Dear Lynn,

As with most studies, this one has a lot of holes in it when trying to evaluate a breastfed vs. formula-fed infant.  The breastfed babies were the control group.  It was acknowledged that they might be receiving up to 2 oz. of formula a day in addition to breastmilk.  The babies randomized in the study were totally formula-fed and this was a comparison of growth dependent on type of formula used - a special type, which contained in increase in protein and various vitamins and minerals, and the usual off-the-shelf formula most parents give once baby goes home.

Conclusions: The babies given the special formula grew longer and heavier than either the babies fed regular formula or breastfed.  Growth was monitored at various intervals up to 18 months. Scores on developmental tests were slightly higher in the special formula group, but the increase was not considered statistically significant (breastfed babies were not tested.)

Of note:  Growth at 18 months was not monitored in the breastfed babies, so we don't know if they caught up by that point.  Illnesses were monitored in the formula group, but not in the breastfed group, so we don't know how much sicker the formula fed babies were - the study did acknowledge that it would be expected that the breastfed babies would have less illness.  The breastfed babies were not given the developmental tests given to the other babies, so we don't know how they stacked up in that regard (I think we can all guess - maybe that's why it wasn't measured).  Interestingly, the one area where breastfed babies did better than both formula groups (at 9 months - again, no measure at 18 months) was in head circumference.

So what does this study show?  It shows that you can manipulate the growth of weight and length in young babies through nutritional manipulation.  No kidding.  It shows that breastfed premies grew more slowly in these categories up to 9 months of age compared to totally formula-fed premies.

What doesn't it show?  It doesn't show whether the formula-fed babies were healthier or smarter than the breastfed babies - all other studies show that breastfed babies come out on top in these categories, hands-down.  It doesn't even show what the growth of the breastfed babies was past 9 months.

We know that premies may have deficits in growth in some areas - particularly bone develpment - which may or may not be longlasting.  It may be the breastmilk does not totally make up for these deficits, in that these babies may never be as large or tall as they might have been had they been carried to term.  However, does the possiblity of better growth in these areas offset the known risks to health and mental development which are present when formula feeding is used instead of or in addition to breastfeeding?

The authors do not state that breastfeeding should be in any way limited in premies after they go home.  They do say that breastfed babies may need some supplementation in order to catch up in growth, particularly in the area of bone mineralization.  Again, this is debatable at this point in time, based on available research.

This doctor needs to go back and look at this study again.  She has totally misinterpreted just about everything in it.  From the authors: "However, this small pilot study did not address the question of whether the growth benefit would persist beyond the neonatal period, nor whether it would have any long-term consequences for neurodevelopment."





Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
mailto:[log in to unmask]

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