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Subject:
From:
Nancy Mohrbacher <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 19 Nov 2015 10:00:32 -0600
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That 2013 study from Flaherman and her colleagues drove me crazy enough 
that I wrote a blog post about it here:

http://www.nancymohrbacher.com/blog/2013/5/17/formula-use-breastfeeding-the-moral-of-the-story.html 


To me, its real takeaway was the importance of using biologically 
appropriate feeding volumes when supplements are given. Most newborns 
are way oversupplemented, which throws off normal feeding patterns and 
undermines getting breastfeeding back on track. The one thing these 
researchers did right (certainly it was *not* using formula instead of 
expressed mother's milk!) was to limit the amount of supplement given to 
10 mL. I think that is the best explanation for its results.

Just my .02 cents,
Nancy Mohrbacher, IBCLC, FILCA
Chicago suburbs.
www.NancyMohrbacher.com


Nikkie wrote:
In the week before Similac launched their "formula for supplementation",
Pediatrics published this article:

Effect of Early Limited Formula on Duration and
Exclusivity of Breastfeeding in At-Risk Infants: An RCT
Valerie J. Flaherman, MD, MPH , , Janelle Aby, MD , Anthony E. Burgos, MD,
MPH , Kathryn A. Lee, RN, PhD , Michael D. Cabana, MD, MPH , , and Thomas B.
Newman, MD, MPH ,

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

11/18/2015 Effect of Early Limited Formula on Duration and Exclusivity of
Breastfeeding in At-Risk Infants: An RCT | Pediatrics

http://pediatrics.aappublications.org/content/131/6/1059.full

How was 5% decided to be the cut off for weight loss? Giving formula in the
hospital has been shown to undermine exclusive breastfeeding (a public
health goal in the US), and to undermine breastfeeding once the dyad goes
home.

The answer lies in the disclaimer, where one of the authors of this
dreadful article was a paid consultant to two different formula companies.

sigh. . ..



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