Professor of Pediatrics Cohen Children's Medical Center Cohen Children's Medical Center Princeton, New Jersey, United States
Background: Formula provided to breastfeeding infants in the nursery has been linked with earlier cessation of breastfeeding, so it is only recommended when medically necessary. Objective: To examine if newborns supplemented with formula in the nursery are less likely to be exclusively breastfed at their initial ambulatory post-discharge newborn visit. Design/Methods: We analyzed the baseline data of healthy breastfeeding mothers participating in a randomized controlled clinical trial of breastfeeding promotion. Eligibility criteria included mothers 17 years and older with healthy full-term infants at 7 days of age or less at enrollment. Hospitalists provided postpartum care in the nursery. Eligible mothers were required to receive pediatric care only in our practice, while their birth hospital varied. Self-reported demographic and maternal characteristics (e.g., first baby being breastfed; COVID-19 at delivery), including whether the newborn had received any formula in the nursery and breastfeeding exclusivity at the initial newborn visit, were assessed. Comparisons were analyzed using Chi-square, Fisher Exact, or 2-sample t-tests. Results: Baseline data from 139 participants showed racial, ethnic, and socioeconomic diversity – 27% Black, 35% Asian, 8% white, and 31% Other; 24% were Hispanic; 48% had less than a bachelor's degree; 27% were enrolled in WIC. There were no differences in demographic and maternal characteristics between those mothers who supplemented with formula in the nursery (62%) and those who did not (38%) (p>0.05). 40% of infants were exclusively breastfeeding at the initial ambulatory post-discharge newborn visit, while 60% were breastfeeding and supplementing with formula. 79% of moms whose newborns did not receive formula in the nursery were exclusively breastfeeding at the initial ambulatory newborn visit, while only 16% of moms whose newborns did receive formula in the nursery were exclusively breastfeeding (p < 0.0001).
Conclusion(s): The introduction of formula during the initial postpartum period in the nursery was associated with fewer infants being exclusively breastfed at their initial ambulatory post-discharge newborn visit in our diverse population of mothers. Our results emphasize the importance of hospital initiatives, such as Baby-Friendly USA, that minimize formula usage and promote breastfeeding exclusivity.
