Hospitals may not consistently support breastfeeding targets

(Reuters Health) - Roughly half of breastfed newborns in New York State hospitals are also given formula, though there’s wide variation in feeding practices suggesting that differing hospital policies contribute to the problem, researchers say.

Pediatricians recommend that mothers exclusively breastfeed infants until they’re at least 6 months of age because it can reduce babies’ risk of ear and respiratory infections, sudden infant death syndrome, allergies, childhood obesity and diabetes.

Mothers can benefit too, with longer periods of breastfeeding linked to lower risks of depression, bone deterioration and certain cancers.

For the new study, researchers examined birth certificate data on 160,911 infants born at 126 hospitals statewide in 2014. Overall, they found, 48.5 percent of infants who were fed breast milk were also given formula.

Just 18.2 percent of breastfed newborns received formula at community hospitals that treat low-risk patients, compared to 50.6 percent to 57 percent at hospitals that handle more complex cases. But certain groups, including black, Hispanic, Asian and less educated mothers, had higher odds of supplementation at community hospitals.

“Every mother should have an equal chance to be supported to exclusively breastfeed,” said Dr. Lori Feldman-Winter, a pediatrics researcher at Cooper Medical School of Rowan University in Camden, New Jersey, who wasn’t involved in the study.

Compared to white babies at community hospitals, black and Hispanic infants were almost twice as likely to get formula supplements, and the odds were almost three times higher for Asian newborns, the study found.

Babies of color were also more likely to get formula at hospitals that treat more complex cases, but the differences relative to white infants were not as pronounced.

At community hospitals, mothers without a high school degree were almost three times more likely to get formula for their babies than women with at master’s degree; at regional perinatal centers that treat the most complex patients the odds were doubled.

Women insured by Medicaid, the government health program for the poor, were 60 percent more likely to get formula for their babies as women with other insurance at regional perinatal centers; at community hospitals the odds increased by 27 percent.

Across all hospital levels, there were some places that met the HealthyPeople 2020 goal of reducing the proportion of newborns who receive supplemental formula to no more than 14 percent. This benchmark was set to encourage exclusive breastfeeding as often as possible while allowing for cases when women may be unable to do this.

One limitation of the study is that researchers lacked data on mothers’ planned feeding intentions or the reasons why the infant was supplemented with formula, the study authors, led by Dr. Trang Nguyen of the New York State Department of Health, write in the journal Pediatrics.

Medical evidence clearly shows that breastfeeding is crucial to the healthy growth and development of infants, and also provides important health benefits to mothers, the health department said in an emailed statement. Breastfeeding data for each hospital in the state is available on the health department’s website (here:

Formula supplements may be needed in some circumstances, such as when the mother and infant are separated due to serious medical issues, when a baby has jaundice or when a newborn has very low birth weight or loses more weight than expected after birth, said Jennifer Yourkavitch, a certified lactation counselor at the University of North Carolina, Chapel Hill, who wasn’t involved in the study.

But it still is done too often, Feldman-Winter said.

“It is normal for mothers to produce very little milk volume during the first days of breastfeeding, and this is accompanied by normal weight loss in their babies,” Feldman-Winter said by email. “Over-supplementing with infant formula can lead to excess weight gain during the first years of life, and that is associated with being overweight at two years of age.”

SOURCE: Pediatrics, online June 26, 2017.