Published online June 2, 2008
PEDIATRICS Vol. 121 No. 6 June 2008, pp. e1510-e1516 (doi:10.1542/peds.2007-1757)

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ARTICLE

Differential Gender Response to Respiratory Infections and to the Protective Effect of Breast Milk in Preterm Infants

M. Inés Klein, MD^a, Eduardo Bergel, PhD^b,c, Luz Gibbons, PhD^b, Silvina Coviello, MS^a, Gabriela Bauer, MD^d, Alicia Benitez, MD^e, M. Elina Serra, MD^a, M. Florencia Delgado, MS^a, Guillermina A. Melendi, MD^a,f, Susana Rodríguez, MD^d, Steven R. Kleeberger, PhD^g and Fernando P. Polack, MD^a,f,h,i

^a Fundacion INFANT, Buenos Aires, Argentina
^b Instituto de Efectividad Clinica y Sanitaria, Buenos Aires, Argentina
^c United Nations Development Programme/United Nations Population Fund/World Health Organization/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, Geneva, Switzerland
^d High Risk Clinics, Hospital de Pediatria Juan P. Garrahan, Buenos Aires, Argentina
^e High Risk Clinics, Maternidad Sarda, Buenos Aires, Argentina; Department of
^f Pediatrics, School of Medicine, and Departments of
^h Molecular Microbiology and Immunology
ⁱ International Health, Johns Hopkins University, Baltimore, Maryland
^g National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina

OBJECTIVE. The protective role of breastfeeding against severe acute lung disease in infants is well established, but its mechanism is unclear. Most hypotheses assume that breastfeeding confers similar passive protection to every infant; however, a few observations have suggested that the benefits of breast milk against severe lung disease may differ according to gender. The objective of this study was to determine whether the effect of breastfeeding on susceptibility to severe acute lung disease among infants at high risk is different for girls and boys.

METHODS. A cohort was analyzed prospectively by use of 2 different strategies: (1) predictors of first episode of rehospitalization by univariate and multivariate analyses using robust Poisson regression and (2) mean number of rehospitalizations between groups using multiple regression negative binomial models.

RESULTS. A total of 119 high-risk, very low birth weight infants were enrolled. Breast milk protected girls but not boys against severe acute lung disease. The interaction between breastfeeding and gender was clinically and statistically significant, even after adjustment for variables that can affect severity of acute lung disease. Disease was most severe in formula-fed girls (versus formula-fed boys).

CONCLUSIONS. Breastfeeding decreased the risk for severe acute lung disease in girls but not in boys. These findings suggest that breast milk protection is not universally conferred by passive transfer of humoral immunity (which should be gender indifferent), show that respiratory symptoms may be amenable to nonspecific modulation, and identify nonbreastfed preterm infant girls as an at-risk group for severe acute lung disease.

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Key Words: lower respiratory infection • breast milk • respiratory syncytial virus • prematurity • gender

Abbreviations: VLBW—very low birth weight • RSV—respiratory syncytial virus • hMPV—human metapneumovirus • hPIV—human parainfluenza virus • BPD—bronchopulmonary dysplasia • LRI—lower respiratory infection

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Accepted Nov 16, 2007.

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