Hi Sarah, 
I was waiting to reply until I had gotten a hold of the Pediatrics paper to have a good look at it myself. Frustratingly many uni library subscriptions for Pediatrics has a 1 year delay in access- it's a huge pain!

There's substantial research showing that addition of infant formula to the diet of a young baby increases their susceptibility to infection resulting in infection rates that are often not dissimilar to that of fully formula fed infants. Just how much formula is needed is unknown- one would expect that there would be some interaction between the age of the infant, volume and frequency of formula fed etc. Some of the mechanisms by which feeding a baby formula facilitates and maintains infection are well documented. 

As for allergic diseases, much of the research is very poorly carried out (long term retrospective recall of infant feeding) and we're a long way from clarity in that particular muddy hole, though as you say there are plausible mechanisms by which early exposure to foreign foods like cows milk may be problematic. 

There are also concerns about how early exposure to infant formula may predispose infants to developing type 1 diabetes (has anyone seen any recent outcomes of the TRIGR study?)

So whilst theres lots of questions still to be answered, I think we can be confident in saying that unless there is a medical indication there is no benefit to infant health in giving newborns infant formula. We can also say with some confidence that giving a newborn infant formula increases their susceptibility to infection and *may* have other negative outcomes for the infant. 

Karleen Gribble
Australia



> 
> With regard to the question of effects of a little bit of formula, I'd be interested to know if you have any *outcome* research into this. Yes, I'm aware that studies have found changes in newborn gut flora associated with formula supplementation and that this raises theoretical concerns, but, as yet, the only studies I've seen into outcomes are the allergy studies which seem to be a bit too contradictory to draw firm conclusions from as yet. So, if you know of others, I'd love to know of them.
> 
> Meanwhile, looking forward to hearing more about what you felt the statistical problems with the paper to be.
> 
> 
> Best wishes,
> 
> Dr Sarah Vaughan
> MBChB MRCGP
> 
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