Case-control study of exclusive breast feeding and severe bronchiolitis in the United States
Ruth J Geller1,2, Nancy R Inhofe3, Cassandra C Crifase1
1Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Insights
Exclusive breastfeeding significantly lowers the risk of infant bronchiolitis hospitalization. This finding highlights a key modifiable factor for preventing severe infant illness and reducing hospital admissions.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Bronchiolitis is a leading cause of infant hospitalization with limited known modifiable risk factors.
- While breastfeeding may reduce bronchiolitis risk, the impact of exclusive versus partial breastfeeding remains unclear.
Purpose of the Study:
- To determine the association between exclusive or partial breastfeeding in early infancy (0-2.9 months) and the risk of bronchiolitis hospitalization.
- To analyze the protective effects of different breastfeeding intensities (exclusive, predominant, occasional) against bronchiolitis hospitalization.
Main Methods:
- A case-control study utilizing data from two prospective US cohorts (Multicenter Airway Research Collaboration).
- Infants hospitalized for bronchiolitis (cases, n=921) were compared to healthy infants (controls, n=719).
- Breastfeeding history was collected via parent interviews, and multivariable logistic regression adjusted for covariates.
Main Results:
- Exclusive breastfeeding was associated with a 48% reduction in the odds of bronchiolitis hospitalization compared to partial breastfeeding (aOR 0.52, 95% CI 0.39-0.69).
- Exclusive breastfeeding showed a 58% reduced odds of hospitalization compared to no breastfeeding (aOR 0.42, 95% CI 0.23-0.77).
- Predominant and occasional breastfeeding did not show a significant reduction in hospitalization odds.
Conclusions:
- Exclusive breastfeeding demonstrates a strong protective effect against hospitalization for bronchiolitis in infants.
- Promoting exclusive breastfeeding is a crucial strategy for preventing severe infant respiratory illness.
Background:
Bronchiolitis is a major cause of infant illness, with few known modifiable risk factors. Breast feeding may reduce risk of severe bronchiolitis, but the association of exclusive vs. partial breast feeding with severe bronchiolitis is unclear.
Objective:
To estimate the association of exclusive vs. partial breast feeding during ages 0-2.9 months with bronchiolitis hospitalisation during infancy.
Methods:
We conducted a case-control study as a secondary analysis of two prospective US cohorts in the Multicenter Airway Research Collaboration. Cases were enrolled in a 17-centre study of infants hospitalised for bronchiolitis during 2011-2014 (n = 921). Controls were enrolled in a five-centre study of healthy infants during 2013-2014 and 2017 (n = 719). Breast feeding history during ages 0-2.9 months was collected by parent interview. Among breastfed infants, the association of exclusive vs. partial breast feeding with odds of bronchiolitis hospitalisation was estimated using a multivariable logistic regression model adjusted for demographic variables, parental asthma history, and early-life exposures. As a secondary analysis, we estimated the associations of exclusive, predominant, and occasional breast feeding vs. no breast feeding with the odds of bronchiolitis hospitalisation.
Results:
Among 1640 infants, the prevalence of exclusive breast feeding was 187/921 (20.3%) among cases and 275/719 (38.3%) among controls. Exclusive vs. partial breast feeding was associated with 48% reduced odds of bronchiolitis hospitalisation (adjusted odds ratio [OR] 0.52, 95% confidence interval [CI] 0.39, 0.69). In the secondary analysis, exclusive vs. no breast feeding was associated with 58% reduced odds of bronchiolitis hospitalisation (OR 0.42, 95% CI 0.23, 0.77), whereas predominant breast feeding (OR 0.77, 95% CI 0.37, 1.57) and occasional breast feeding (OR 0.98, 95% CI 0.57, 1.69) were not associated with meaningfully reduced odds of bronchiolitis hospitalisation.
Conclusion:
Exclusive breast feeding had a strong protective association against bronchiolitis hospitalisation.
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