Cystic Fibrosis

CF: Infant Feeding

• Intervention
  In infants with CF, what is the relationship between exclusive breastfeeding, mixed feeding or formula feeding and mortality and survival?

  • Conclusion

    In infants with cystic fibrosis (CF), there were no studies identified that reported on the relationship between exclusive breastfeeding, mixed feeding or formula feeding and mortality and survival.

  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Search Plan and Results: CF: Dietary Intake: Infant Feeding 2018
     
  In infants with CF, what is the relationship between exclusive breastfeeding, mixed feeding or formula feeding and lung function?

  • Conclusion

    Two observational studies reported that infants with cystsic fibrosis (CF) breastfed for at least 4-6 months, exclusively or partially, may have higher FEV1 percentage of predicted for age at ≥6 years compared with infants who are formula fed only. However, findings may be due to reverse causation (disease severity affected breastfeeding duration) or other confounding variables.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In infants with CF, what is the relationship between exclusive breastfeeding, mixed feeding or formula feeding and lung function?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Colombo C, Costantini D, Zazzeron L, Faelli N, Russo M, Ghisleni D, Gatelli I, Giovannini M, Riva E, Zetterström R, Agostoni C. Benefits of breastfeeding in cystic fibrosis: a single-centre follow-up survey. Acta Paediatrica 2007; 96:1228-32
      • Parker E, O'Sullivan B, Shea J, Regan M, Freedman S. Survey of breast-feeding practices and outcomes in the cystic fibrosis population. Pediatric Pulmonology 2004; 37:362-7
  • Search Plan and Results: CF: Dietary Intake: Infant Feeding 2018
     
  In infants with CF, what is the relationship between exclusive breastfeeding, mixed feeding or formula feeding and quality of life?

  • Conclusion

    In infants with cystic fibrosis (CF), there were no studies identified that reported on the relationship between exclusive breastfeeding, mixed feeding or formula feeding and quality of life.

  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Search Plan and Results: CF: Dietary Intake: Infant Feeding 2018
     
  In infants with CF, what is the relationship between exclusive breastfeeding, mixed feeding or formula feeding and anthropometric measures and growth?

  • Conclusion

    In infants with cystic fibrosis (CF), limited evidence was mixed in regards to the influence of infant feeding modality on weight and length gain. Three cohort studies reported no significant differences in weight gain or weight-for-age z-scores between breastfed and formula-fed infants, even when considering exclusivity (2 studies). However, one study reported a significant decline in weight z-scores from birth to 2 years of age, particularly from 2-6 months, for infants who had been exclusively breastfed for ≥2 months, though there was no change in other feeding groups. In infants with CF, four cohort studies concluded that breastfeeding duration and exclusivity did not influence length gain.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In infants with CF, what is the relationship between exclusive breastfeeding, mixed feeding or formula feeding and anthropometric measures and growth?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Colombo C, Costantini D, Zazzeron L, Faelli N, Russo M, Ghisleni D, Gatelli I, Giovannini M, Riva E, Zetterström R, Agostoni C. Benefits of breastfeeding in cystic fibrosis: a single-centre follow-up survey. Acta Paediatrica 2007; 96:1228-32
      • Jadin S, Wu G, Zhang Z, Shoff S, Tippets B, Farrell P, Miller T, Rock M, Levy H, Lai H. Growth and pulmonary outcomes during the first 2 y of life of breastfed and formula-fed infants diagnosed with cystic fibrosis through the Wisconsin Routine Newborn Screening Program. The American Journal of Clinical Nutrition 2011; 93:1038-47
      • Leung D, Heltshe S, Borowitz D, Gelfond D, Kloster M, Heubi J, Stalvey M, Ramsey B. Effects of Diagnosis by Newborn Screening for Cystic Fibrosis on Weight and Length in the First Year of Life. JAMA Pediatrics 2017; 171:546-554
      • Munck A, Boulkedid R, Weiss L, Foucaud P, Wizla-Derambure N, Reix P, Bremont F, Derelle J, Schroedt J, Alberti C. Nutritional Status in the First 2 Years of Life in Cystic Fibrosis Diagnosed by Newborn Screening. Journal of Pediatric Gastroenterology and Nutrition 2018; 67:123-130
  • Search Plan and Results: CF: Dietary Intake: Infant Feeding 2018
     
  In infants with CF, what is the relationship between exclusive breastfeeding, mixed feeding or formula feeding and morbidities (length of stay, antibiotic use)?

  • Conclusion

    In infants with cystic fibrosis (CF), one large, cross-sectional survey study reported that breastfeeding exclusively for ≥6 months was associated with a decrease in IV antibiotic use over the previous 2 years compared to no breastfeeding (p=0.03, adjusted for age), though there was no significant benefit noted with non-exclusive or shorter breastfeeding duration. However, findings may be due to reverse causation (disease severity affected breastfeeding duration) or other confounding variables. 

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In infants with CF, what is the relationship between exclusive breastfeeding, mixed feeding or formula feeding and morbidities (length of stay, antibiotic use)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Parker E, O'Sullivan B, Shea J, Regan M, Freedman S. Survey of breast-feeding practices and outcomes in the cystic fibrosis population. Pediatric Pulmonology 2004; 37:362-7
  • Search Plan and Results: CF: Dietary Intake: Infant Feeding 2018
     
  In infants with CF, what is the relationship between exclusive breastfeeding, mixed feeding or formula feeding and gastrointestinal symptoms?

  • Conclusion

    In infants with cystic fibrosis (CF), there were no studies identified that reported on the relationship between exclusive breastfeeding, mixed feeding or formula feeding and gastrointestinal symptoms.

  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Search Plan and Results: CF: Dietary Intake: Infant Feeding 2018
     
  In infants with CF, what is the relationship between exclusive breastfeeding, mixed feeding or formula feeding and anemia?

  • Conclusion

    In infants with cystic fibrosis (CF) who were exclusively breast-fed compared to exclusively formula-fed for the first three months of life, one cohort study reported a trend toward higher rates of anemia at six months, but this difference did not reach statistical significance. Incidence of anemia was twice as frequent in infants who were pancreatic insufficient.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In infants with CF, what is the relationship between exclusive breastfeeding, mixed feeding or formula feeding and anemia?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Munck A, Boulkedid R, Weiss L, Foucaud P, Wizla-Derambure N, Reix P, Bremont F, Derelle J, Schroedt J, Alberti C. Nutritional Status in the First 2 Years of Life in Cystic Fibrosis Diagnosed by Newborn Screening. Journal of Pediatric Gastroenterology and Nutrition 2018; 67:123-130
  • Search Plan and Results: CF: Dietary Intake: Infant Feeding 2018