New Brunswick study documents reduced infections

Antagonists of breastfeeding have long insisted that the benefits of breastfeeding may exist for infants in poor countries where environments make artificial feeding inappropriate, but for industrialized nations breastfeeding benefits are minimal and those studies claiming benefits may have methodological flaws.(2) The recently published results of a New Brunswick retrospective study (1) designed to control important confounding variables, again affirm the fundamental importance of breastfeeding to infant health and dispute such spurious claims.

The New Brunswick study researchers Beaudry, Dufour and Macoux from the Universite Laval compared health outcomes between breastfed and bottle fed during the first six months of life. The study population consisted of 776 full term infants selected by modified cluster sampling from all infants born in New Brunswick during a two year period to primiparous women. Data was collected by means of a self-administered questionnaire mailed to every mother one week prior to her infant reaching 6 months of age. Each infant was classified as breastfed or bottle fed. Breastfeeding included infants who were exclusively breastfed and those receiving breastmilk in addition to water and/or artificial baby milks or unmodified cow's milk. Bottle fed infants were those who received no breastmilk and were fed either artificial baby milks or cow's milk. Three categories of illnesses were recorded, gastrointestinal episodes, respiratory illnesses and other infectious illnesses, allergy or anaemia.

Fifty-six percent of infants were breastfed at birth and only 31% received breastmilk at 3 months and 16% at 6 months. Exclusive breastfeeding was very low after the first few weeks, 13% at 3 months and 1% at 6 months. In spite of low levels of exclusive breastfeeding and after adjustment for confounding factors, the results showed a significant protective effect of breastfeeding against total illnesses during the first six months. The incidence of gastrointestinal disease was 47% lower in the breastfed infants, the rate of respiratory illness was 34% lower in breastfed infants. By separating out ear infections from other respiratory infections the incidence for breastfeeding infants was 56% lower. Interestingly, the authors also looked at the rate of hospitalization for respiratory illness and noted only one admission while infants were breastfed compared to 51 admissions for the bottlefed.

The New Brunswick results are consequential for a number of reasons. First, the results provide confirmation that breastfed infants have superior health outcomes in Canada as everywhere else. This substantiation adds to the already large body of data affirming that breastfeeding is the only safe means to feed infants, that breastfeeding protects against childhood cancers (3), insulin dependent diabetes (4), (5), sudden infant death syndrome (6), (7) allergies (8) to name a few. Conversely it confirms the inferior nature of artificial baby milks and raises the question of the relevant role of these products in infant feeding.

Second, the New Brunswick study results corroborate the need for breastfeeding protection in Canada. Just like the ban on tobacco advertising was essential to reduce consumption, so the elimination of advertising and other promotions of artificial feeding products is essential as a strategy to increase breastfeeding rates.

Third, the New Brunswick study corroborates the substantial savings in health care costs when infants are breastfed. At an average daily cost of $800 to $1000 per day for hospitalization of an infant with respiratory disease, the costs related to the bottlefeeding group would be 51 times that of the breastfed group. While foreign companies reap the profits of at least $490 million annually for formula sales is it fair that Canadian tax payers pay the tab for illnesses related to bottlefeeding?

Last and also critical, this study shows the need to improve how breastfeeding is practised. Health outcomes when infants are exclusively breastfed have been shown (9) to be substantively greater than when infants are partially breastfed. No doubt by factoring out the impact of exclusive breastfeeding, this study would have confirmed previous research documenting of even greater health benefits. Many infants receive their first supplementary feed while still in hospital, a quick route to mixed feeding and early weaning. Why are public health policies of Code regulation and improved hospital practices, desperately needed to increase exclusive breastfeeding rates, not being implemented? Whose interests are being protected by lack of legislation to protect breastfeeding?

References

1. Beaudry, M. et al. Relationship between infant feeding and infections during the first six months of life. J Pediatr 126:191-197, 1995 Back

2. Bauchner, H. et al. Studies of breastfeeding and infections: how good is the evidence? JAMA 256:887-892, 1986. Back

3. Davis, M.K. et al. Infant Feeding and Childhood Cancer. Lancet 2:365-368, 1988. Back

4. Hamman, R.F. et al. Reduced risk of IDDM among breastfed children. Diabetes 37:1625-1632, 1988. Back

5. Ilonen, J. et al. A bovine albumin peptide as a possible trigger of IDDM. N Eng J Med 327:302-307, 1992. Back

6. Protective role of human milk against sudden infant death from infant botulism. J Pediatr 100:568-373, 1982. Back

7. Mitchell, E.A. et al. Results from the first year of the New Zealand cot death study. New Zealand Med J 104: 71-76, 1991. Back

8. Merret, T.G. et al. Infant feeding and allergy: twelve-month prospective study of 500 babies born in allergic families. Ann Allergy 61:32-20, 1988. Back

9. Lucas, A. et al. Breastmilk and neonatal necrotizing enterocolitis. Lancet 336:1519-1523, 1990. Back

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