title: In-Hospital Formula Supplementation of Healthy Newborns: Practices, Reasons, and Their Medical Justification.
abstract: In-hospital formula supplementation is a common practice and has been shown to be a strong determinant of shorter exclusive and any breastfeeding.
  
  
  
  To investigate the reasons for and circumstances in which in-hospital formula supplementation occurs and whether the stated reasons are medically acceptable.
  
  
  
  This prospective cohort study was conducted among 342 mother-infant pairs from April to July 2011 at the Department of Obstetrics and Gynecology, University Hospital of Split, Croatia. Data were collected based on "every feed" charts and WHO/UNICEF "Questionnaire for Monitoring Baby-Friendly Hospitals". We used WHO/UNICEF Baby-Friendly Hospital Initiative and Academy of Breastfeeding Medicine documents on indications for supplemental feeding.
  
  
  
  During the first 48 hours and entire hospital stay, 49.5% and 62.8% of infants, respectively, received supplements, given on average 16.68 ± 18.6 hours after delivery. In 94.1% of supplemented infants, healthy newborns were given artificial milk, of which 5.9% of mothers had not been notified. The most common maternal reasons for supplementing were "lack of milk" (49.8%), a "crying baby" (35.5%), "cesarean section" (11.5%), newborn weight loss (10.6%), and sore nipples (10.1%). Of all the given reasons, 24.6% were categorized as being medically acceptable. Primiparas were 1.3 times more likely to supplement in hospital, whereas multiparas were 1.3 times more likely to exclusively breastfeed.
  
  
  
  In our study, most reasons for formula supplementation of healthy term newborns were not standard acceptable medical reasons, indicating a need for improved maternal support, revision of hospital policies, and training of hospital staff.
authors.affiliation: 1 Department of General Practice, Split and Dalmatia County Health Centre , Split, Croatia .
authors.forename: Marija
authors.initials: M
authors.lastname: Boban
authors.affiliation: 2 Department of Clinical Skills, University of Split School of Medicine , Split, Croatia .
authors.forename: Irena
authors.initials: I
authors.lastname: Zakarija-Grković
mesh_terms: D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data*; D017523:Croatia / Q000453:epidemiology; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006293:Health Promotion; D006760:Hospitalization; D006801:Humans; D041943:Infant Formula / Q000706:statistics & numerical data*; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008297:Male; D009035:Mothers / Q000523:psychology; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013997:Time Factors
keywords: breastfeeding; exclusive breastfeeding; formula supplementation; justification of supplementation; maternity hospital