No Benefit of Additional Foods, Fluids in Breast-Fed Infants

From Medscape Education Clinical Briefs News Author: Lara C. Pullen, PhD CME Author: Laurie Barclay, MD 12/21/2011 Clinical Context Breast-feeding provides all of the nutritional, immunologic, and psychological requirements needed for a healthy, term infant to thrive, and it also benefits maternal health and well-being. Health organizations throughout the world recommend exclusive breast-feeding for 6 months. However, mothers in many countries and communities supplement breast-feeding with other fluids or foods before the infant is 6 months old, suggesting perceived benefits of early supplementation or lack of awareness of the possible risks. The objective of this Cochrane review by Becker and colleagues was to evaluate the benefits and harms of supplementation for full-term healthy breast-fed infants and to examine the timing and type of supplementation. Study Synopsis and Perspective Current research supports the World Health Organization's recommendation for exclusive breast feeding for the first 6 months after birth, according to a Cochrane review that was designed to assess the benefits and harms of supplementation for full-term healthy breast-fed infants up to 6 months of age. The systematic literature review included 6 trials (814 infants) and was published online December 7 and in the December issue of the Cochrane Library. The review included randomized or quasi-randomized controlled trials in infants younger than 6 months of age and compared exclusive breast-feeding vs breast-feeding with any additional food or fluids. All of the studies were conducted many years ago (1982 - 1999). There was a significant difference favoring exclusive breast-feeding over fluid supplementation up to and including week 20 (risk ratio, 1.45; 95% confidence interval [CI], 1.05 - 1.99). The review also raised concerns that the addition of glucose water at 70 mL/kg/day might displace nutrients provided by breast milk. Three trials examined infant morbidity and found a statistically, but not clinically, significant difference in temperature at 72 hours (mean difference [MD], 0.10°; 95% CI, 0.01° - 0.19°) in glucose-supplemented infants compared with exclusively breast-fed infants. In addition, serum glucose levels were higher in glucose-supplemented infants at 24 hours, but not at 48 hours (−0.24 mmol/L; 95% CI, −0.51 to 0.03). In addition to finding no benefit from fluid supplementation of newborns or infants (up to age 6 months), the review found possible negative effects on the duration of breast-feeding from the brief use of additional water or glucose water. The studies were independently selected for inclusion in the review by 2 authors, and 3 authors extracted the data and assessed the risk for bias. The review was performed because although the World Health Organization and other organizations recommend exclusive breast-feeding for 6 months, the addition of other fluids or foods is common in many countries and communities. This practice suggests perceived benefits of early supplementation or lack of awareness of the possible risks. Although the review focused on the effects on the infant during the first 6 months of life, the authors noted that supplementation with nonhuman milk may have effects on the developing gastrointestinal, metabolic, and immune systems that persist through childhood and beyond. The review also did not include the effect of an artificial teat on infant sucking skills or its role as a potential source of infection. The review was also limited in that it only looked at effects on the infants and did not include the possible effects of supplementation on the mother. These could include engorgement, mastitis, earlier return to fertility, nutritional status, maternal use of time, and maternal mental health and financial effects. The authors have disclosed no relevant financial relationships. Cochrane Library. Published online December 7, 2011. Abstract Related Link Information about The Baby-Friendly Hospital Initiative, which discourages infant supplementation, was developed by WHO and UNICEF and is available online. Clinical Implications According to a Cochrane review of randomized controlled trials in healthy, breast-fed newborn infants, the benefits or harms of supplementation or the effect of timing and type of supplementation could not be determined. However, brief use of additional water or glucose water had no detectable benefit to newborn infants and possible negative effects on the duration of breast-feeding. For infants 4 to 6 months old, there was no detectable benefit from additional foods nor any detectable risks related to morbidity or weight change. This Cochrane review found no evidence to disagree with international health associations' recommendation for exclusive breast-feeding for healthy infants for the first 6 months.