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Lactation Information and Discussion

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Subject:
From:
Marsha Walker <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 19 Nov 2015 08:52:35 -0500
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The article on early formula supplementation by Flaherman et al (Effect of
early limited formula on duration and exclusivity of breastfeeding in
at-risk infants) in Pediatrics has received a sound critical response
pointing out the many problems with this research. I have to wonder how it
even received IRB approval when we know that formula supplementation of the
breastfed infant can immediately change the microbiome of the newborn gut
to an inflammatory state, opening the way literally for invasion of
pathogens and interfering with the programming of the immune system. This
is something that none of the mothers in this study were informed about. A
normal healthy full term infant who has lost 5% of birth weight is not
considered an at-risk infant. This was a very small sample of infants who
were fed 10mL of formula after every breastfeeding which is the volume of a
full feeding. One of the authors is a consultant for 4 formula
companies--hardly without a massive conflict of interest!

This leaves me with a laundry list of questions such as why wasn't donor
human milk used as the supplement rather than infant formula? Why was 5%
weight loss even considered to place an infant at risk? Why wasn't diaper
output considered in the weight loss calculations? Why wasn't maternal IV
fluid volume factored into infant weight loss. Diuresis of excess maternal
IV fluid can drop infant weight rapidly.

Too much risk in my mind from this practice. Infant formula supplementation
should be used only when it is medically necessary. This article coincided
with the release of the formula labeled for breastfeeding supplementation,
hardly a coincidence!

Marsha Walker, RN, IBCLC
Weston, MA

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