While the study that showed infant mortality at 4/1000 may have been valid at the time the study was published (Rogan, 1989, Cancer from PCB's in Breast Milk? A risk benefit analysis. Pediatric Research 25:105A ), infant mortality rates have dropped significantly since then and it is almost certainly not still true. In the US, rates have dropped from 15/1000 in 1989 to 7/1000 in 1999. Furthermore, Rogan's estimate was based on a mathematical model, not an epidemiological study and has never been substantiated by data. At least 1/2 of the current infant mortality in the US is from causes which breastfeeding cannot contribute to- congenital anomalies, RDS, maternal complications, placenta/cord, accidents, birth asphyxia. That would account for 3.5/1000. If you look at the other half SIDS, low birth weight (bottle feeding would only be secondary from reduced interbirth interval), neonatal infections, pneumonia and other I would be surprised if you could make a case for even 1/2 being attributable to bottle-feeding. Some will be iatrogenic nursery infections that feeding method may influence, but it certainly couldn't be considered causal. You could probably make a good case for pneumonia and SIDS. Studies show a 2-5 fold increase in risk for pneumonia from bottle-feeding, if we attribute 80% of pneumonia deaths pneumonia it would represent 0.12/1000 infant deaths per year. SIDS deaths have gone from 1.39/1000 in 1989 to 0.64 in 1998, if 80%(highest estimate I have seen) of those cases are attributable to bottle feeding it would translate to 0.51/1000 infant deaths per year in US. Because feeding method is highly correlated with socio-economic status and poverty in this country and so are infant death rates, and because breastfeeding is not well defined, it is very difficult to demonstrate that any of these deaths are directly attributable to feeding method. If we assume that 1/2 of the 3.5/1000 deaths may be influenced by feeding method (and that is quite a stretch), the maximum impact might be about 1.75/1000 deaths attributable to bottle feeding. You can probably defend 0.5-1/1000 deaths attributable to feeding method as a contributing cause. Of the approximately 25,000 infant deaths per year in the US that would be between 1800 and 6500 which is still a lot of inexcusably dead babies. I think the real problem is that deaths attributable to bottle-feeding are insidious and less recognized. If a baby dies in a car accident it is easy to assign cause, but it is more difficult to recognize problems associated with formula feeding. Cathy Liles *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html