Abstract
In low- and middle-income countries, the protective effect of breastfeeding against infections is well established, but in high-income countries, the effect could be weakened by higher hygienic conditions. We aimed to examine the association between breastfeeding and infections in the first 2 years of life, in a high-income country with relatively short breastfeeding duration. Among 10,349 young children from the nationwide Etude Longitudinale Française depuis l’Enfance (ELFE) birth cohort, breastfeeding and parent-reported hospitalizations, bronchiolitis and otitis events, and antibiotic use were prospectively collected up to 2 years. Never-breastfed infants were used as reference group. Any breastfeeding for <3 months was associated with higher risks of hospitalizations from gastrointestinal infections or fever. Predominant breastfeeding for <1 month was associated with higher risk of a single hospital admission while predominant breastfeeding for ≥3 months was associated with a lower risk of long duration (≥4 nights) of hospitalization. Ever breastfeeding was associated with lower risk of antibiotic use. This study confirmed the well-known associations between breastfeeding and hospitalizations but also highlighted a strong inverse association between breastfeeding and antibiotic use. Although we cannot infer causality from this observational study, this finding is worth highlighting in a context of rising concern regarding antibiotic resistance.
Highlights
In 2013, infectious diseases were in the four main categories of leading causes of death among children under 5 years of age worldwide [1]
The World Health Organization (WHO) recommends exclusive breastfeeding for 6 months, or at least the first 4 months of life [2]
In the Etude Longitudinale Française depuis l’Enfance (ELFE) study, predominant breastfeeding for over 3 months was related to lower risk of at least 4 nights of hospitalization up to 2 years, while any breastfeeding for over 3 months was related to higher risk of 1 or 2 bronchiolitis events in the first 2 years of age
Summary
In 2013, infectious diseases were in the four main categories of leading causes of death among children under 5 years of age worldwide [1]. Infections are the leading causes of death in sub-Saharan African countries but not in high-income countries. The good hygienic conditions and health care system available in some countries significantly reduce the prevalence and fatal issue of such diseases but do not fully prevent them. The World Health Organization (WHO) recommends exclusive breastfeeding for 6 months, or at least the first 4 months of life [2]. These recommendations were mainly based on the protective effect of breastfeeding against infectious morbidity and mortality [3].
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