Behind warm marketing campaigns, Abbott and Mead Johnson have turned neonatal intensive care units into arenas of brutal competition, with premature babies and vulnerable parents caught in the middle. A KFF Health News investigation into three lawsuits that went to trial in 2024 exposes how formula manufacturers use hospital contracts as gateways to lifelong brand loyalty, sometimes prioritizing market share over infant safety .

How Do Formula Companies Win Over Hospitals and Parents?

The strategy is straightforward: control what a baby eats in the hospital, and you likely control what the family buys at home. Industry documents reviewed in litigation show that over 74% of the time, an infant fed a particular formula brand in the hospital stays on that brand after discharge . This "first bottle fed" approach is so central to the business model that Abbott's internal training materials from a decade ago projected it would generate more than $1.5 billion in sales .

• Exclusive Hospital Contracts: Manufacturers vie for contracts that can be "exclusive" or nearly so, giving them complete control over which products are used in neonatal intensive care units and creating brand loyalty from day one.
• Sales Incentives and Competition: Abbott rolled out a "Flip & Win" incentive plan with cash rewards for sales representatives who switched hospitals from rival Mead Johnson, while internal documents described employees who "owned" thousands of babies exclusively or "stole" hundreds of formula feeders from competitors.
• Strategic Timing and Targeting: One Abbott document noted that more than half of first feedings happen at night, stating "Nighttime is the right time to drive your business," while Mead Johnson training materials encouraged sales representatives to overhear patient information in NICUs and use it to promote products.

What Happened When Abbott Sponsored a Clinical Trial Against Its Competitor?

In 2013, an Abbott scientist named Bridget Barrett-Reis reviewed study results showing that babies fed Mead Johnson Nutrition's acidified liquid human milk fortifier, a nutritional supplement added to breast milk in intensive care units, developed certain complications at higher rates than those given Abbott's fortifier . The email describing these findings used two exclamation points, and Abbott subsequently sponsored a clinical trial called AL16 to test the products head-to-head .

The results were striking. Far more infants given Mead Johnson's product developed metabolic acidosis, a buildup of acid in the blood, than those fed Abbott's product: 19 versus four, according to results published in the journal PharmacoEconomics . The findings were publicized by Abbott to gain market share from Mead Johnson, but the trial raised serious safety concerns.

Two outside doctors monitoring infants in the study became so alarmed that they refused to enroll any more babies. Neonatologist Robert White of Memorial Hospital in South Bend, Indiana, and Pediatrix Medical Group, an investigator in the study, wrote to Abbott in April 2016 about a "serious adverse event" in which a child developed "profound metabolic acidosis while on the study fortifier," describing the severity as "unlike what we would see in most children with these issues" . Abbott replied that the company was "taking your concerns very seriously" .

South Bend, Indiana, and Pediatrix Medical Group, an investigator in the study

Notably, at least some of the consent forms used to inform parents about risks did not mention metabolic acidosis or necrotizing enterocolitis, another serious condition identified in the 2013 email that prompted the study .

What Are the Ethical Questions Raised by This Investigation?

Abbott has defended the trial, with spokesperson Scott Stoffel stating in November that the study "was safe and ethical" and was "led by 20 non-Abbott investigators" and approved "by 14 independent safety review boards at hospitals" . However, federal records show that Abbott's Barrett-Reis chaired the study .

Mead Johnson executive Cindy Hasseberg argued in a deposition that Abbott waged a "smear campaign" against the acidified fortifier that was "very hard to come back from" . A Mead Johnson spokesperson stated that existing studies "cannot responsibly support" any connection between the acidified fortifier and conditions such as necrotizing enterocolitis or metabolic acidosis .

The investigation, based on records from three lawsuits against formula manufacturers, reveals how scientific research can become a marketing tool in the high-stakes business of infant nutrition. Internal company documents show that winning in the NICU is described as "critical to contract gains and acquisition," and one Mead Johnson slide deck for a 2020 national sales meeting outlined a plan for "Branding NICU Babies," urging employees to "open up a can of 'Whoop Ass'" to win more sales from neonatal intensive care units .

For parents of premature infants, the implications are sobering. While making life-or-death decisions about their fragile newborns, many families are unaware that the products being used in the hospital are part of a calculated commercial strategy, and that the research supporting those products may have been designed partly to gain competitive advantage rather than purely to advance infant health.