Abstract
Background: Viral respiratory tract infections (VRI) are a major reason for hospitalization in children younger than 5 years. A case control study was conducted to investigate the potential role of breastfeeding in protecting children <1 year of age from VRI.Methods: Patients admitted for a respiratory tract infections routinely underwent a nasopharyngeal aspirate, which was tested with an RT-PCR for 14 respiratory viruses. Hospitalized infants positive for viruses were enrolled as cases; healthy controls were enrolled among patients admitted for ultrasound hip screening. The effect of breastfeeding on pertussis was investigated through multivariable analysis.Results: We enrolled a total of 496 patients: 238 cases and 258 healthy controls. Among cases, eighty-six patients (36.1%) had a rinovirus, 78 (32.8%) an RSV, 22 (9.2%) an adenovirus, and 37 (15.5%) a coinfections with multiple viruses. The number of households was significantly higher in cases (mean in cases 4.5; mean 3.7 in controls, p < 0.001) and the proportion of infants having siblings (79% in cases vs. 43% in controls, p < 0.001). Proportion of smoking mothers was higher in cases than in controls (21.4 vs. 10.1%, p = 0.001). Among cases 44.5% were exclusively breastfed at symptoms onset vs. 48.8% of healthy controls. According to the multivariable analysis, being exclusively breastfed at symptom onset was associated with a higher risk of viral respiratory infection (3.7; 95% CI 1.64–8.41), however a longer breastfeeding duration was protective (OR 0.98; 95% CI 0.97–0.99). Also having at least one sibling was associated to a higher risk (OR 3.6; 95% CI 2.14–5.92) as well as having a smoking mother (OR 2.6; 95% CI 1.33–4.89).Conclusions: Breastfeeding remains a mainstay of prevention for numerous diseases and its protective role increases with duration. However, being breastfed when mothers carry a respiratory infection may increase the risk of transmission, acting as a proxy for closer contacts. In future studies, potential confounding variables as pattern of contacts with other individuals, should be taken into account.
Highlights
Viral respiratory tract infections (VRI) are a major reason for hospitalization in children younger than 5 years
The protective role of breastfeeding against respiratory infections has been repeatedly demonstrated for children living in developing countries [10,11,12]
We report here the results of a case-control study exploring the association of breastfeeding with viral respiratory infections in a metropolitan area, in children younger than 12 months of age
Summary
Viral respiratory tract infections (VRI) are a major reason for hospitalization in children younger than 5 years. Studies conducted in industrialized countries report a prevalence of respiratory tract infections ranging from 3.4 to 32.1% in the first year of life [1,2,3,4]. Respiratory tract infections are a major reason for hospitalization in children younger than 5 years [5,6,7]. Different studies have explored and confirmed the role of clinical and socioeconomic risk factors for respiratory tract infections, including birth weight, gestational age, socioeconomic status, ethnicity, number of siblings, day care attendance, and parental smoking [4, 8, 9]. Breastfeeding is described as protective in industrialized countries, different study designs, definitions (e.g., for infant feeding and kind of infection), timing of evaluation of exposure (feeding), and outcome (infection), have been used in studies performed this setting
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