by Cadey Harrel MD
When is it appropriate to supplement the healthy term breastfed infant?
It is well established that most mother/infant dyads will successfully establish breastfeeding if given early opportunities to breastfeed and adequate breastfeeding assistance. However, supplementary feedings of healthy breastfed newborns in the hospital are a commonplace practice despite widespread recommendations against doing so outside of medical indications.
Supplementation with formula in the neonatal period is associated with decreased exclusive breastfeeding in the first 6 months of life, and an overall shorter duration of breastfeeding. Unnecessary supplementation can be reduced by implementing optimal breastfeeding support as outlined by the Baby Friendly Hospital Initiative’s Ten Steps to Successful Breastfeeding, both in the hospital and in communities.
The Academy of Breastfeeding Medicine released a new evidence-based protocol in March 2017 with guidelines for management of healthy, term, breastfed neonates. This includes strategies to prevent the need for supplementary feeds, and outlines medical indications for and methods of supplementation for healthy, term, breastfed infants.
What do you think the protocol outlines as a medical indication for supplementary infant feedings in term, healthy, breastfed infants? (choose 1 or more)
- Maternal malnourishment or illness.
- Perceived insufficiency of colostrum prior to the milk ‘coming in’ (aka secretory activation) and copious milk production.
- Weight loss of 9% at 48 hours of life with a normal infant exam and normal voiding and stooling.
- Hyperbilirubinemia at day 5 of life with continued weight loss and limited voiding and stooling.
- To prevent asymptomatic hypoglycemia in an infant born to a mother with Gestational Diabetes Mellitus.
See the Answer
The answer is D
ABM Clinical Protocol #3: Supplementary Feedings in the Healthy Term Breastfed Neonate, Revised 2017
Ann Kellams, Cadey Harrel, Stephanie Omage, Carrie Gregory, Casey Rosen-Carole, and the Academy of Breastfeeding Medicine
Breastfeeding Medicine 12(3) 2017
Comment by the Author Cadey Harrel MD
Suboptimal-intake jaundice of the newborn results in hyperbilirubinemia that characteristically begins at 2-5 days of life, and is marked by ongoing weight loss, and limited voiding and stooling. The Academy of Breastfeeding Medicine recommends careful assessment of breast milk production and infant milk transfer, as well as supplemental feedings preferably of expressed or donor human milk in appropriate volumes for the infant’s age.
While severe illness that incapacitates a new mother may temporarily preclude breastfeeding, malnourishment and illness are not contraindications for breastfeeding and do not result in poor quality milk.
Small amounts of colostrum prior to secretory activation is normal and appropriate in a healthy newborn, and new parents should be reassured of this. Infant weight loss of >8-10% is normal in some healthy term infants in the immediate neonatal period.
As long as the physical exam is normal, such weight loss should not prompt immediate supplementation, although assessment for adequate milk production and transfer is important.
There is no evidence that healthy, term, infants with risk factors for hypoglycemia should be supplemented as a preventative measure.