Abstract
BackgroundAcute gastroenteritis (AGE) is a leading cause of infectious morbidity in childhood. Clinical studies have implicated caesarean section, early birth and formula feeding in modifying normal gut microbiota development and immune system homeostasis in early life. Rates of early birth and cesarean delivery are also increasing worldwide. This study aimed to investigate the independent and combined associations of the mode and timing of birth and breastmilk feeding with AGE hospitalisations in early childhood.MethodsPopulation-based record-linkage study of 893,360 singleton livebirths of at least 33 weeks gestation without major congenital conditions born in hospital, New South Wales, Australia, 2001–2011. Using age at first AGE hospital admission, Cox-regression was used to estimate the associations for gestational age, vaginal birth or caesarean delivery by labour onset and formula-only feeding while adjusting for confounders.ResultsThere were 41,274 (4.6 %) children admitted to hospital at least once for AGE and the median age at first admission was 1.4 years. Risk of AGE admission increased with decreasing gestational age (37–38 weeks: 15 % increased risk, 33–36 weeks: 25 %), caesarean section (20 %), planned birth (17 %) and formula-only feeding (18 %). The rate of AGE admission was highest for children who were born preterm by modes of birth other than vaginal birth following the spontaneous onset of labour and who received formula-only at discharge from birth care (62–78 %).ConclusionsVaginal birth following spontaneous onset of labour at 39+ weeks gestation with any breastfeeding minimised the risk of gastroenteritis hospitalisation in early childhood. Given increasing trends in early planned birth and caesarean section worldwide, these results provide important information about the impact obstetric interventions may have on the development of the infant gut microbiota and immunity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-016-0591-0) contains supplementary material, which is available to authorized users.
Highlights
Acute gastroenteritis (AGE) is a leading cause of infectious morbidity in childhood
Of the 893,360 children included in the study, 28 % were delivered by caesarean section, 41 % were planned births, 27 % were born before 39 weeks gestation and 12 % were fed only formula in the birth admission (Table 1)
Compared to vaginal birth following spontaneous onset of labour, all other modes of birth were independently associated with a 12–23 % increased rate of AGE admission (Table 2)
Summary
Clinical studies have implicated caesarean section, early birth and formula feeding in modifying normal gut microbiota development and immune system homeostasis in early life. This study aimed to investigate the independent and combined associations of the mode and timing of birth and breastmilk feeding with AGE hospitalisations in early childhood. Acute gastroenteritis is characterised by viral or bacterial infection causing diarrhea and vomiting and is a leading cause of infectious morbidity in infants and children worldwide even in developed countries including Australia, where the incidence is highest in the first two years of life [1, 2]. Bacterial colonisation and the immune response in the gut are further supported by exposure to the nutritional, growth and immunological factors contained in breastmilk [7]. Coli. in infants delivered by caesarean section or fed formula rather than breastmilk [8]
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