The Effects of 6-Month Exclusive Breastfeeding on Febrile Seizure: A Systematic Review and Meta-Analysis

Bronchiolitis is a major cause of infant illness, with few known modifiable risk factors. Breast feeding may reduce risk of severe bronchiolitis, but the association of exclusive vs. partial breast feeding with severe bronchiolitis is unclear. To estimate the association of exclusive vs. partial breast feeding during ages 0-2.9months with bronchiolitis hospitalisation during infancy. We conducted a case-control study as a secondary analysis of two prospective US cohorts in the Multicenter Airway Research Collaboration. Cases were enrolled in a 17-centre study of infants hospitalised for bronchiolitis during 2011-2014 (n= 921). Controls were enrolled in a five-centre study of healthy infants during 2013-2014 and 2017 (n= 719). Breast feeding history during ages 0-2.9months was collected by parent interview. Among breastfed infants, the association of exclusive vs. partial breast feeding with odds of bronchiolitis hospitalisation was estimated using a multivariable logistic regression model adjusted for demographic variables, parental asthma history, and early-life exposures. As a secondary analysis, we estimated the associations of exclusive, predominant, and occasional breast feeding vs. no breast feeding with the odds of bronchiolitis hospitalisation. Among 1640 infants, the prevalence of exclusive breast feeding was 187/921 (20.3%) among cases and 275/719 (38.3%) among controls. Exclusive vs. partial breast feeding was associated with 48% reduced odds of bronchiolitis hospitalisation (adjusted odds ratio [OR] 0.52, 95% confidence interval [CI] 0.39, 0.69). In the secondary analysis, exclusive vs. no breast feeding was associated with 58% reduced odds of bronchiolitis hospitalisation (OR 0.42, 95% CI 0.23, 0.77), whereas predominant breast feeding (OR 0.77, 95% CI 0.37, 1.57) and occasional breast feeding (OR 0.98, 95% CI 0.57, 1.69) were not associated with meaningfully reduced odds of bronchiolitis hospitalisation. Exclusive breast feeding had a strong protective association against bronchiolitis hospitalisation.

BackgroundIn Indonesia, nearly half of all children aged less than six months were not exclusively breastfed in 2017. This study aimed to compare the cost of providing direct or indirect exclusive breastfeeding 0–6 months, partial exclusive breastfeeding and commercial milk formula only. This study also assessed the maternal socioeconomic and mental health factors to providing exclusive breastfeeding.MethodsData were collected in 2018 via a cross-sectional survey of 456 mothers in Bandung City and Purwakarta District, West Java Province, Indonesia, who had children aged less than six months. We used micro-costing to calculate the cost of productivity, equipment, supplies, and training of mothers when providing direct exclusive breastfeeding, indirect exclusive breastfeeding, partial exclusive breastfeeding (a mix of breastfeed and commercial milk formula), and infant formula/commercial milk formula only. Logistic regression was used to determine the impact of several independent variables, including mother’s level of depression, on exclusive breastfeeding.ResultsTo provide direct exclusive breastfeeding, the cost per mother in the first six months is US$81.08, which is less expensive than indirect exclusive breastfeeding (US$171.15), partial exclusive breastfeeding (US$487.8) and commercial milk formula (US$494.9). We also found that education and age are associated with the decision to provide direct exclusive breastfeeding. Mothers who work will most likely provide indirect exclusive breastfeeding, commercial milk formula, or partial breastfeeding as opposed to direct exclusive breastfeeding. Finally, although severe depression symptoms have a positive relationship with the decision to provide commercial milk formula over direct exclusive breastfeeding, the evidence here is not strong.ConclusionsThe total cost of providing only commercial milk formula is 6-times higher than the cost of direct exclusive breastfeeding. The presence of severe depression symptoms is positively related to mothers opting for other feeding methods aside of direct exclusive breastfeeding and indirect exclusive breastfeeding. This study shows that direct exclusive breastfeeding is economically preferable to other methods, supports policies to reduce the time cost of exclusive breastfeeding (e.g., paid maternity leave and maternal cash transfers), and addresses the importance of mother’s mental health to ensure successful breastfeeding.

