Delayed breastfeeding initiation increases risk of neonatal mortality
Delayed breastfeeding initiation increases risk of neonatal mortality
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DOI：
10.1542/peds.2005-1496
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发表时间：
2006-03-01
期刊：
影响因子：
8
通讯作者：
Kirkwood, BR
中科院分区：
文献类型：
--
作者：
Edmond, KM;Zandoh, C;Kirkwood, BR
背景。促进母乳喂养是一项重要的儿童生存策略。尽管其对新生儿死亡率的影响有广泛的科学依据，但其对新生儿死亡率影响的证据却很少。 目的。我们试图评估开始母乳喂养的时间对任何影响的影响。方法。这项研究利用了加纳农村地区正在进行的一项大型孕产妇维生素 A 补充剂试验的每 4 周监测系统，该试验涉及所有育龄妇女及其婴儿。它的目的是评估开始母乳喂养的时间和类型（纯母乳喂养、主要母乳喂养或部分母乳喂养）是否与新生儿死亡风险相关。该分析基于 2003 年 7 月至 2004 年 6 月期间出生的 10 947 名母乳喂养的单胎婴儿，这些婴儿存活到第 2 天，并且其母亲在新生儿期接受了探访。结果。 71% 的婴儿在出生第一天开始母乳喂养，只有 1.3% 的婴儿在出生后第三天开始母乳喂养； 70% 在新生儿期纯母乳喂养。除母乳外还接受乳汁或固体食物的儿童，新生儿死亡的风险要高出四倍。随着母乳喂养开始时间从 1 小时到第 7 天的延迟增加，新生儿死亡风险增加，出现明显的剂量反应；总体而言，较晚开始（第 1 天后）与风险增加 2.4 倍相关。当重新调整模型，排除死亡高风险婴儿（出生当天不适、先天性异常、早产、访谈时不适）或排除第一周（第 2 - 7 天）内的死亡时，这种效应的大小相似。结论。促进尽早开始母乳喂养有可能为实现儿童生存千年发展目标做出重大贡献；如果所有婴儿从第一天开始母乳喂养，则可以避免 16% 的新生儿死亡；如果在第一个小时内开始母乳喂养，则可以避免 22% 的新生儿死亡。母乳喂养促进计划应强调早期开始和纯母乳喂养。这对于撒哈拉以南非洲地区尤其重要，那里的新生儿和婴儿死亡率很高，但大多数妇女已经完全或主要母乳喂养婴儿。
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 breast-feeding 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 10 947 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.