| Abstract |
Background: Human milk is the most suitable food for newborn and young infants and its exclusive supply for at least the first six months of life ought to be universally provided. A wide array of benefits of breastfeeding have been well documented, including financial, psychosocial, developmental and prevention of illnesses, including infections. Although it has long been shown that breastfed infants are less prone to a variety of infections, skeptics have asserted that breastfeeding and formula-feeding mothers differ in ways which might alter infantile risk for infection and that the breastfeeding protective effect may be attributable to confounding factors and may be expressed less in societies with high health standards.
Purpose:Σο prospectively investigate the effect of breastfeeding on both the frequency, expressed as number of infectious episodes, and the severity, expressed as need for doctor visits and hospitalization for common infections throughout the first year of life, in a well-defined, well-vaccinated infant population with adequate health standards. Based on existing experience in the field, the study was designed first to verify the hypothesis that breastfeeding protects against common infantile infections, second to explore the impact of exclusive breastfeeding and its duration, and third to investigate this impact during both the first and the second 6 months of infancy (months 1–6 and months 6–12).
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Summary Μητρικϐσ Θηλαςμϐσ και Λοιμώξεισ
Study design: The study was conducted as a prospective observational study in a fixed cohort in the island of Crete. From a total of 6,878 births in 2004, a representative cohort of 1,049 (15.2%) mother-infant pairs was formed. Sampling was based on consecutive births in random days from October to December, 2004 and from April to July, 2005. This 2-period sampling facilitated assessment of the effect of breastfeeding on infections as related to season of birth. In 926 infants, successfully followed up for 12 months, feeding mode and all infectious episodes, including acute otitis media (AOM), acute respiratory infection (ARI), gastroenteritis, urinary tract infection, conjunctivitis and thrush, were recorded at 1, 3, 6, 9 and 12 months of life. Severity of infections was estimated by the number of doctor visits and admissions to hospital. Potential confounders evaluated were ethnic origin, average parental age (years), average years of parental education, birth weight, sex, season of birth (autumn/spring), gestation duration, delivery mode and number of siblings.
Results: Of the initial sample of 1,049 mother–infant pairs, 1,027 (97.9%), 996 (94.9%), 984 (93.8%), 915 (87.2%) and 926 (88.2%) were available for follow-up at months 1, 3, 6, 9 and 12 postpartum, respectively. Breastfeeding rates for the total cohort were 60.7%, 35.3%, 16.7% and 4.48% (including 24.6%, 17.2%, 10.2% and 3.49% of exclusive breastfeeding) at months 1, 3, 6 and 12, respectively. Infants exclusively breastfed for 6 months, as per WHO recommendations, presented with fewer infectious episodes than their partially breastfed or non-breastfed peers and this protective effect persisted after adjustment for potential confounders for ARI (OR 0.58, 95% CI 0.36 to 0.92), AOM (OR 0.37, 95% CI 0.13 to 1.05) and thrush (OR 0.14, 95% CI 0.02 to 1.02).
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Μητρικϐσ Θηλαςμϐσ και Λοιμώξεισ Summary
Prolonged exclusive breastfeeding was associated with fewer infectious episodes (rs =−0.07, p=0.019) and fewer admissions to hospital for infection (rs =−0.06, p=0.037) in the first year of life. Partial breastfeeding was not related to protective effect. Several confounding factors, including parental age and education, ethnicity, presence of other siblings, environmental tobacco smoke exposure and season of birth were demonstrated to have an effect on frequency of infections during infancy. Breast-fed infants were found to have, on average, 0.7 fewer infections in their first year of life than their non-exclusively breast-fed counterparts (p=0.005), after adjusting for potential confounders.
Conclusions: Findings from this large-scale prospective study in a well-defined infant population with adequate healthcare standards suggest that exclusive breastfeeding contributes to protection against common infections during infancy and lessens the frequency and severity of infectious episodes. Partial breastfeeding did not seem to provide this protective effect.
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