Protective Effect of Breastfeeding Against Febrile Seizure: A Nationwide Study in Korea

Background: Breast milk is widely accepted as the best nutrition for all newborn infants. World Health Organization has recommended exclusive breastfeeding for 6 months. Rate of 4-month and 6-month exclusive breastfeeding in Thailand are 20.7% and 14.5%, respectively. There is no data reported for preterm infants. Objectives: 1) To determine rate of 4-month exclusive or predominant breastfeeding and partial breastfeeding in preterm infants. 2) To determine feeding pattern during hospitalization and at home in preterm infants. 3) To determine promoting factors of successful breastfeeding. Materials and methods: This was a cohort study in mothers of preterm infants with gestational age ≤ 34 weeks and birth weight ≤ 2000 grams. Data is collected from medical records and by parental interview. The mother-infant dyads will be followed after discharged from hospital until 4 months of age. Results: The study period was between 1 March 2009 and 28 February 2010. There were 90 mothers recruited. Data of 74 mothers with complete follow up were analyzed. Mean maternal age was 29.67 ± 7.43 years old. Median gestational age at delivery was 31 (interquartile range 4) weeks. Mean infants birth weight was 1412.71 ± 339.18 grams. Rate of exclusive or predominant and partial breastfeeding were 32.4% and 29.7%, respectively. After adjusted for mother work at home, multiple pregnancy, previous breastfeeding experience, mother stay with infants and exclusive breastfeeding in the last 24 hours by multiple logistic regression analysis, promoting factors of successful exclusive breastfeeding were mother work at home (OR 6.77, 95%CI 1.80, 25.55), previous breastfeeding experience (OR 5.09, 95%CI 1.39, 18.65), exclusive breastfeeding in the last 24 hours (OR 4.70, 95%CI 1.17, 18.89) and mother stay with infants (OR 4.22, 95%CI 1.17, 15.68). Conclusion: Exclusive breastfeeding in preterm infants is possible. Mothers stay with their infants during long hospitalization and exclusive breastfeeding during the last 24 hours before discharge are significant promoting factors that should be supported by health personnel. Mother work at home is the other significant promoting factor of successful 4-months exclusive or predominant breastfeeding.

Exclusive Breastfeeding Is Recommended in the First 6 Months of Life for Healthy Term Infants

Background: Exclusive breastfeeding up to 6 months of age is the global recommendation of the World Health Organization because of its established benefits. Previous studies show that exclusive breastfeeding can protect infants during infancy but effects of breastfeeding beyond infancy are inconclusive. This study aims to identify if exclusive breastfeeding up to 6 months of age is protective for pneumonia up to 5 years of age. Methods: Systematic literature search was conducted on the following electronic databases: Pubmed, MEDLINE, EMBASE, CINAHL, SciHub, Herdin, Google Scholar, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews to identify all relevant studies assessing the effect of exclusive breastfeeding on development of pneumonia in children from birth to 5 years of age. Fixed effects meta-analysis was performed to generate pooled effect estimates (odds ratio) on the probability of developing pneumonia up to 5 years of age in exclusively breastfed compared to non-exclusively breastfed infants. Results: Five studies were included in the analysis. Exclusive breastfeeding from birth to 6 months has a protective effect against pneumonia in children up to 5 years of age. The probability of developing pneumonia in children until 5 years of age was significantly lower in those who were exclusively breastfed compared to those who were not exclusively breastfed (OR=0.86; 95%CI=0.77-0.95, pvalue=0.003) by 23%. Systematic review showed benefit of exclusive breastfeeding and continued breastfeeding for longer protection against developing pneumonia. Conclusion: Exclusive breastfeeding from birth to 6 months is associated with statistically significant reduction in the incidence of pneumonia up to 5 years of age. Results highlighted the importance of exclusive breastfeeding up to 6 months of age as an intervention in reducing pneumonia morbidity up to 5 years of age, thereby supporting the global recommendation of breastfeeding.

