Formula supplementation remains a risk for cow's milk allergy in breast‐fed infants

医学 婴儿配方奶粉 母乳喂养 过敏性 母乳喂养 母乳 儿科 逻辑回归 配方奶粉喂养 过敏 产科 内科学 免疫学 生物化学 化学
作者
Eimear Kelly,Gillian DunnGalvin,Brendan P. Murphy,Jonathan O’B Hourihane
出处
期刊:Pediatric Allergy and Immunology [Wiley]
卷期号:30 (8): 810-816 被引量:29
标识
DOI:10.1111/pai.13108
摘要

Abstract Background Many breastfed babies in Ireland receive formula supplementation within 24 hours of birth. We explored (a) impact of formula supplementation on the likelihood of developing cow's milk protein allergy (CMPA) and (b) current practice of formula supplementation (<24 hours) among mothers intending to breastfeed. Method Fifty‐five CMPA‐diagnosed children, fed at <24 hours of age (breast only, formula only or breast with formula supplementation), were recruited, and 55 milk‐tolerant age‐ and sex‐matched controls were identified retrospectively in Cork University Maternity Hospital. Two logistic regressions (LoR) examined neonatal feed types on likelihood of developing CMPA while controlling for parental atopy and infant sex. Formula supplementation was then prospectively measured among a separate group of 179 breastfeeding mothers. Linear regression (LiR) analysis was used to examine the subjective and objective reasons for formula supplementation, in addition to examining pre‐existing factors. Results Two LoR examined the infant groups: exclusively breastfed, exclusively formula‐fed or breastfed with formula supplementation. The first LoR model which showed only formula supplementation was significant in prediction of development of CMPA ( χ 2 (3) = 25.74, P < .05), with 74% diagnostic accuracy when parental atopy and infant sex were controlled for. Breastfed infants given formula supplements were 7.03 (95% CI, 1.82‐27.25) times more likely to exhibit CMPA than those who were exclusively breastfed. Formula supplementation was significant (OR 16.62, 95% CI 3.89‐71.11), indicating that breastfed infants who were given formula supplements were 16 times more likely to exhibit CMPA than those who were exclusively bottle‐fed. Exclusively formula‐fed infants (odds ratio 0.42, 95% CI, 0.16‐1.07) were not significantly more likely to exhibit CMPA than those who were exclusively breastfed in either model ( P > .05). About 45.8% of breastfed infants (<24 hours) received supplemental formula. LiR investigated importance of the subjective and objective reasons, in predicting formula supplementation. This model was significant F (8,170) = 66.95, P < .05) explaining 75% of total variance. The subjective factors ‘no latch’ and ‘mum unwell’ were the strongest predictors ( β > .45). Objective factors and pre‐existing factors had lower ß values with only mode of delivery and infant hypoglycaemia being significant. Conclusion Breastfed babies are still being put at significantly increased risk of CMPA by receiving supplemental formula in the first 24 hours of life, despite the major predictors of supplementation being subjective and remediable in other ways. Mothers and healthcare providers should be better educated on the benefits of exclusive breastfeeding and resourced adequately to avoid unnecessary formula supplementation to reduce risk of development of CMPA.

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