{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T22:30:10Z","timestamp":1791239410631,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2019,8,29]],"date-time":"2019-08-29T00:00:00Z","timestamp":1567036800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Allergy Immunology"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Many breastfed babies in Ireland receive formula supplementation within 24\u00a0hours of birth. We explored (a) impact of formula supplementation on the likelihood of developing cow's milk protein allergy (CMPA) and (b) current practice of formula supplementation (&lt;24\u00a0hours) among mothers intending to breastfeed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Fifty\u2010five CMPA\u2010diagnosed children, fed at &lt;24\u00a0hours of age (breast only, formula only or breast with formula supplementation), were recruited, and 55 milk\u2010tolerant age\u2010 and sex\u2010matched controls were identified retrospectively in Cork University Maternity Hospital. Two logistic regressions (LoR) examined neonatal feed types on likelihood of developing CMPA while controlling for parental atopy and infant sex. Formula supplementation was then prospectively measured among a separate group of 179 breastfeeding mothers. Linear regression (LiR) analysis was used to examine the subjective and objective reasons for formula supplementation, in addition to examining pre\u2010existing factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Two LoR examined the infant groups: exclusively breastfed, exclusively formula\u2010fed or breastfed with formula supplementation. The first LoR model which showed only formula supplementation was significant in prediction of development of CMPA (<jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup> (3)\u00a0=\u00a025.74, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.05), with 74% diagnostic accuracy when parental atopy and infant sex were controlled for. Breastfed infants given formula supplements were 7.03 (95% CI, 1.82\u201027.25) times more likely to exhibit CMPA than those who were exclusively breastfed. Formula supplementation was significant (OR 16.62, 95% CI 3.89\u201071.11), indicating that breastfed infants who were given formula supplements were 16 times more likely to exhibit CMPA than those who were exclusively bottle\u2010fed. Exclusively formula\u2010fed infants (odds ratio 0.42, 95% CI, 0.16\u20101.07) were not significantly more likely to exhibit CMPA than those who were exclusively breastfed in either model (<jats:italic>P<\/jats:italic>\u00a0&gt;\u00a0.05).<\/jats:p><jats:p>About 45.8% of breastfed infants (&lt;24\u00a0hours) received supplemental formula. LiR investigated importance of the subjective and objective reasons, in predicting formula supplementation. This model was significant <jats:italic>F<\/jats:italic>(8,170)\u00a0=\u00a066.95, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.05) explaining 75% of total variance. The subjective factors \u2018no latch\u2019 and \u2018mum unwell\u2019 were the strongest predictors (<jats:italic>\u03b2<\/jats:italic>\u00a0&gt;\u00a0.45). Objective factors and pre\u2010existing factors had lower \u00df values with only mode of delivery and infant hypoglycaemia being significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Breastfed babies are still being put at significantly increased risk of CMPA by receiving supplemental formula in the first 24\u00a0hours of life, despite the major predictors of supplementation being subjective and remediable in other ways. Mothers and healthcare providers should be better educated on the benefits of exclusive breastfeeding and resourced adequately to avoid unnecessary formula supplementation to reduce risk of development of CMPA.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pai.13108","type":"journal-article","created":{"date-parts":[[2019,7,12]],"date-time":"2019-07-12T06:13:27Z","timestamp":1562912007000},"page":"810-816","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Formula supplementation remains a risk for cow's milk allergy in breast\u2010fed infants"],"prefix":"10.1111","volume":"30","author":[{"given":"Eimear","family":"Kelly","sequence":"first","affiliation":[{"name":"Paediatrics and Child Health and INFANT Centre University College Cork Cork Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gillian","family":"DunnGalvin","sequence":"additional","affiliation":[{"name":"Applied Psychology University College Cork Cork Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan P.","family":"Murphy","sequence":"additional","affiliation":[{"name":"Paediatrics and Child Health and INFANT Centre University College Cork Cork Ireland"},{"name":"Neonatology Cork University Maternity Hospital Cork Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4997-9857","authenticated-orcid":false,"given":"Jonathan","family":"O\u2019B Hourihane","sequence":"additional","affiliation":[{"name":"Paediatrics and Child Health and INFANT Centre University College Cork Cork 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