To compare breastfeeding (BF) initiation among 317 women with chronic hypertension (CHTN) and 106 women with CHTN superimposed on pregestational diabetes (CHTN-DM) who intended exclusive or partial BF. Retrospective cohort study of women who delivered at≥34 weeks of gestation. At discharge, exclusive BF was defined by direct BF or BF complemented with expressed breast milk (EBM) while partial BF was defined by formula supplementation. CHTN and CHTN-DM groups were similar in prior BF experience (42 vs 52%), intention to BF exclusively (89 vs 79%) and intention to partially BF (11 vs 21%). Women in the CHTN group were younger (31 vs 33y), more likely primiparous (44 vs 27%), and delivered vaginally (59 vs 36%) at term (85 vs 75%). Women in the CHTN-DM group had higher repeat cesarean rates (32 vs 18%), preterm birth (25 vs 15%), neonatal hypoglycemia (42 vs 14%) and NICU admission (38 vs 16%). At discharge, exclusive BF rates among CHTN was higher (48 vs 19%), while rates of partial BF (34 vs 44%) and FF (18 vs 37%) were lower than in the CHTN-DM group. BF initiation (exclusive plus partial BF) occurred in 82%of CHTN and in 63% of CHTN-DM. Although intention to BF was similar, BF initiation rates were higher for the CHTN compared to the CHTN-DM group. Exclusive BF was low in the CHTN and even lower in the CHTN-DM group signaling the need for targeted interventions if BF initiation rates are to be improved.

Timing of initiation, patterns of breastfeeding, and infant survival: prospective analysis of pooled data from three randomised trials.

Primary prevention of atopic dermatitis in breast-fed infants: what is the evidence?

Abstract. According to the Institute of Health Consensus Conference, the occurrence of febrile seizures in infants and toddlers aged 3 – 5 years old is associated with fever without any evidence of infection or intracranial causes. Children with a high body temperature of 380C (rectal temperature) are subject to febrile seizure. About 90% of febrile seizures sufferers are children under five years. In Indonesia, the prevalence of febrile is estimated to 2 – 4% while the data shown in Bahteramas Hospital during the past three years indicated an increased incidence of febrile seizures in as many as 17, 87, and 149 patients respectively in 2013, 2014, and 2015. The present study aimed to understand the relation between neonatal asphyxia and exclusive breastfeeding to the incidence of febrile seizures in children at Bahteramas Hospital, Southeast Sulawesi. This study is an analytical study with a case-control approach. The population of the study was mothers whose child suffering from febrile seizures in Mawar room from January to Mei 2016 as many as 105 patients, later 60 patients were enrolled in the study using an accidental sampling technique. The statistical analysis was made using an odds ratio and binary logistic regression. The results show that neonatal asphyxia (OR=4.750) and exclusive breastfeeding ( OR=4.929) are associated with the incidence of febrile seizures in children. It is suggested for mothers to prevent their toddlers from asphyxia and promoting a 6-month exclusive breastfeeding practice to naturally boost immunity from febrile seizure.

Breastfeeding benefits mothers and infants. Although immigration in many regions has increased in the last three decades, it is unknown whether immigrant women have better breastfeeding outcomes than non-immigrants. The aim of this study was to conduct a systematic review and meta-analysis to determine whether breastfeeding rates differ between immigrant and non-immigrant women. We searched Medline, Embase, PsycINFO, CINAHL and Google Scholar, 1950 to 2016. We included peer-reviewed cross-sectional and cohort studies of women aged ≥16years that assessed and compared breastfeeding rates in immigrant and non-immigrant women. Two independent reviewers extracted data using predefined standard procedures. The analysis included 29 studies representing 1,539,659 women from 14 countries. Immigrant women were more likely than non-immigrants to initiate any (exclusive or partial) breastfeeding (pooled adjusted prevalence ratio 1.13, 95% confidence interval [CI] 1.07-1.19; 11 studies). Exclusive breastfeeding initiation was higher but borderline significant (adjusted prevalence ratio 1.20, 95% CI 1.00-1.45; 5 studies, p=0.056). Immigrant women were more likely than non-immigrants to continue any breastfeeding between 12- and 24-week postpartum (pooled adjusted risk ratio 2.04, 95% CI 1.79-2.32; 3 studies) and>24weeks (adjusted risk ratio 1.33, 95% CI 1.02-1.73; 6 studies) but not exclusive breastfeeding. Immigrant women are more likely than non-immigrants to initiate and maintain any breastfeeding, but exclusive breastfeeding remains a challenge for both immigrants and non-immigrants. Social and cultural factors need to be considered to understand the extent to which immigrant status is an independent predictor of positive breastfeeding practices.

