Effect of Breastfeeding on Postoperative Complications Among Pediatric Patients

CQ #299 – April 15, 2024

by Anne Eglash MD, IBCLC, FABM

#LACTFACT

Breastfeeding reduces the risk of post-operative complications in the pediatric population.

Effects of breastfeeding in postoperative complication in pediatric population: a systematic review

Annals of Medicine & Surgery 86(4); p. 2124-2129, April 2024

What is the benefit of breastfeeding among infants who are post-op?

Knowing that breastfeeding reduces the risk of infection and promotes wound healing, the researchers for this week’s clinical question performed a systematic review of 6 relevant studies to evaluate the effects of breastfeeding on postoperative complication rates in pediatric patients.

Overall, the authors found that breastfeeding reduces the risk of post-operative complications compared to not breastfeeding. What exactly did they find? See the question!

What do you think are accurate statements regarding the reduction in post-op complications among infants who are breastfed? Choose 1 or more:

Infants with congenital cardiac defects have a shorter length of stay post-op if fed breastmilk as compared to fortified expressed breastmilk.
Breastfeeding reduces the risk of shunt infections among infants under 6 months of age undergoing ventriculoperitoneal shunts for hydrocephalus.
Breastfed Infants diagnosed with meconium ileus and cystic fibrosis have fewer complications than non-breastfed infants.
Exclusive breastmilk feeding is associated with a lower risk of necrotizing enterocolitis among post-op infants with congenital cardiac defects.

See the Answer

Correct Answers: B, C , and D (not A)

Effects of breastfeeding in postoperative complication in pediatric population: a systematic review

Annals of Medicine & Surgery 86(4); p. 2124-2129, April 2024

Ghosh, Bikonaa; Sripathi, Samhrutha; Nuthalapati, Bhargav Sai; Dwivedi, Ayush; Pandey, Ayush; Sarkar, Prianka

Abstract

Introduction

Surgical complications in younger patients can lead to infections, delayed healing, prolonged hospital stays, and other negative outcomes, significantly affecting their recovery. This study explores the potential impact of breastfeeding on mitigating these complications, aiming to enhance our understanding of postoperative care for paediatric and adolescent patients.

Methodology

The authors conducted a systematic search on databases such as PubMed, Scopus, Web of Science, and EMBASE, using relevant MESH keywords, adhering to the “Preferred Reporting Items for Systematic Reviews and Meta-analysis” methodology. Quality assessments were performed, and studies scoring above 70% were included for standardized data incorporation. Data extraction followed Cochrane Consumers and Communication Review group’s guidelines. Bias and ethical criteria were considered and provided valuable evidence to answer the research question.

Results

Among 402 initially reviewed articles, six met inclusion criteria: 3 observational cohort studies, 2 systematic reviews, and 1 randomized controlled trial. The selected literature consistently demonstrates a significant reduction in postoperative infection rates and improved outcomes. Breastfeeding shortened postoperative hospital stays, accelerated recovery, and enhanced nutritional status, potentially reducing healthcare resource utilization and patient financial burden. Lower mortality and morbidity rates were also observed.

Conclusion

This systematic review provides compelling evidence of breastfeeding’s positive impact on surgical outcomes in the paediatric population. While the authors’ findings support the benefits of breastfeeding in this age group, further large-scale, multicenter research is needed to provide stronger evidence for guiding clinical practices.

IABLE Comment by Anne Eglash MD, IBCLC, FABM

Infants with congenital cardiac defects who received fortified expressed breastmilk post-operatively were found to have favorable post-op outcomes as compared to the infants who received expressed breastmilk, including shorter length of mechanical ventilation, length of hospital stay, infection and mortality rate.

In one study of infants with meconium ileus-associated cystic fibrosis, those who were not breastfed had nearly 3 times the risk of negative outcomes as compared to those who were breastfed. Among infants with hydrocephalus who underwent shunt placement, the rate of shunt infection was 8.5%, 16.5%, and 26% among infants who were exclusively breastfed, mixed fed, and exclusively formula fed, respectively.

Given the limited but compelling data on the effect of breastfeeding and breastmilk in the post-op pediatric population, hospitals should facilitate breastfeeding and support lactating parents to improve post-surgical outcomes.

Nanette Jolly

April 15, 2024 at 5:21 PM

While this is not a surprising finding, it reflects the situation that many/most infants undergoing surgery are not breastfed, but receive substitutes. I am saddened by the reports needing to state that supporting breastfeeding is a valuable intervention.