Aimin Chen and Walter J. Rogan
Breastfeeding and the Risk of Postneonatal Death in the United States
Pediatrics 2004 113:e435-e439.

Applause to authors Aimin Chen and Walter J. Rogan for their analysis of
infant death risks in regards to breastfeeding!! Finally the effort has
begun, for the benefit of all future infants.

The authors calculate the risk of death between 28 days and 12 months of
age for those who have ever breastfed versus those who have not, reporting
an odds ratio of .79. This represents 79% (4/5ths) the risk of death for
having ever breastfed, or 1/.79 = 26% more deaths for formula fed infants.

The authors eliminated deaths during the first 28 days in attempt to avoid
confounding by what they refer to as “reverse causality;” suggesting that
many sick newborns may be unable to breastfeed, skewing the numbers. All
deaths from congenital anomalies and malignant tumors have also been
eliminated from their sample. When including these infants, the odds ratio
goes to .74.

The authors went on to attempt a calculation for benefits of extended
breastfeeding. A measure of 3 months was used, because this period
represents a large portion of the infant deaths, and those who die are
unable to breastfeed beyond their death age. Their calculation for 3 months
of breastfeeding versus never OR EVER breastfeeding brings an odds ratio
of .62 (which comes to 1/.62 = 61% greater deaths for formula feeding less
than 3 months). It is unfortunate that they could not calculate 3 months of
exclusive breastfeeding versus only no breastmilk.

Palmer’s article, The Deadly Influence of Formula in America,
http://www.naturalfamilyonline.com/BF/200312-formula-report2.htm  ,
released earlier this year, attempts to calculate a similar odds ratio from
existing U.S. studies, for deaths including the first month. Because two
thirds of all infant deaths occur in the first month, results can be
expected to vary. Palmer also attempted to use 3 months of any or exclusive
breastmilk versus no breastmilk, when these numbers were available,
attempting to measure the power of breastfeeding for a “significant” amount
of time. Studies used did vary in the length of breastfeeding, from any
breastmilk at all to 6 months of exclusive breastfeeding.

Worldwide studies demonstrate that the greatest difference in survival
between breastfed and formula fed infants is in the first 28 days.
Hopefully a future study similar to that of Chen and Rogan will be able to
measure these first days as well.

More examination of whether the mother intended to breastfeed (whether she
succeeded or not) needs to be made (eliminating much of the inability to
breastfeed due to illness). Actually, this intention has been taken into
account in many studies already – these studies demonstrating consistency
in findings with those that made no such allowance.

Breastmilk makes a solid difference in the survival of premature births,
although the magnitude is weaker than some other risk measures. Chen and
Rogan suggest that deaths in the first 28 days are most attributable to
preterm births or congenital abnormalities. The survival benefit of
breastfeeding may be underrepresented in this current study’s sample, as
preterm infants suffer an even greater portion of total deaths during the
first 28 days after birth. Palmer also suggests that breastfeeding provides
an as-of-yet unmeasurable survival benefit for congenital anomalies.

Following on findings of available studies, Palmer contends that exclusive
breastfeeding may make the greatest difference in all categories in the
first month following birth. Chen and Rogan do admit in their discussion
that “excluding these deaths also excludes the chance to examine whether
breastfeeding has any effects on these deaths,” although some rougher
calculations of theirs suggests that this may not be the case. Clearly,
this is a wide open area for further careful examination.

In their measure of extended breastfeeding, no measure of exclusivity of
breastfeeding has been taken into account in this current study. A
multitude of studies demonstrate that exclusive breastfeeding brings
notably greater health or survival than formula (or food) supplemented.

While Palmer’s article (democratically, but somewhat opposing personal
opinion) assumed death from injury to be equal for breastfed and formula
fed infants, this current study suggests a survival benefit for breastfed
here as well.

Palmer’s article suggests a .50 odds ratio for breastfeeding (more weighted
by “extended” breastfeeding) from birth to one year (or 1/.5 = 2 times the
risk of death for formula fed). If Chen and Rogan had made a
differentiation in their extended breastfeeding calculation to compare 3
months of only exclusive breastfeeding to only no breastfeeding, their
number (which was .62 for any breastmilk for 3 months versus no breastmilk
or breastfeeding for less than 3 months), their resultant number would have
likely approached more closely Palmer’s suggestion. Future studies will
likely measure this, as well as the first 28 days of life.

In the Chen/Rogan study, risk analyses made in reference to specific races
demonstrated little difference in the survival rates for ever
breastfeeding. Re-including malignancy and congenital anomaly deaths led to
a slighty greater survival benefit for ever breastfeeding.

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