by Anne Eglash MD, IBCLC, FABM
Does breastfeeding reduce the risk of hospitalization for infection among children less than 5 years of age? Studies from high income countries have demonstrated that 25% of hospitalizations for children under age 5 are due to infection.
A group of Australian researchers evaluated a population of 488,603 children, and followed each child for an average of 4.2 years. They found that approximately 20% were hospitalized for infection at some point, with 25% of these children being hospitalized more than once for infection.
The average age for first hospitalization was 1.1 years.
What statements do you think are true regarding the risk of childhood hospitalization for infection under the age of 5. Choose 1 or more:
- Not breastfeeding increases the risk of hospitalization for infection.
- Earlier gestational age increases the risk of hospitalization for infection.
- Cesarean birth increases the risk of hospitalization for infection.
- Planned birth is NOT associated with an increased risk of hospitalization for infection.
- Infants born at 35-37 weeks who never breastfed had a 20-28% increased risk of more than 1 hospitalization for infection, as compared to breastfeeding infants born 39+ weeks spontaneously.
See the Answer
Answer:All except D are correct
Gestation at birth, mode of birth, infant feeding and childhood hospitalization with infection
Bentley JP, Burgner DP, Shand AW ,Bell JC, Miller JE, Nassar N
INTRODUCTION:
Infections are a leading cause of mortality and morbidity in preschool children. We aimed to assess the impact of the co-occurrence of cesarean section, early birth and formula feeding on hospitalization with infection in early childhood.
MATERIAL AND METHODS:
Population-based retrospective record-linkage cohort study of 488 603 singleton live births ≥32 weeks’ gestational age in New South Wales, Australia, 2007-2012. Multivariable Cox-regression was used to estimate independent and combined adjusted associations of gestational age, mode of birth (vaginal or cesarean section by labor onset) and formula feeding with time to first and repeat hospitalization with infection for children less than five years of age.
RESULTS:
In all, 95 346 (19.5%) children were hospitalized with infection, and of these 24.8% (23 615) more than once. Median age at first and repeat hospitalization was 1.1 and 1.7 years, respectively. Earlier gestation, modes of birth other than spontaneous vaginal, and formula feeding were independently associated with an increased risk of first and repeat hospitalization with infection. At 32-36 weeks’ gestation, co-occurrence of perinatal factors (cf. spontaneous vaginal birth at 39+ weeks without formula feeding) was associated with a 2-fold and 1.5-fold increased risk of first and repeat hospitalization, respectively. For births at 37-38 weeks, the increased risk was 1.5-fold and 1.25-fold for first and repeat hospitalization, respectively.
CONCLUSIONS:
Cesarean section, labor induction, birth at <39 weeks and formula feeding increase the risk of infection-related hospitalization in childhood, which increases further when these factors co-occur. Reducing early planned birth and supporting breastfeeding are potentially cost-effective approaches to reducing the risk of hospitalization.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
The rate of hospitalization for infection reported in this Australian study is much higher than the rate reported in the USA from 2012, which was 0.7%. Perhaps this reflects a difference in management of childhood infection between the USA and Australian health systems. In the USA, we have been increasingly monitoring children with potentially invasive infections as outpatients, after receiving a workup including a blood culture, followed by a shot of antibiotics. In fact, such outpatient management plus the effectiveness of vaccinations has led to the closure of many community pediatric hospital wards in the USA.
The authors found that infants born via spontaneous labor as opposed to planned birth had a lower risk of hospitalization for infection. There was no clear biologic explanation for this finding, other than postulating that there may be a difference in the microbiome between infants born spontaneously vs infants born via induction. It is understandable that an infant born prematurely has a higher risk of severe infection necessitating hospitalization. I believe this is due to lack of exclusive breastfeeding, an immature immune system, and gut colonization of virulent bacteria acquired during an NICU stay.
Maria Lennon
One reason that infants born via planned birth have a higher infection rate is that due to the protocols of induction, there are usually many more vaginal exams and increased incidence of Artificial Rupture of Membranes. Both of these interventions are associated with increased infection, thereby increasing hospitalization.
macslure
Data from 33 studies were examined, and a protective association between breastfeeding and the risk of LRTD hospitalization was found from each study.