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ELECTRONIC ARTICLE:
Aimin Chen and Walter J. Rogan
Breastfeeding and the Risk of Postneonatal Death in the United States
Pediatrics 2004; 113: e435-e439 [Abstract] [Full text] [PDF]
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eLetters published:

[Read eLetters] Major confounder not adjusted for in your study
Esther R. Aronson   (6 May 2004)
[Read eLetters] response to Dr. Aronson
Walter J. Rogan, Aimin Chen   (7 May 2004)

Major confounder not adjusted for in your study 6 May 2004
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Esther R. Aronson,
Family physician, breastfeeding mother of three
Clalit Health Services, Bet Shemesh, Israel.

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Re: Major confounder not adjusted for in your study

nmandy{at}lycos.com Esther R. Aronson

I'm surprised your study did not address, nor adjust for, children who were in a daycare setting vs. those who were not. Women who must return to work soon after birth often breastfeed less, or do not initiate breastfeeding; Infants in daycare (especially of low quality and with a high child/caregiver ratio) are more prone to SIDS, injuries, and exposure to potentially fatal infectious agents.

I wonder if the results of your study might not have been very different if the mothers' work and use of other care providers were noted and adjusted for.

response to Dr. Aronson 7 May 2004
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Walter J. Rogan,
physician
NIEHS,
Aimin Chen

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Re: response to Dr. Aronson

rogan{at}niehs.nih.gov Walter J. Rogan, et al.

We appreciate Dr. Aronson's interest. In the study that produced the data we used, mothers of infants who died were not asked questions about day care, so we cannot examine her hypothesis.