Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality

Bibliographic Data

ID23318907
AuthorsKaren M Edmond (Kintampo Health Research Centre, Ghana Health Service, Kintampo, Brong Ahafo Region, Ghana), Karen Edmond (0000-0001-5421-0511, London School of Hygiene & Tropical Medicine), Charles Zandoh (Kintampo Health Research Centre, Ghana Health Service, Kintampo, Brong Ahafo Region, Ghana), Maria Quigley (0000-0002-8058-6181, University of Oxford), Maria A Quigley (National Perinatal Epidemiology Unit, Oxford University, Oxford, United Kingdom), Seeba Amenga-Etego (Kintampo Health Research Centre, Ghana Health Service, Kintampo, Brong Ahafo Region, Ghana), Seeba Amenga‐Etego (Kintampo Health Research Centre), Seth Owusu-Agyei (Kintampo Health Research Centre, Ghana Health Service, Kintampo, Brong Ahafo Region, Ghana), Seth Owusu‐Agyei (0000-0002-0807-1781, Kintampo Health Research Centre), Burton Kirkwood (0000-0001-5274-6072, London School of Hygiene & Tropical Medicine), Betty R Kirkwood (Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom)
Year2006
Volume117
Issue3
Pagese380-e386
Publication date2006-03-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenuePEDIATRICS (JOURNAL)
Journal identifiersISSN: 0031-4005 • E-ISSN: 1098-4275
PublisherAmerican Academy of Pediatrics (AAP) (PUBLISHER)
DOI10.1542/peds.2005-1496
PMID16510618
OpenAlexW2170898524
LanguageEN
Citations received104
References cited19

BACKGROUND. Breastfeeding promotion is a key child survival strategy. Although there is an extensive scientific basis for its impact on postneonatal mortality, evidence is sparse for its impact on neonatal mortality. OBJECTIVES. We sought to assess the contribution of the timing of initiation of breastfeeding to any impact. METHODS. This study took advantage of the 4-weekly surveillance system from a large ongoing maternal vitamin A supplementation trial in rural Ghana involving all women of childbearing age and their infants. It was designed to evaluate whether timing of initiation of breastfeeding and type (exclusive, predominant, or partial) are associated with risk of neonatal mortality. The analysis is based on 10947 breastfed singleton infants born between July 2003 and June 2004 who survived to day 2 and whose mothers were visited in the neonatal period. RESULTS. Breastfeeding was initiated within the first day of birth in 71% of infants and by the end of day 3 in all but 1.3% of them; 70% were exclusively breastfed during the neonatal period. The risk of neonatal death was fourfold higher in children given milk-based fluids or solids in addition to breast milk. There was a marked dose response of increasing risk of neonatal mortality with increasing delay in initiation of breastfeeding from 1 hour to day 7; overall late initiation (after day 1) was associated with a 2.4-fold increase in risk. The size of this effect was similar when the model was refitted excluding infants at high risk of death (unwell on the day of birth, congenital abnormalities, premature, unwell at the time of interview) or when deaths during the first week (days 2–7) were excluded. CONCLUSIONS. Promotion of early initiation of breastfeeding has the potential to make a major contribution to the achievement of the child survival millennium development goal; 16% of neonatal deaths could be saved if all infants were breastfed from day 1 and 22% if breastfeeding started within the first hour. Breastfeeding-promotion programs should emphasize early initiation as well as exclusive breastfeeding. This has particular relevance for sub-Saharan Africa, where neonatal and infant mortality rates are high but most women already exclusively or predominantly breastfeed their infants.

Breast feeding · Breast milk · Breastfeeding · Breastfeeding promotion · Environmental health · Infant mortality · Neonatal mortality · Obstetrics · Population · Breastfeeding Practices and Influences · Child Nutrition and Water Access · Global Maternal and Child Health · Medicine · Pediatrics

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