The Importance of Breastfeeding the CF Infant

One of the most important ways to get your CF infant off to a good start in life is to breastfeed him. There are several reasons why this is so:

1) Breastmilk contains its own lipases. That is, breastmilk actually contains its own enzymes designed to break down fat. Thus, if your CF infant is pancreatic insufficient and their pancreas is not able to provide sufficient enzymes to break down food, the lipases in breastmilk will help digestion.

2) Research has shown that various vitamins and minerals in breastmilk are present in forms that are maximally absorbable. For example, scientists once thought breastmilk was low in iron. However, they eventually determined that the iron in breastmilk is present in a form that is almost 100% absorbable by the human body, and thus the "low" amount was actually the proper amount under these circumstances. Because CF infants are at great risk for malnutrition because their bodies do not readily absorb nutrients from their food, this property of breastmilk becomes very important.

3) Because it is so easily digestible, breastmilk also does not form large curds in the gut, as artificial formulas are prone to do. This property allows for easy passage of the breastmilk through the gut, lessening the chance of bowel blockage which is otherwise common in CF.

4) Breastmilk is extremely high in DHA, or docosahexaenoic acid. As mentioned in the section on DHA, researchers have recently shown that cell membrane levels of DHA are decreased about 3-fold in CF persons, while arachidonic acid (AA) is increased about 3-fold. This imbalance in membrane lipids leads to inspissated plugs in the pancreas and other organs, which is one of the first manifestations of the disease beginning even in utero. (Indeed, these researchers propose that mothers pregnant with children that might have CF should also take DHA supplements to prevent such damage.) Breastfeeding the CF infant allows for natural supplementation of DHA, which is only found in certain more expensive infant formulas.

5) Breastmilk contains immune factors that allow the mother's immune system to govern the infant's immune system until the latter is fully developed. In normal infants, this translates into significantly less illness in those infants that have been breastfed. Recent figures indicate that breastfed infants experience 1/5 the incidence of respiratory illness, 1/4 the incidence of gastrointestinal illness, and 1/25 the chance of dying from these illnesses as infants that are fed artificial formula. Though there are no figures directly comparing the illnesses of breastfed CF infants versus CF infants that are artificially fed, we are convinced the immunoprotective effects are similar. For example, the two of our five children that had not had chicken pox came down with it last August. I was then nursing our 2 month old who had CF, and who had also not been exposed to chicken pox before. I was very worried that the 2 month old would get the chicken pox since he was in constant contact with the two children who had it. However, because my immune system was governing his, and because I have developed immunity to chicken pox, my nursling never developed it. This was a powerful testimony to me of the reality of the immunoprotective effects of breastfeeding.

6) Breastmilk also contains twice the levels of antioxidants as formula. Since the CF infant is less able to protect himself from oxidant damage to the lung, this is another excellent reason to breastfeed your CF baby. Here is a press release about the research that uncovered this fact.

"Breastmilk, even from mothers who deliver prematurely, contains twice the levels of antioxidants as commercial formula, according to a study presented at the Experimental Biology 2001 meeting in Orlando, FL in April. Dr. James Friel of Memorial University in St. John's in Newfoundland noted that the lungs and immune systems of premature infants are not as
developed as full-term infants. In an interview with Reuters Health, Dr. Friel said, "That means that these infants are under attack by oxygen free
radicals but lack the ability to cope with that stress." The resulting oxidative stress is associated with respiratory distress syndrome,
hemorrhage, eye disorders, and various other problems.
Earlier studies found that breastmilk contains "antioxidant enzymes, but we thought the levels of these enzymes may be greater in milk produced by
mothers of premature infants," he said.

Dr. Friel compared milk from 28 women who had preterm deliveries to milk from 17 women who delivered at full term. The milk was collected at weeks 1, 2, and 12. The result was surprising. "There was really no difference in the antioxidant protection level from week to week. It was all good," Dr. Friel said. Likewise, "there was no difference [in the breastmilk] between the mothers of premature babies and the mothers of full-term babies."

