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Subject:
From:
Nikki Lee <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Wed, 6 Jan 2010 13:03:08 -0500
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Clin Infect Dis. <javascript:AL_get(this, 'jour', 'Clin Infect Dis.');> 2010
Jan 4. [Epub ahead of print]
Elevations in Mortality Associated with Weaning Persist into the Second Year
of Life among Uninfected Children Born to HIV-Infected Mothers.

Kuhn L<https://mail.google.com/pubmed?term=%22Kuhn%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>,
Sinkala M<https://mail.google.com/pubmed?term=%22Sinkala%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>,
Semrau K<https://mail.google.com/pubmed?term=%22Semrau%20K%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>,
Kankasa C<https://mail.google.com/pubmed?term=%22Kankasa%20C%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>,
Kasonde P<https://mail.google.com/pubmed?term=%22Kasonde%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>,
Mwiya M<https://mail.google.com/pubmed?term=%22Mwiya%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>,
Hu CC<https://mail.google.com/pubmed?term=%22Hu%20CC%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>,
Tsai WY<https://mail.google.com/pubmed?term=%22Tsai%20WY%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>,
Thea DM<https://mail.google.com/pubmed?term=%22Thea%20DM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>,
Aldrovandi GM<https://mail.google.com/pubmed?term=%22Aldrovandi%20GM%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstract>
.

Gertrude H. Sergievsky Center, College of Physicians and Surgeons, and
Departments of 2Epidemiology and 3Biostatistics, Mailman School of Public
Health, Columbia University, New York, New York; 4Center for International
Health and Development, Boston University School of Public Health, Boston,
Massachusetts; 5Department of Pediatrics, Children's Hospital Los Angeles,
University of Southern California, Los Angeles; and 6Lusaka District Health
Management Team and 7University Teaching Hospital, University of Zambia,
Lusaka, Zambia.

Background. Early weaning has been recommended to reduce postnatal human
immunodeficiency virus (HIV) transmission. We evaluated the safety of
stopping breast-feeding at different ages for mortality of uninfected
children born to HIV-infected mothers.



Methods. During a trial of early weaning, 958 HIV-infected mothers and their
infants were recruited and followed up from birth to 24 months postpartum in
Lusaka, Zambia. One-half of the cohort was randomized to wean abruptly at 4
months, and the other half of the cohort was randomized to continue
breast-feeding. We examined associations between uninfected child mortality
and actual breast-feeding duration and investigated possible confounding and
effect modification.



Results. The mortality rate among 749 uninfected children was 9.4% by 12
months of age and 13.6% by 24 months of age. Weaning during the interval
encouraged by the protocol (4-5 months of age) was associated with a
2.03-fold increased risk of mortality (95% confidence interval [CI],
1.13-3.65), weaning at 6-11 months of age was associated with a 3.54-fold
increase (95% CI, 1.68-7.46), and weaning at 12-18 months of age was
associated with a 4.22-fold increase (95% CI, 1.59-11.24). Significant
effect modification was detected, such that risks associated with weaning
were stronger among infants born to mothers with higher CD4(+) cell counts
(>350 cells/muL).



Conclusion. Shortening the normal duration of breast-feeding for uninfected
children born to HIV-infected mothers living in low-resource settings is
associated with significant increases in mortality extending into the second
year of life. Intensive nutritional and counseling interventions reduce but
do not eliminate this excess mortality.

-- 
Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI
craniosacral therapy practitioner
www.breastfeedingalwaysbest.com

             ***********************************************

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