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PEDIATRICS Vol. 113 No. 5 May 2004, pp. e435-e439

ELECTRONIC ARTICLE

Breastfeeding and the Risk of Postneonatal Death in the United States

Aimin Chen, MD, PhD and Walter J. Rogan, MD

From the Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina

Objective. Breastfed infants in the United States have lower rates of morbidity, especially from infectious disease, but there are few contemporary studies in the developed world of the effect of breastfeeding on postneonatal mortality. We evaluated the effect of breastfeeding on postneonatal mortality in United States using 1988 National Maternal and Infant Health Survey (NMIHS) data.

Methods. Nationally representative samples of 1204 infants who died between 28 days and 1 year from causes other than congenital anomaly or malignant tumor (cases of postneonatal death) and 7740 children who were still alive at 1 year (controls) were included. We calculated overall and cause-specific odds ratios for ever/never breastfeeding among all children, conducted race and birth weight–specific analyses, and looked for duration–response effects.

Results. Overall, children who were ever breastfed had 0.79 (95% confidence interval [CI]: 0.67–0.93) times the risk of never breastfed children for dying in the postneonatal period. Longer breastfeeding was associated with lower risk. Odds ratios by cause of death varied from 0.59 (95% CI: 0.38–0.94) for injuries to 0.84 (95% CI: 0.67–1.05) for sudden infant death syndrome.

Conclusions. Breastfeeding is associated with a reduction in risk for postneonatal death. This large data set allowed robust estimates and control of confounding, but the effects of breast milk and breastfeeding cannot be separated completely from other characteristics of the mother and child. Assuming causality, however, promoting breastfeeding has the potential to save or delay ~720 postneonatal deaths in the United States each year.

Key Words: breastfeeding • infant mortality • cause of death • risk • logistic models

Abbreviations: SIDS, sudden infant death syndrome • NMIHS, National Maternal and Infant Health Survey • OR, odds ratio • CI, confidence interval

Received for publication Sep 8, 2003; Accepted Dec 22, 2003.




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P3Rs:

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Major confounder not adjusted for in your study
Esther R. Aronson
Pediatrics Online, 6 May 2004 [Full text]
response to Dr. Aronson
Walter J. Rogan, et al.
Pediatrics Online, 7 May 2004 [Full text]