A comparison of intakes of breast-fed and bottle-fed infants during the first two days of life

Objective: In the first days of life, breast-fed infants consume minimal amounts of milk; this may be explained by substrate limitation (limited milk output) and/or by self-limitation (through low appetite and/or suck-swallow competency). The spontaneous milk intake of unrestricted formula-fed infants has not been studied to date. We compared the spontaneous formula intake of unrestricted formula-fed infants to that of breast-fed infants over the first 48 hours of life. We hypothesized that 1) spontaneous formula intake of unrestricted infants is much higher than that of breast-fed infants and 2) spontaneous formula intake correlates positively with gestational age or birthweight. Methods: We studied 43 healthy, term infants. By maternal choice, 15 infants were exclusively breast-fed and 28 were formula-fed ad libitum every four hours. Breast-fed infants were weighed before and one hour after initiation of feeding, and intake was calculated from the difference between the measurements and corrected individually for the infant's normal postnatal decrease in body weight. Bottles offered to formula-fed infants contained 60 cc, and the remainder was carefully measured. Intakes were expressed as cc/kg/d, and weight changes as % of birthweight. Statistical methods included Student's t tests and stepwise regression analysis. Results: Breast feeding on Day 1 was 9.6 +/- 10.3 (mean +/- SD) vs. 18.5 +/-9.6 cc/kg/d in formula-fed infants (p = 0.011); on Day 2 it was 13.0 +/- 11.3 vs. 42.2 +/- 14.2 cc/kg/d (p < 0.001). Breast-fed infants lost significantly more weight on Day 2 (p = 0.015). In multiple regression, when the dependent variable was the second-day intake, the significant independent variables were group (higher intake in the formula-fed group), weight loss (the higher the weight loss, the lower the intake), and first-day intake (the higher the first-day intake, the higher the second-day intake). Conclusion: Newborn infants offered formula ad libitum every four hours consumed much larger amounts than breast-fed infants fed according to the same schedule. In addition, weight loss was more marked in breast-fed infants on Day 2 of life.