Timing of breastfeeding initiation and exclusivity of breastfeeding during the first month of life: effects of neonatal mortality and morbidity

This paper reviews the evidence relating the timing of initiation of breastfeeding, as well as exclusive breastfeeding, to infant survival and health outcomes in the first month of life.Methods:

• The authors conducted a systematic literature review of two databases. This identified 11 relevant and eligible articles to be included in the meta-analysis.
• All the papers included were published between 1982 and 2011 and covered studies across Asia, America, and Africa.
• The quality of evidence was assessed independently by two reviewers. In general, mortality-related evidence was considered to be of ‘moderate’ quality, while morbidity-related evidence was classified as ‘low’ quality.
• ‘Early’ initiation of breastfeeding was defined in two ways depending on the article; either within the first hour of birth, or within 24 hours of birth.

Key findings and facts:

• The risk of death in the first 28 days of life (neonatal mortality) was found to be twice as high among newborns who were breastfed after the first hour of life, relative to those who were breastfed within the first hour of life.
• The risk of neonatal mortality was lower among newborns who were (1) breastfed within the first 24 hours of birth relative to those who were breastfed after 24 hours, and (2) exclusively breastfed relative to those who were only partially breastfed. Risk of illnesses, including sepsis, respiratory infections and diarrhoea, was found to be higher among newborns who were partially breastfed relative to those who were exclusively breastfed.

Key recommendations:The findings of this study provide further support for two interventions to reduce newborn deaths and illnesses: 1) early initiation of breastfeeding, and 2) exclusive breastfeeding of newborns in the first 28 days of life.The abstract from this article can be accessed here. Payment of subscription is required to access the full article.Khan, J., Vesel, L., Bahl, R., & Martines, J.C. (2014). Timing of breastfeeding initiation and exclusivity of breastfeeding during the first month of life: effects on neonatal mortality and morbidity – a systematic review and meta-analysis. Maternal and Child Health Journal, (Early online publication).