Influence and Mechanisms of Maternal and Infant Diets on the Development of Childhood Asthma

Ruth Nduati and colleagues (May 26, p 1651)1Nduati R Richardson BA John G et al.Effect of breastfeeding on mortality among HIV-1 infected women: a randomised trial.Lancet. 2001; 357: 1651-1655Summary Full Text Full Text PDF PubMed Scopus (138) Google Scholar claim to show that breastfeeding strikingly increases mortality among HIV-1-positive mothers. In her May 26 commentary, Marie-Louise Newell2Newell ML Does breastfeeding really affect mortality among HIV-1 infected women?.Lancet. 2001; 357: 1634-1635Summary Full Text Full Text PDF PubMed Scopus (14) Google Scholar discusses some of the study's limitations and compares it with research by Coutsoudis and coworkers3Coutsoudis A Coovadia H Pillay K Kuhn L Are HIV-infected women who breastfeed at increased risk of mortality?.AIDS. 2001; 15: 653-655Crossref PubMed Scopus (53) Google Scholar that draws very different conclusions. We have concerns about some additional issues. Balanced randomisation is essential in clinical trials. We believe Nduati and colleagues' randomisation was not successful. In a more detailed description of the trial4Nduati R Richardson BA John G et al.Effect of breastfeeding and formula feeding on transmission of HIV-1: a randomized clinical trial.JAMA. 2000; 283: 1167-1174Crossref PubMed Scopus (740) Google Scholar, at birth only two of the babies in the formula-fed group were believed to be HIV-1 positive, compared with nine assigned breastfeeding. Obviously, method of feeding cannot have any impact on HIV-1 status at the time of birth, and these results suggest important differences between the mothers in the treatment groups that were not detected by the researchers nor balanced by randomisation. The iniability to mask feeding methods introduces a potential source of bias. In addition, the formula-feeding mothers might have had more extensive contact with researchers for education about the correct way to prepare formula.4Nduati R Richardson BA John G et al.Effect of breastfeeding and formula feeding on transmission of HIV-1: a randomized clinical trial.JAMA. 2000; 283: 1167-1174Crossref PubMed Scopus (740) Google Scholar These women might have, if only indirectly, received more health-care interventions than those in the breastfeeding group. Unlike Coutsoudis, Nduati and colleagues do not distinguish between partial and exclusive breastfeeding, and do not precisely define exclusive breastfeeding. 9% of mothers were exclusively breastfeeding by 6 months, which is a much higher proportion than the 3·5% at 4–5 months in the general population in Kenya.5Kenya Central Statistical Bureau and Macro InternationalDemographic and health survey. Macro International, Calverton MD1998Google Scholar This difference might be due partly to the WHO definition of exclusive breastfeeding not being used by Nduati and colleagues. Adherence to exclusive formula feeding was only 71%, meaning that 29% of the mothers practised partial breastfeeding. Given that adherence was based on selfreporting, this proportion is probably an overestimate. Because the analysis was done by intention to treat, differences between the two groups in actual feeding practices are unclear, since they both contained substantial proportions of mixed feeders. Some mothers in the formula-feeding group might have breastfed more than some mothers in the breastfeeding group. Nduati and colleagues claim they have no reason to believe that dropouts (which were greater in number than deaths) differed between groups, but there is no reason to believe that they are the same. For example, a seriously ill woman might find formula preparation too great an effort and drop out. Conversely, some of the healthiest mothers with highest socioeconomic status in the breastfeeding group might have believed that their babies were at a disadvantage and left the trial to change to formula feeding. We are concerned that Nduati and colleauges' policy recommendations may be based on their conclusions that there is no risk to the health of mother or child from exclusive breastfeeding. An additional concern is the lack of written witnessed consent for participation. Surely, even if verbal information was given, women could still sign their names. Policy decisions based on this information may seriously impact the lives of millions of mothers and children. We believe the raw data need reanalysis. Phyll Buchanan, David Crowe, Ted Greiner, George Kent, Tessa Martyn, Valerie McClain, Pamela Morrison, Denise Parker, Magda Sachs, Karen Zeretzke contributed to the writing of the letter. Breastfeeding in HIV-1-positive mothersAuthors' reply Full-Text PDF

