Early and Higher Volumes of Formula Supplementation after Birth Impact Breastfeeding Rates at Discharge in Well-Baby Nursery: A Retrospective Cohort Study

Navin Kumar; Mohammed Al-Nahar; Nathalee Harris; Venkatesh Sampath

doi:10.1055/a-2217-9174

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(S 01): e3293-e3304
DOI: 10.1055/a-2217-9174

Original Article

Early and Higher Volumes of Formula Supplementation after Birth Impact Breastfeeding Rates at Discharge in Well-Baby Nursery: A Retrospective Cohort Study

Navin Kumar

¹Department of Pediatrics/Neonatology, Hurley Children's Hospital, Flint, Michigan

,

Mohammed Al-Nahar

¹Department of Pediatrics/Neonatology, Hurley Children's Hospital, Flint, Michigan

,

Nathalee Harris

¹Department of Pediatrics/Neonatology, Hurley Children's Hospital, Flint, Michigan

,

Venkatesh Sampath

²Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri

› Author Affiliations

Abstract

Objective Physiologic breast milk production in the first 24 hours is estimated to be between 2 and 10 mL per feed. Many mothers intending to breastfeed use formula supplementation (FS) early on, which can affect successful breastfeeding. Whether the volume and timing of FS introduced in the first 24 hours of life (24 HOL) impacts the rate of “breastfeeding at discharge” (BFAD) is not well-studied and was investigated herein.

Study Design Single-center, retrospective, chart review of breastfeeding infants born at ≥35 weeks who received supplementation in the first 24 HOL. Comprehensive demographic data pertaining to maternal and infant characteristics, along with infant feeding data, were collected. Four supplementation characteristics, (timing, rate, volume [mL/kg per feed], and type [expressed breast milk (EBM) or formula]) were correlated with BFAD.

Results Among 3,102 supplemented infants in whom mothers intended to breastfeed, 1,031 (33.2%) infants were BFAD. At baseline, African American, Medicaid-insured, and single mothers had lower odds of BFAD. The overall maximum volume of FS per feed was 11.0 mL/kg (interquartile range 8.0–14.4). With each hour of delay in first supplementation, the odds of BFAD increased by 2.8% (95% confidence interval [CI] 0.022, 0.035). With every 1 mL/kg increase in the first formula volume, subsequent supplementation frequency increased by 4.5%. A positive association was observed between BFAD and a lower rate of supplementation (cutoff value ≤35.1%). However, among infants with these lower rates of supplementation, each unit increase in maximum FS, from 2 to 15 mL/kg, decreased the probability of BFAD by 4.2% (3.6–4.7%). Additionally, we observed that infants who were given at least one EBM supplementation (n = 223; 7.2%) had substantially increased rates of BFAD (odds ratio [OR] = 9.8, 95% CI 7.2–13.3).

Conclusion Early and higher volumes of FS negatively impacted BFAD. Birthweight-based FS of feeding with physiological volumes may increase breastfeeding rates at discharge.

Key Points

Higher volumes of first supplementation increases subsequent supplementation frequency.
For each unit increase in maximum supplementation, BFAD probability decreases by 4.2%.
Even one EBM supplementation increases rates of BFAD.

Keywords

breastfeeding at discharge - breastfeeding supplementation - volume of formula supplementation - birthweight-based supplementation

Full Text

References

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