing formula use for breastfed infants during the birth hospitalization. No previous randomized trials report the effects of brief early formula use. The objective of the study was to determine if small formula volumes before the onset of mature milk production might reduce formula use at 1 week and improve breastfeeding at 3 months for newborns at risk for breastfeeding problems.

METHODS: We randomly assigned 40 exclusively breastfeeding term infants, 24 to 48 hours old, who had lost ≥5% birth weight to early limited formula (ELF) intervention (10 mL formula by syringe after each breastfeeding and discontinued when mature milk production began) or control (continued exclusive breastfeeding). Our outcomes were breastfeeding and formula use at 1 week and 1, 2, and 3 months.

RESULTS: Among infants randomly assigned to ELF during the birth hospitalization, 2 (10%) of 20 used formula at 1 week of age, compared with 9 (47%) of 19 control infants assigned during the birth hospitalization to continue exclusive breastfeeding (P = .01). At 3 months, 15 (79%) of 19 infants assigned to ELF during the birth hospitalization were breastfeeding exclusively, compared with 8 (42%) of 19 controls (P = .02).

CONCLUSIONS: Early limited formula may reduce longer-term formula use at 1 week and increase breastfeeding at 3 months for some infants. ELF may be a successful temporary coping strategy for mothers to support breastfeeding newborns with early weight loss. ELF has the potential for increasing rates of longer-term breastfeeding without supplementation based on findings from this RCT.

  • breastfeeding
  • lactation
  • infant formula
  • Abbreviations:
    CI —
    confidence interval
    ELF —
    early limited formula
    • Accepted February 8, 2013.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 131, Issue 6
    1 Jun 2013
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    Effect of Early Limited Formula on Duration and Exclusivity of Breastfeeding in At-Risk Infants: An RCT
    Valerie J. Flaherman, Janelle Aby, Anthony E. Burgos, Kathryn A. Lee, Michael D. Cabana, Thomas B. Newman
    Pediatrics Jun 2013, 131 (6) 1059-1065; DOI: 10.1542/peds.2012-2809

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    Effect of Early Limited Formula on Duration and Exclusivity of Breastfeeding in At-Risk Infants: An RCT
    Valerie J. Flaherman, Janelle Aby, Anthony E. Burgos, Kathryn A. Lee, Michael D. Cabana, Thomas B. Newman
    Pediatrics Jun 2013, 131 (6) 1059-1065; DOI: 10.1542/peds.2012-2809
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