Early Initiation of Breastfeeding Protects Against Early-Onset Sepsis Among Newborns: Evidence from Rural Bangladesh

Abstract

Background: In Bangladesh, neonatal sepsis is the cause of 24% of neonatal deaths, over 65% of which occur in the early-newborn stage (0-7 days). Only 50% of women initiate breastfeeding their newborn within 1 hour of birth. The mechanism by which early initiation of breastfeeding reduces neonatal deaths is unclear, although the most likely pathway is by decreasing neonatal sepsis. This study explores the effect of breastfeeding initiation time on early-onset newborn sepsis. Methods: We used data from a large community-based trial in Bangladesh where we enrolled pregnant women from 2013-2015 covering 30,646 newborns. Syndromic sepsis was defined using newborn danger signs reported by “The Young-Infants Clinical Science Study Group.” We categorized the timing of initiation of breastfeeding as within 1 hour, 1-24 hours, 24-48 hours, ≥48 hours of birth, and never breastfed. The analysis includes descriptive statistics, risk attribution, and binomial logistic-regression while adjusting for clustering effects of the trial design, and maternal and infant characteristics. Findings: 29,873 live-births had information on breastfeeding initiation among whom 4,437 (14·8%) neonates had signs of sepsis by the 7th day after birth. Two-thirds of the newborns [66·7%, (n=19,914)] had breastfeeding initiated within 1hr of birth. The mean time to initiation was 3·8 hours (±16·6 hours), and by the end of 48 hours, all but 5·7% of neonates were breastfed. The proportion of children with syndromic sepsis increased as the initiation of breastfeeding was delayed from 1 hour (12·0%), 24 hours (15·7%), 48 hours (27·7%), to more than 48 hours (36·7%) after birth. It would be possible to avert 15·9%, 10·6% and 8·5% of early-onset sepsis cases if all children initiated breastfeeding within 1, 24 or 48 hours of birth respectively. The odds of having sepsis is significantly higher among late initiators. Children who initiated after 48 hours (OR 4·13, 95% CI 3·48-4·89) and children who never initiated (OR 4·77, 95% CI 3·52-6·47) had the highest odds of having signs of sepsis. Interpretation: Our findings indicate that the timing of initiation of breastfeeding, especially within the first hour of birth, has a significant protective effect on early-onset sepsis among newborns. Community-based interventions to promote early initiation of breastfeeding should be tailored to suit the needs of populations where newborns are delivered at home by unskilled attendants, the rate of LBW is high, and post-natal care is limited. Clinical Trial Number: Australia New Zealand Clinical Trials Registry (ANZCTR): The registration ID is ACTRN12612000588897. Funding Statement: National Health and Medical Research Council [NHMRC] (of Australia) funded this study (#1026864). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The Ethical Review Committee (ERC) of the icddr,b, and the Human Research Ethics Committee (HREC) of the University of Sydney have granted ethics approval for the parent study. We obtained written informed consent, from pregnant women during enrollment into the study, which provided full disclosure regarding the study.