Breastfeeding practices and childhood growth in a Canadian newborn screened cystic fibrosis population

Introduction Newborn screening for cystic fibrosis (CF) has provided an opportunity to intervene earlier to improve growth outcomes in these children. However, the focus on nutrition and growth from birth in this population has led to increased use of formula fortification and consequently lower breastfeeding rates. This is at odds with the mounting evidence that breastfeeding not only offers the known immunological benefits that all babies benefit from, but also milder disease severity and preserved lung function. It is currently unclear whether encouraging breastfeeding in infants with CF can come at the cost of growth outcomes. The purpose of this study was to evaluate the breastfeeding practices in our clinic and to assess how this affects short- and long-term growth, specifically in the Canadian population. Methods This is a survey of newborn-screened children with CF followed from 2008 onwards. Mothers were surveyed about their breastfeeding practices. Clinical data, such as demographics and anthropometric measurements at each clinic visit for the first ten years of life were obtained through the Canadian CF Registry. Flexible non-linear regression was used to compare changes in height-for-age and weight-for-age z-scores with age accounting for repeated measures in the same person. Results The survey was completed by 48 mothers; the demographics of their babies were representative of our clinic (58% female, 98% pancreatic insufficient, 17% with meconium ileus at birth). While the intended plan was to exclusively breastfeed for 71% of mothers, only 50% exclusively breastfed for the first four months. Children who were breastfed for at least four months started at a higher height-for-age z-score (Δ 0.78, 95% CI 0.20, 1.37; p=0.01), but there was no overall difference in height-for-age between breastfed-predominant and formula-predominant children. There were also no differences in weight-for-age z-scores between groups. Conclusions Clinicians may safely encourage breastfeeding with close follow up for infants with CF, as this does promote good growth and weight gain. Breastfeeding is highly beneficial for both infant health and maternal well-being, and with normal growth expected, encouragement of this route with supportive guidance and intervention when required can supplement early CF care.

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