From the March issue of Pediatrics:

PEDIATRICS Vol. 117 No. 3 March 2006, pp. e380-e386
Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality

Karen M. Edmond, , Charles Zandoh,  Maria A. Quigley, Seeba Amenga-Etego, Seth Owusu-Agyei, 
and Betty R. Kirkwood

BACKGROUND. Breastfeeding promotion is a key child survival strategy. Although there is an 
extensive scientific basis for its impact on postneonatal mortality, evidence is sparse for its impact 
on neonatal mortality.

RESULTS. Breastfeeding was initiated within the first day of birth in 71% of infants and by the end 
of day 3 in all but 1.3% of them; 70% were exclusively breastfed during the neonatal period. The 
risk of neonatal death was fourfold higher in children given milk-based fluids or solids in addition 
to breast milk. There was a marked dose response of increasing risk of neonatal mortality with 
increasing delay in initiation of breastfeeding from 1 hour to day 7; overall late initiation (after day 
1) was associated with a 2.4-fold increase in risk. The size of this effect was similar when the 
model was refitted excluding infants at high risk of death (unwell on the day of birth, congenital 
abnormalities, premature, unwell at the time of interview) or when deaths during the first week 
(days 2–7) were excluded.

CONCLUSIONS. Promotion of early initiation of breastfeeding has the potential to make a major 
contribution to the achievement of the child survival millennium development goal; 16% of 
neonatal deaths could be saved if all infants were breastfed from day 1 and 22% if breastfeeding 
started within the first hour. Breastfeeding-promotion programs should emphasize early initiation 
as well as exclusive breastfeeding. This has particular relevance for sub-Saharan Africa, where 
neonatal and infant mortality rates are high but most women already exclusively or predominantly 
breastfeed their infants.

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