Predictors of supplementation for breastfed babies in a Baby-Friendly hospital

Abstract Problem Supplementation of breastfed babies is common during the hospital stay. Background The Baby Friendly Hospital Initiative (BFHI) optimises practices to support exclusive breastfeeding, yet supplementation is still prevalent. Objective To determine predictors for supplementation in a cohort of breastfed babies in a Baby-Friendly hospital. Methods Electronic hospital records of 1530 healthy term or near term singleton infants and their mothers were examined retrospectively and analysed to identify factors associated with in-hospital supplementation using Poisson regression (unadjusted and adjusted). Findings Fifteen percent of breastfed infants were supplemented during their hospital stay. Analysis by multivariable Poisson regression found that supplementation was independently associated with overweight (reference normal weight) (aRR [adjusted relative risk] = 1.46; 95% CI: 1.11–1.93); primiparity (aRR = 1.40; 95% CI: 1.09–1.80); early term gestation (37–37 6 weeks, aRR = 2.79; 95% CI: 1.88–4.15; 38–38 6 weeks, aRR = 2.03, 95%CI: 1.46–2.82); birthweight less than 2500 grams (reference 3000–3499 grams) (aRR = 3.60; 95% CI: 2.32–5.60) and use of postpartum uterotonic (aRR = 2.47; 95% CI: 1.09–5.55). Greater than 65 minutes of skin-to-skin contact at birth reduced the risk of supplementation (aRR = 0.66; 95% CI; 0.48–0.92). Conclusion These identified predictors for supplementation, can inform the development of interventions for mother-infant pairs antenatally or in the early postpartum period around increased breastfeeding education and support to reduce supplementation. It may also be possible to reduce supplementation through judicious use of postpartum uterotonics and facilitation of mother-infant skin-to-skin contact at birth for greater than one hour duration.