Maternal and Child Health Journal

, Volume 19, Issue 3, pp 468–479 | Cite as

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

  • Jehangir Khan
  • Linda Vesel
  • Rajiv Bahl
  • José Carlos Martines


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.


Breastfeeding 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


Supplementary material

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Jehangir Khan
    • 1
  • Linda Vesel
    • 2
  • Rajiv Bahl
    • 3
  • José Carlos Martines
    • 3
  1. 1.Faculty of MedicineLund UniversityMalmoSweden
  2. 2.Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
  3. 3.Maternal, Newborn, Child and Adolescent HealthWorld Health OrganizationGenevaSwitzerland

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