Timing of Breastfeeding Initiation and Exclusivity of Breastfeeding During the First Month of Life: Effects on Neonatal Mortality and Morbidity—A Systematic Review and Meta-analysis
- 2.6k Downloads
The purpose of this study was to review the evidence on the effect of initiation of breastfeeding early after birth and of exclusive breastfeeding during the first month in reducing neonatal mortality and morbidity. We searched Cochrane and PubMed databases for all available papers addressing our review questions and identified eleven papers. Data were extracted using a standard abstraction form. Evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. Meta-analysis was done using STATA 11.0. Early initiation of breastfeeding was associated with a reduced risk of neonatal mortality. Initiating breastfeeding after the first hour doubled the risk of neonatal mortality. Exclusively breastfed neonates had a lower risk of mortality and infection-related deaths in the first month than partially breastfed neonates. Exclusively breastfed neonates also had a significantly lower risk of sepsis, diarrhea and respiratory infections compared with those partially breastfed. The pooled evidence indicates that substantial benefits in reducing neonatal mortality and morbidity can be achieved with effective promotion of early initiation of breastfeeding and exclusive breastfeeding during the first month of life.
KeywordsBreastfeeding Neonates Mortality and morbidity
We are grateful to Dr Karen Edmond, Dr Luke Mullany and Dr Cesar Victora for providing us additional information on the results of their studies. We are also thankful to Tomas Allen, the librarian at the WHO Geneva for his support in developing the search strategy for this review. This work was supported by the Department of Maternal, Newborn, Child and Adolescent Health of the World Health Organization, Geneva, Switzerland.
Conflict of interest
- 1.Levels & Trends in Child Mortality, report. (2013). Estimates developed by the UN inter-agency group for child mortality estimation. New York: UNICEF.Google Scholar
- 2.Black, R. E., Cousens, S., Johnson, H. L., Lawn, J. E., Rudan, I., Bassani, D. G., et al. (2010). Child Health Epidemiology Reference Group of WHO and UNICEF. Global, regional, and national causes of child mortality in 2008: A systematic analysis. Lancet, 375(9730), 1969–1987. doi: 10.1016/S0140-6736(10)60549-1.CrossRefPubMedGoogle Scholar
- 4.World Health Organization. (2012). Newborns: Reducing mortality. Available from http://www.who.int/mediacentre/factsheets/fs333/en/. Accessed June 2012.
- 5.United Nations International Children Emergency Fund (UNICEF). (2012). Early initiation of breast feeding. Available from http://www.childinfo.org/breastfeeding_initiation.php. Accessed June 2012.
- 6.National Family Health Survey, India. (1992–1993). Available from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&frm=1&source=web&cd=1&ved=0CC8QFjAA&url=http%3A%2F%2Fwww.measuredhs.com%2Fpubs%2Fpdf%2FFRIND1%2FFRIND1.pdf&ei=RQCnUdSMDpKM4gTo9YGwCw&usg=AFQjCNFS4uop0Uiz_qzLb55gnFED3JmLmA&sig2=lznUMWepTWlJz2q-3oRi_A&bvm=bv.47244034,d.bGE.
- 7.Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Medicine, 6, e1000100. doi: 10.1371/journal.pmed.1000100.CrossRefPubMedCentralPubMedGoogle Scholar
- 11.GRADE working group. (2012). Available from http://www.gradeworkinggroup.org/. Accessed June 2012.
- 19.Edmond, K. M., Kirkwood, B. R., Amenga-Etego, S., Owusu-Agyei, S., & Hurt, L. S. (2007). Effect of early infant feeding practices on infection-specific neonatal mortality: An investigation of the causal links with observational data from rural Ghana. The American Journal of Clinical Nutrition, 86(4), 1126–1131.PubMedGoogle Scholar
- 21.Early Initiation of Breastfeeding: the Key to Survival and Beyond. Available from http://new.paho.org/hq/dmdocuments/2010/Eight%20Pager%20English%20FINAL.pdf. Accessed June 2012.
- 23.International Institute for Population Sciences (IIPS) and Macro International. (2007). National Family Health Survey (NFHS-3), 2005-06: India: Volume I. Mumbai: IIPS.Google Scholar
- 24.Tawiah-Agyemang, C., Kirkwood, B. R., Edmond, K., Bazzano, A., & Hill, Z. (2008) Early initiation of breast-feeding in Ghana: Barriers and facilitators. Journal of Perinatology, 28 Suppl 2, S46–S52. doi: 10.1038/jp.2008.173.
- 25.World Health Organization. (2011). Guidelines on optimal feeding of low birth weight in low and middle income countries. World Health Organization. Available from http://www.who.int/maternal_child_adolescent/documents/9789241548366.pdf. Accessed March 2014.
- 27.World Health Organization. (1998). Evidence for the ten steps to successful breastfeeding. World Health Organization. Available from http://whqlibdoc.who.int/publications/2004/9241591544_eng.pdf.
- 28.World Health Organization and UNICEF. (2009). Baby-friendly hospital initiative: Revised, updated and expanded for integrated care. World Health Organization and UNICEF. Available from http://whqlibdoc.who.int/publications/2009/9789241594967_eng.pdf.