Dr. Friel also attempted to enhance breastmilk by fortifying it with more antioxidant enzymes. He also tried the same "fortification" with
formula. He discovered that when he added antioxidants found in breastmilk to commerical formula, "the formula offered better protection against free radicals [than it had before]. But when we offered additional enzymes to the breastmilk, it didn't increase the antioxidant protection of breastmilk. He concluded that it is difficult to improve nature." (May-June 2001, CCL Family Foundations)

In sum, then, your CF infant will benefit greatly from breastfeeding. Indeed, in the scientific literature it is noted that CF infants that are breastfed remain asymptomatic longer than infants that are artificially fed. If there is even the slightest chance your newborn could have CF, the best thing you could do for him is to breastfeed him! Here is a scientific abstract from 2000 about the generally better health of CF infants and children who were breastfed. I have kept current on this literature, and these results have been replicated in later studies as well:

"Is the Onset or Severity of Cystic Fibrosis Influenced by Breastfeeding?"
SD Freedman (1), BP O'Sullivan (2), MM Regan (1), EM Parker (2), JC Shea (1).
1. Beth Israel Deaconess Medical Center, Boston, MA
2. University of Massachusetts Medical School, Worcester, MA
Abstract 500 presented at the 14th annual North American Cystic Fibrosis Conference, November 2000.
Although breastfeeding (BF) is advocated for healthy children, it was initially thought to be detrimental in infants with CF. However, this viewpoint has changed over the last decade. The aim of this study was to determine if BF affects the severity and onset of CF symptoms. Methods: 3500 questionnaires were sent to 30 accredited CF centers for anonymous completion. 618 questionnaires have been returned thus far and computer scanned. Statistical analyses were restricted to pancreatic insufficient patients </= 15 years of age who did not present with meconium ileus and do not have short bowel syndrome (n=396). Age at onset of symptoms and diagnosis, FEV1 and IV antibiotic use were analyzed based on BF characteristics. Results: BF for >/= 4 months (exclusively or with formula) resulted in a significant delay in onset of symptoms compared with no breastfeeding or breastfeeding < 4 months (p=.04). 62.2% of those BF exclusively had FEV1 > 90% compared to 51.5% of those not BF, although this did not reach statistical significance. IV antibiotic use over the last 2 years revealed that 9.8% of patients exclusively BF had >/= 2 courses of IV antibiotics and 65.9% had no IV antibiotic use, compared to 21.2% of non-BF patients having >/= 2 courses and 58.2% receiving none (p=0.014). A severity index incorporating current FEV1 and IV antibiotic use over the past 2 years demonstrated an inverse association between months of BF and severity of disease in children currently </= 15 years of age (p=0.049). Discussion: Based on this preliminary analysis, BF for >/= 4 months is associated with delayed onset of symptoms and decreased severity of disease. There are several potential explanations for these findings including recall bias and consumption of other constituents of breast milk not found in formula such as immunoglobulins and docosahexaenoic acid (DHA). The latter is of interest given our findings that certain manifestations of CF in cftr -/- mice appear to result from an increase in arachidonic acid and a decrease in DHA. The strong correlation between BF and higher socioeconomic status and decreased cigarette use suggests that BF may also be a marker for other factors contributing to well-being in CF and not the direct cause of improved health. At the least, though, this survey indicates that BF is not harmful to children with CF and may be protective.

Additional more recent findings:

Abstract 354, NACFC 2016
"Joint Profile of Respiratory Infections and Their Associations with Breastfeeding in Infants with CF" , Yang J et al., Emory University

"Breastfeeding lowered the risk of Haemophilus influenzae and Acinetobacter infections during infancy."

Abstract 349, NACFC 2016
"Gut Microbiota in Early Chldhood in Cystic Fibrosis," Zhang, Z. et al., UW-Madison

This team found that CF infants who had been exclusively breastfed for > 30 months had more diverse than those who were not thus fed.

Abstract 603, NACFC 2016
"Essential Fatty Acid (EFA)Abnormalities are Common in Young Children with Cystic Fibrosis," Chin, LH et al., UW-Madison

This team found that at 4 months, CF infants who had been exclusively breastfed tended to be EFA sufficient compared to those who had been formula fed or who had mixed feedings.