Karleen, you mentioned that the value of
exclusive breastfeeding vs mixed feeding is known
to be protective against HIV transmission, and
that's quite true. The first paper was published
by Anna Coutsoudis in 1999, with a follow-up in
2001 and then the results were confirmed by Iliff
et al in the ZVITAMBO study published in
2005. But the special protection against other
diseases associated with exclusive breastfeeding
was known before that - HIV was just one more
that others applied this knowledge to, eg
Elizabeth Preble and Ellen Piwoz may have been
amongst the first to make the suggestion (in
1998) that EBF might be protective in the
context of HIV. Looking through their writings
and digging around to find out what other studies
have been done on the difference in health
outcomes between exclusive and
predominant/partial breastfeeding in the newborn
period, many sources seem to lead back to the same few studies:
A Brazilian study showed 5-fold and 2-fold
increased mortality due to diarrhea and
respiratory infections, respectively, in infants
aged birth to 2 mo who were given breast milk
plus milk supplements vs those exclusively
breastfed, after controlling for reverse
causality (Victora CG, Smith PG, Vaughan JP, et
al. Evidence for protection by breast-feeding
against infant deaths from infectious diseases in
Brazil. Lancet 1987;2:319–22.)
A large study from Bangladesh showed a reduction
of mortality due to acute respiratory infection
with exclusive breastfeeding, beyond its role in
preventing infectious diseases due to
contaminated food, which also contribute to the
strong protection against diarrhoea. (Arifeen S,
Black RE, Antelman G, Bacqui A, Caulfield L,
Becker S. Exclusive breastfeeding reduces acute
respiratory infection and diarrhea deaths among
infants in Dhaka slums. Pediatrics 2001;108:E67.)
A study from Pakistan reported a 3-fold reduction
in risk of early neonatal sepsis due to
exclusively vs partial breastfeeding (Bhutta ZA,
Ysuf K. Early onset neonatal sepsis in Pakistan:
a case control study of risk factors in a birth
cohort. Am J Perinatol 1997;14:577–81.)
Risks for neonates of of prelacteal feeds, eg
hypernatremia,(Akre J. Infant feeding: the
physiological basis. Bull World Health Organ
1989;67(suppl):1–108) acidosis (de L Costello
AM, Pal DK, Manandhar DS, Rajbhandari S, Land JM,
Patel N. Neonatal hypoglycaemia in Nepal 2:
availability of alternative fuels. Arch Dis Child
Fetal Neonatal Ed 2000;82:F52–8.) and
hypogycaemia (Oppe TE, Redstone D. Calcium and
phosphorous levels in healthy newborn infants
given various types of milk. Lancet 1968;1:1045–8.)
Pamela Morrison IBCLC
Rustington, England
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