SourceLocation and Type of TrialInterventionPerinatal/Neonatal Outcome
WHO Collaborative Study Team528Studies from Brazil, The Gambia, Ghana, Pakistan, The Philippines and Senegal; pooled analysis of existing studiesMultiple studies evaluating exclusive breastfeeding versus mixed or formula feeding and providing data on outcomes in infancy were combined in this pooled analysis.Pooled OR for mortality in nonbreastfed individuals was 5.8 (CI: 3.4–9.8) for infants <2 mo of age.
Coutsoudis et al724South Africa; urban hospital setting; PCS549 women-infant pairs were studied; 1 cohort of infants was never breastfed (n = 156), a second cohort was exclusively breastfed (n = 103), and a third cohort received mixed feeding (n = 288). Among 549 infants, 3 distinct groups were studied: (1) those who were exclusively breastfed, (2) those who were given mixed feeds, and (3) those who were never breastfed.Breastfed and nonbreastfed infants had comparable rates of HIV infection (acquired from mothers who were HIV positive). Exclusive breastfeeding to 3 mo or longer was associated with a significantly lower risk of infection (hazard ratio: 0.52; CI: 0.28–0.98, P < .04). Never having breastfed also carried a risk of infection similar to mixed feeding (0.85, CI: 0.51–1.42, P = 0.53).
Kumar et al525India; urban hospital setting; PCS50 newborns were enrolled in the study. group 1 (n = 25) was exclusively breastfed (EBF); group 2 (n = 25) was mixed fed (MF).Although birth weights in both groups were comparable, group 1 infants had significantly greater weight gain from the second month of life onwards (P < .01). EBF infants had 40 sickness episodes per 100 child-mo as compared to 69 per 100 child-mo in group 2. Diarrheal episodes were 20 per 100 child-mo in group 2 as compared to 6 per 100 child-mo in group 1 (P < .01). Cases of pneumonia, otitis media and hospitalization were also more common among MF infants than EBF infants (4 vs 3; 3 vs 1; and 5 vs 2, respectively), although the sample size was too small to measure significance.
Augustine et al524India; hospital setting; RCSMortality and morbidity statistics using the records (n = 169) of all the infants (60 preterm and 109 term) admitted during the first 7 d of life in a rural pediatrics ward over 1 y were analyzed.Exclusive breastfeeding was associated with the lowest rate of mortality (29%), compared with infants not yet fed (64%) or those receiving sugar water or cow's milk with or without breastfeeding (43%).
Singh et al526India, urban and rural settings; Cross-sectional surveyData from a cross-sectional survey on the relationship between colostrum and neonatal and post-neonatal deaths, in which a cohort of newborn infants (n = 826) were followed up, was analyzed for mortality patterns.In the rural high socioeconomic group, no neonatal deaths were found among the subgroup that received colostrum, and 8.2% of neonates died in the subgroup that did not receive colostrum. As a general conclusion, 1.7% of urban neonates and 2.6% of urban postneonates who received colostrum died, compared with 6.3% and 7.1%, respectively, who did not receive colostrum. In rural areas, comparable neonatal and postneonatal death rates were 1.7% and 1.7%, respectively, for infants who received colostrum, and 7.4% and 3.5%, respectively, for infants who did not receive colostrum.
Victora et al523Brazil; urban hospital setting; CCSCases (n = 357) in which young infants had died of infections were identified through coroner's records. 2 controls were matched to each case for age and socioeconomic status (n = 714).Compared with infants who were exclusively breastfed, those who were mixed-fed (given formula or cow's milk in addition to breast milk) had 4.2 times the risk of death from diarrhea (CI: 1.7–10.1), whereas those who were completely weaned (not receiving any breast milk) had a risk 14.2 times higher (CI: 5.9–34.1). Compared with exclusively breastfed infants, mixed-fed infants and completely weaned infants had 1.6 times (CI: 0.7–3.6), and 3.6 times (CI: 1.7–7.5) the risk of death from respiratory infections.
Habicht et al527Malaysia; urban and rural settings; RCSSample consisted of 5357 births between 1940 and 1975, with an average IMR of 47.8 infant deaths per 1000 live births. Sample was restricted to babies who could have lived until the end of the at-risk period. 83% of infants were fully breastfed.The effects of breastfeeding on infant mortality were reported for 3 sub-periods of infancy: 8–28 d, 29 d-6 mo, and 7–12 mo. Reductions in deaths per 1000 infants per added month of full breastfeeding were 68.6 (CI: 41.1–96.1), 24.9 (CI: 13.4–36.4), and 3.4 (CI: 1.6–5.2) for the periods 8–28 d, 29 d-6 mo, and 7–12 mo, respectively. Reductions in deaths per 1000 infants per added month of partial breastfeeding were 21.9 (CI:–7.9–51.7), 11.2 (CI: 0.2–22.2), and 1.7 (CI: 0.4–3.0) for the 3 time periods, respectively.
Narayanan et al505India; urban hospital setting; RCTA total of 226 LBW infants were randomly assigned to 1 of 4 intervention groups. Group 1 (n = 57) was fed raw expressed human milk only; group 2 (n = 56) was fed human milk subjected to holder pasteurization. Group 3 (n = 56) was fed raw milk from 9 am until 9 pm (5 feeds) and formula for 3 feeds at night. Group 4 (n = 57) was fed pasteurized human milk from 9 am until 9 pm and formula for the remaining 3 feeds.There was a 68% reduction in neonatal infection rates in group 1 (10.5%) compared to group 4 (33%); however, sample size was too small for statistical significance.
Clavano522Philippines; urban hospital setting; PCS9886 newborn infants were followed up to assess the relationship of neonatal mortality and diarrhea to feeding patterns.Of the 138 infants with diarrhea, 90% were formula fed, 6% were partially breastfed, and 4% were exclusively breastfed. Mode of infant feeding was also significantly related to mortality. Of the 67 infants who died, 96% were formula fed, 1% was partially breastfed, and 3% were exclusively breastfed. After rooming-in and formal breastfeeding policies were introduced, the proportion of infants exclusively breastfeeding increased by 135%, and the incidence of death among clinically infected newborns dropped by 95.3%.