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Breastfeeding and wheeze-related outcomes in high-risk infants: A systematic review and meta-analysis
Soriah M Harvey1,2, Vanessa E Murphy1,2, Olivia M Whalen1,3
1Priority Research Centre Grow Up Well, University of Newcastle, Newcastle, NSW, Australia.
Insights
Breastfeeding significantly reduces wheezing risk in infants with a family history of asthma or atopy. The protective effect is strongest during the first six months of life.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Infants with a family history of asthma/atopy face a high risk of wheezing.
- The influence of breastfeeding on respiratory health in these high-risk infants remains unclear.
Purpose of the Study:
- To systematically review evidence on the association between breastfeeding and wheeze incidence and severity in high-risk infants.
- To evaluate the impact of breastfeeding on respiratory outcomes in infants predisposed to asthma/atopy.
Main Methods:
- A systematic search of electronic databases and reference lists was conducted.
- 15 observational studies assessing breastfeeding and respiratory outcomes in high-risk infants were included.
- Meta-analyses were performed for primary outcomes: wheeze incidence in the first year and first six months of life.
Main Results:
- Breastfeeding was linked to a 32% reduction in wheezing odds in the first year of life (9 studies).
- The protective association was stronger in the first six months, with a 55% reduction in wheezing odds (5 studies).
- Extended breastfeeding (longer than 3 months) showed a 50% reduced odds of wheezing at 6 months (3 studies).
Conclusions:
- Breastfeeding demonstrates a protective effect against wheezing in high-risk infants, particularly within the first six months.
- Further research is warranted to explore breastfeeding's impact on wheeze severity and intensity.
- The review was registered with PROSPERO (CRD42019118631).
Background:
The risk of wheezing is high in infancy and is heightened in infants with a family history of asthma/atopy. The role of breastfeeding in influencing respiratory health for these high-risk infants is unclear.
Objectives:
To systematically appraise evidence for the association between breastfeeding and wheeze incidences and severity in high-risk infants.
Methods:
Studies identified through electronic databases and reference lists were eligible if they assessed breastfeeding and respiratory outcomes in infants with a family history of asthma/atopy. The primary outcome was wheeze incidences in the first year of life. Secondary outcomes were wheeze incidences in the first 6 months of life, indicators of wheeze severity (recurrent wheeze, health-care utilization, and medication use), and other wheeze-related outcomes [bronchiolitis, pneumonia, croup, and incidence of lower respiratory tract infection (LRTI)] up to 12 months old. Meta-analyses were conducted where possible.
Results:
Of 1843 articles screened, 15 observational studies met the inclusion criteria. Breastfeeding was associated with 32% reduced odds of wheezing during the first year of life (ever vs. never: OR, 0.68; 95% CI: 0.53, 0.88; n = 9 studies); this association was even stronger in the first 6 months (OR, 0.45; 95% CI: 0.27, 0.75; n = 5 studies). Breastfeeding for a "longer" versus "shorter" time (approximately longer vs. shorter than 3 months) was associated with 50% reduced odds of wheezing at the age of 6 months (OR, 0.50; 95% CI: 0.39, 0.64; n = 3 studies).
Conclusions:
Breastfeeding was associated with reduced odds of wheezing in high-risk infants, with the strongest protection in the first 6 months. More research is needed to understand the impact of breastfeeding intensity on wheezing and to examine additional respiratory outcomes, including wheeze severity. This review was registered at PROSPERO as CRD42019118631.
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