Objective: To compare breastfeeding (BF) practices, particularly exclusive BF (EBF), among women with and without a history of gestational diabetes mellitus (GDM) during the first six postpartum months and assess the impact of EBF on offspring weight from birth to six months postpartum. Materials and Methods: The present study was a prospective study that included 244 women, with 123 with a history of GDM (GDM group) and 121 without a history of GDM (non-GDM group). All participants were first interviewed on the discharge date and then via telephone at 1, 2, 3, 4, 5, and 6 months postpartum. BF practices were classified as EBF, partial BF (PBF), or no BF. Data on infant weight at six months were evaluated. Results: Upon hospital discharge, women mostly practiced PBF with 53.6% PBF versus 30.1% EBF in the GDM group and 48.8% PBF versus 38.0% EBF in the non-GDM group. However, EBF was more commonly practiced than PBF, during the first six months postpartum. The 6-month EBF rates for the GDM and non-GDM groups were 28.4% and 17.4%, respectively (p=0.039). In a multivariate analysis, only the intended EBF period was a factor that significantly impacted 6-month EBF rates (adjusted odds ratio 3.49 and 95% confidence interval 1.48 to 8.22). EBF for six months resulted in reduced weight gain during the first six months of life among offspring of women in both groups. Conclusion: The GDM group practiced EBF for six months postpartum more frequently than the non-GDM group. However, a history of GDM was not an independent predictor of EBF success over six months. EBF demonstrated lower offspring weight gain from birth to six months postpartum for women with and without a history of GDM. These findings may be used to design targeted educational programs for informed postpartum BF practices. Keywords: Breastfeeding practices; Breastmilk; Exclusive breastfeeding; Gestational diabetes mellitus; Infant weight gain; Postpartum

ObjectiveTo compare exclusive breastfeeding (BF) and BF initiation among 185 women with Type 1 and 212 women with Type 2 pregestational diabetes who intended exclusive or partial BF and delivered at ≥34 weeks of gestation.MethodsRetrospective cohort study. At discharge, exclusive BF is direct BF or BF complemented with expressed breast milk. BF initiation is defined by exclusive or partial BF.ResultsType 1 and Type 2 groups were similar in prior BF experience (69 vs 67%) but were different in intention to BF exclusively (92 vs 78%) and partially (8 vs 22%). Women in the Type 1 group were younger (median age 30 vs 33y), likely to be primiparous (47 vs 25%), have a lower median BMI (32 vs 36 kg/m2) and deliver by primary cesarean (37 vs 26%). Infants born to Type 1 women were more likely to be admitted to the NICU (44 vs 18%) and to have hypoglycemia (59 vs 41%). At discharge, exclusive BF among Type 1 was higher (34 vs 23%), partial BF was similar (47 vs 46%) while FF (formula feeding) was lower (19 vs 31%) than in the Type 2 group. BF initiation occurred in 81% of Type 1 and 69% of Type 2 women.ConclusionIntention to BF exclusively was higher in Type 1 women compared to Type 2. At discharge, exclusive BF and BF initiation were lower and FF higher in the Type 2 group highlighting the need for different strategies if lactation in this special population is to be improved.