Delayed breastfeeding initiation and infant survival: A systematic review and meta-analysis

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Abstract

Objective

To assess the existing evidence regarding breastfeeding initiation time and infant morbidity and mortality.

Study design

We conducted a systematic review and meta-analysis. We searched Pubmed, Embase, Web of Science, CINAHL, Popline, LILACS, AIM, and Index Medicus to identify existing evidence. We included observational studies and randomized control trials that examined the association between breastfeeding initiation time and mortality, morbidity, or nutrition outcomes from birth through 12 months of age in a population of infants who all initiated breastfeeding. Two reviewers independently extracted data from eligible studies using a standardized form. We pooled effect estimates using fixed-effects meta-analysis.

Results

We pooled five studies, including 136,047 infants, which examined the association between very early breastfeeding initiation and neonatal mortality. Compared to infants who initiated breastfeeding ≤1 hour after birth, infants who initiated breastfeeding 2–23 hours after birth had a 33% greater risk of neonatal mortality (95% CI: 13–56%, I ² = 0%), and infants who initiated breastfeeding ≥24 hours after birth had a 2.19-fold greater risk of neonatal mortality (95% CI: 1.73–2.77, I ² = 33%). Among the subgroup of infants exclusively breastfed in the neonatal period, those who initiated breastfeeding ≥24 hours after birth had an 85% greater risk of neonatal mortality compared to infants who initiated <24 hours after birth (95% CI: 29–167%, I ² = 33%).

Conclusions

Policy frameworks and models to estimate newborn and infant survival, as well as health facility policies, should consider the potential independent effect of early breastfeeding initiation.

Related collections

Most cited references 31

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Delayed breastfeeding initiation increases risk of neonatal mortality.

Karen M Edmond, Charles Zandoh, Maria A Quigley … (2006)

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. We sought to assess the contribution of the timing of initiation of breastfeeding to any impact. 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. 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. 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.

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Author and article information

Contributors

Emily R. Smith:

ORCID: http://orcid.org/0000-0001-5715-9459

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: SoftwareRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Lisa Hurt: Role: ConceptualizationRole: Data curationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing

Ranadip Chowdhury: Role: ConceptualizationRole: Data curationRole: Writing – original draftRole: Writing – review & editing

Bireshwar Sinha: Role: ConceptualizationRole: Data curationRole: Writing – original draftRole: Writing – review & editing

Wafaie Fawzi: Role: ConceptualizationRole: SupervisionRole: Writing – review & editing

Karen M. Edmond: Role: ConceptualizationRole: Data curationRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

Umberto Simeoni: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 26 July 2017

Publication date Collection: 2017

Volume: 12

Issue: 7

Electronic Location Identifier: e0180722

Affiliations

[1 ] Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America

[2 ] Division of Population Medicine, Cardiff University School of Medicine, Wales, United Kingdom

[3 ] Centre for Health Research and Development, Society for Applied Studies, New Delhi, India

[4 ] Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America

[5 ] Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America

[6 ] School of Paediatrics and Child Health, University of Western Australia, Perth, Australia

Centre Hospitalier Universitaire Vaudois, FRANCE

Author notes

Competing Interests: The authors have declared that no competing interests exist.

¶ Membership of the Neovita Study Group is provided in the Acknowledgments.

* E-mail: ers231@ 123456mail.harvard.edu

Author information

Emily R. Smith http://orcid.org/0000-0001-5715-9459

Article

Publisher ID: PONE-D-17-03401

DOI: 10.1371/journal.pone.0180722

PMC ID: 5528898

PubMed ID: 28746353

SO-VID: 502a2631-b232-48e5-96c8-d448c0e9788e

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 30 January 2017

Date accepted : 20 June 2017

Page count

Figures: 3, Tables: 4, Pages: 16

Funding

Funded by: funder-id http://dx.doi.org/10.13039/100000002, National Institutes of Health;

Award ID: 5T32AI007358-27

Award Recipient :

ORCID: http://orcid.org/0000-0001-5715-9459

Emily R. Smith

Dr. Emily R. Smith was funded by National Institutes of Health-5T32AI007358-27. The authors received no specific funding for this work.

Custom metadata

Data Availability All relevant data are within the paper and its Supporting Information files.