Formula supplementation of breast-fed infants increases the incidence of cow’s milk protein allergy

摘要

AimOne motivation for breast feeding is to prevent allergicdisease in infants. Many breast fed babies in Irelandreceive formula supplementation, within 24 hours ofbirth, though there are few medical indications for this.We explored (i) impact of upplementation on the likelihoodof developing Cow’s Milk Protein Allergy (CMPA),and (ii) current practice of formula supplementation(<24h) among mothers intending to breast feed.Method55 CMPA-diagnosed children, with 3 feed type levels(breast only; formula only; breast with formula supplementation)and 55 non allergic, age and sex matched controls(born 2010-2011) were identified retrospectively inCork University Maternity Hospital. Logistic regression(LoR) examined formula supplementation on likelihood ofdeveloping CMPA. Formula supplementation was prospectivelymeasured among a separate group of 179breast-feeding mothers. Linear regression (LiR) analysiswas used to examine reasons and pre-existing factors forsupplementation.Results(i) LoR examined which feed type predicted developmentof CMPA. The model, controlling for parentalatopy and infant sex, showed only formula supplementationwas significant, (c2 (3) = 25.74, p < 0.05) with 74%diagnostic accuracy. Infants given top-up formula were7.03 (95% CI, 1.82 - 27.25) times more likely to exhibitCMPA than those who were breast-fed only.(ii) Frequency of current formula supplementation inbreast fed infants (<24h) is 45.8%, with 56% administeredby mother. LiR examined whether reasons for supplementationpredicted development of CMPA. This model(incl. nurse advice and maternal/infant perceived wellbeing)was significant (F(8,170)=66.95, p<0.05) with 75%accuracy. In relation to pre-existing factors, only type ofdelivery predicted whether a mother would supplementwith formula.ConclusionFormula supplementation of breast fed babies in thefirst 24h is rarely medically indicated and is stronglyassociated with an increased risk of developing CMPA.The impact of professional advice is important. Attentionshould be given to measures aimed at reducing thispotentially harmful practice.