title: Effect of early limited formula on duration and exclusivity of breastfeeding in at-risk infants: an RCT.
abstract: OBJECTIVE
  Recent public health efforts focus on reducing formula use for breastfed infants during the birth hospitalization. No previous randomized trials report the effects of brief early formula use. The objective of the study was to determine if small formula volumes before the onset of mature milk production might reduce formula use at 1 week and improve breastfeeding at 3 months for newborns at risk for breastfeeding problems.
  
  
  METHODS
  We randomly assigned 40 exclusively breastfeeding term infants, 24 to 48 hours old, who had lost ≥5% birth weight to early limited formula (ELF) intervention (10 mL formula by syringe after each breastfeeding and discontinued when mature milk production began) or control (continued exclusive breastfeeding). Our outcomes were breastfeeding and formula use at 1 week and 1, 2, and 3 months.
  
  
  RESULTS
  Among infants randomly assigned to ELF during the birth hospitalization, 2 (10%) of 20 used formula at 1 week of age, compared with 9 (47%) of 19 control infants assigned during the birth hospitalization to continue exclusive breastfeeding (P = .01). At 3 months, 15 (79%) of 19 infants assigned to ELF during the birth hospitalization were breastfeeding exclusively, compared with 8 (42%) of 19 controls (P = .02).
  
  
  CONCLUSIONS
  Early limited formula may reduce longer-term formula use at 1 week and increase breastfeeding at 3 months for some infants. ELF may be a successful temporary coping strategy for mothers to support breastfeeding newborns with early weight loss. ELF has the potential for increasing rates of longer-term breastfeeding without supplementation based on findings from this RCT.
authors.affiliation: Department of Pediatrics, University of California, San Francisco, CA 94143-0503, USA. flahermanv@peds.ucsf.edu
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Flaherman
authors.forename: Janelle
authors.initials: J
authors.lastname: Aby
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Burgos
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Lee
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cabana
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Newman
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000379:methods / Q000706:statistics & numerical data*; D002140:California; D005260:Female; D006801:Humans; D041943:Infant Formula / Q000008:administration & dosage* / Q000379:methods; D007231:Infant, Newborn; D008297:Male; D009035:Mothers; D012306:Risk; D013997:Time Factors
keywords: breastfeeding; infant formula; lactation