Abstract
ObjectiveTo assess the existing evidence regarding breastfeeding initiation time and infant morbidity and mortality.Study designWe conducted a systematic review and meta-analysis. We searched Pubmed, Embase, Web of Science, CINAHL, Popline, LILACS, AIM, and Index Medicus to identify existing evidence. We included observational studies and randomized control trials that examined the association between breastfeeding initiation time and mortality, morbidity, or nutrition outcomes from birth through 12 months of age in a population of infants who all initiated breastfeeding. Two reviewers independently extracted data from eligible studies using a standardized form. We pooled effect estimates using fixed-effects meta-analysis.ResultsWe pooled five studies, including 136,047 infants, which examined the association between very early breastfeeding initiation and neonatal mortality. Compared to infants who initiated breastfeeding ≤1 hour after birth, infants who initiated breastfeeding 2–23 hours after birth had a 33% greater risk of neonatal mortality (95% CI: 13–56%, I2 = 0%), and infants who initiated breastfeeding ≥24 hours after birth had a 2.19-fold greater risk of neonatal mortality (95% CI: 1.73–2.77, I2 = 33%). Among the subgroup of infants exclusively breastfed in the neonatal period, those who initiated breastfeeding ≥24 hours after birth had an 85% greater risk of neonatal mortality compared to infants who initiated <24 hours after birth (95% CI: 29–167%, I2 = 33%).ConclusionsPolicy frameworks and models to estimate newborn and infant survival, as well as health facility policies, should consider the potential independent effect of early breastfeeding initiation.
Highlights
Five million deaths in children younger than five years were reported globally in 2015; almost half (46%) of these occurred in the neonatal period [1]
Compared to infants who initiated breastfeeding 1 hour after birth, infants who initiated breastfeeding 2–23 hours after birth had a 33% greater risk of neonatal mortality, and infants who initiated breastfeeding !24 hours after birth had a 2.19-fold greater risk of neonatal mortality
Among the subgroup of infants exclusively breastfed in the neonatal period, those who initiated breastfeeding !24 hours after birth had an 85% greater risk of neonatal mortality compared to infants who initiated
Summary
Five million deaths in children younger than five years were reported globally in 2015; almost half (46%) of these occurred in the neonatal period [1]. Interventions that can be implemented at scale, starting before birth and continuing throughout the postnatal period, are needed to reduce mortality and morbidity in children and young infants [2]. Only 50% of infants in the world are breastfed during the first hour of life, and 60% are exclusively breastfed [3]. The World Health Organization (WHO) recommends that newborns initiate breastfeeding within one hour of birth, but this recommendation is not supported by an official WHO guideline. Additional evidence is needed to inform public health investment and to facilitate the implementation of breastfeeding promotion programs
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