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Breastfeeding and risk of hospitalisation in children under five years-a systematic review and meta-analysis
Sushmita Kerketta1, Pritimayee Sethy1, Sasmita Swain1
1Department of Public Health, ICMR-Regional Medical Research Centre, Bhubaneswar, India.
Insights
Exclusive breastfeeding significantly reduces hospitalizations for respiratory infections in children under five. However, it shows no significant effect on gastrointestinal infection hospitalizations, with benefits most pronounced in the first year of life.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Infant feeding practices significantly impact child health outcomes.
- Hospitalization rates for infections in young children are a major public health concern.
- Understanding the protective effects of breastfeeding is crucial for child survival strategies.
Purpose of the Study:
- To evaluate the association between breastfeeding duration and the risk of hospitalization due to infections in children under five.
- To analyze hospitalization risks for diarrhea, respiratory infections, and all-cause events based on breastfeeding status.
- To synthesize evidence from cohort studies on breastfeeding and child hospitalization.
Main Methods:
- Systematic review and meta-analysis of 16 cohort studies involving 2,780,195 children.
- Searched multiple databases (PubMed, Embase, CINAHL, Scopus, Google Scholar) following PRISMA guidelines.
- Pooled odds ratios using random effects models, assessing risk of bias with the Newcastle-Ottawa scale.
Main Results:
- Exclusive breastfeeding showed a significant reduction in odds of hospitalization for respiratory infections across all age groups (<1, 1-2, 2-5 years).
- No significant reduction in hospitalization odds for gastrointestinal infections was observed in exclusively breastfed children compared to never breastfed.
- Exclusive breastfeeding was associated with reduced odds of all-cause hospitalization in children under one year.
Conclusions:
- Exclusive breastfeeding is associated with a significant reduction in hospitalizations for respiratory infections in young children.
- The protective effect of exclusive breastfeeding is more pronounced in the first year of life.
- Breastfeeding duration does not significantly reduce hospitalization risk for gastrointestinal infections in children under five.
Objective:
To evaluate the association between breastfeeding duration and risk of diarrhoea- and respiratory infection-related, infection-related and all-cause hospitalisation in under-five children from cohort studies.
Methods:
This systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We conducted a systematic literature search across PubMed, Embase, CINAHL, Scopus and Google Scholar for studies related to breastfeeding and hospitalisation in early childhood. Three authors independently screened titles and abstracts, followed by full texts assessment as per eligibility criteria. Data abstracted were pooled using random effects model, and estimates were presented as odds ratios. Odds of hospitalisation were reported across various exposure categories - exclusively breastfed, predominantly breastfed, partially breastfed and never breastfed under age strata of <1 year, 1-2 years and 2-5 years. The New Castle Ottawa scale for cohort studies was used for risk of bias assessment.
Findings:
Total 16 cohort studies, including 27,80,195 children, across global settings, were included in this systematic review, and the majority (13, 81.25%) of studies were performed in high-income country settings. Children under one year of age who were exclusively breastfed had an insignificant reduction in odds of hospitalisation due to gastrointestinal infections compared to those never breastfed, with pooled OR of 0.79 (0.57-1.09), I2-53%. In the case of respiratory infection-specific hospitalisation, a significant reduction in odds of hospitalisation was noted in children across the age bands of <1, 1-2 and 2-5 years with pooled ORs of 0.88 (0.82-0.95), I2-96%; 0.82 (0.70-0.97), I2-61% and 0.73 (0.56-0.95), I2 - NA, respectively. Children <1 year with EBF significantly reduced odds of all-cause hospitalisation compared to those never breastfed with pooled OR of 0.97 (0.97-0.97), I2 - NA.
Conclusion:
This meta-analysis estimated that exclusive breastfeeding practice in children is associated with a significant reduction in odds of hospitalisation due to respiratory infections, and not in the case of gastrointestinal diseases, with greater benefits in the first year of life, based on studies with considerable heterogeneity.
Systematic Review Registration:
https://www.crd.york.ac.uk/prospero/, identifier CRD42024537665.
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