Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory skin disease, characterized by painful, suppurating abscesses in apocrine gland-rich sites. Studies have demonstrated an increased prevalence of inflammatory bowel disease (IBD) (3.3%) in adults with HS compared with the general population (0.41%-0.74%). 1-3 It is unknown whether the same association exists in pediatric patients. However, a recent case series described seven pediatric patients with HS associated with Crohn disease, suggesting a similar pattern may exist. 4 If there is an increased prevalence of IBD in this population, data on how best to screen for this potential association are lacking. While endoscopic evaluation with biopsies is the gold standard for

BACKGROUND AND OBJECTIVES: Guidelines encourage exclusive breastfeeding for healthy newborns but lack specificity regarding criteria for medically indicated supplementation, including type, timing, and best practices. We set out to describe practice patterns and provider perspectives regarding medically indicated supplementation of breastfeeding newborns across the United States.METHODS: From 2017 to 2018, we surveyed the Better Outcomes through Research for Newborns representative from each Better Outcomes through Research for Newborns hospital regarding practices related to medically indicated supplementation. We used descriptive statistics to compare practices between subgroups defined by breastfeeding prevalence and used qualitative methods and an inductive approach to describe provider opinions. RESULTS:Of 96 providers representing discrete hospitals eligible for the study, 71 participated (74% response rate). Practices related to criteria for supplementation and pumping and to type and caloric density of supplements varied widely between hospitals, especially for late preterm infants, whereas practices related to lactation consultant availability and hand expression education were more consistent. The most commonly reported criterion for initiating supplementation was weight loss of $10% from birth weight, and bottle-feeding was the most commonly reported method; however, practices varied widely. Donor milk use was reported at 20 (44%) hospitals with $81% breastfeeding initiation and 1 (4%) hospital with ,80% breastfeeding initiation (P 5 .001). CONCLUSIONS:Strategies related to supplementation vary among US hospitals. Donor milk availability is concentrated in hospitals with the highest prevalence of breastfeeding. Implementation of evidence-based management of supplementation among US hospitals has the potential to improve the care of term and late preterm newborns.

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