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A Meta-analysis

Virginia R. Galton Bachrach, MD, MPH; Eleanor Schwarz, MD, MS; Lela Rose Bachrach, MD, MS

Arch Pediatr Adolesc Med. 2003;157:237-243.

Objective  To examine breastfeeding and the risk of hospitalization for lower respiratory tract disease in healthy full-term infants with access to modern medical care.

Data Sources  MEDLINE, personal communication with researchers, the OVID databases, Dissertation Abstracts Online, and BIOSIS.

Study Selection  The titles, abstracts, and text of studies from developed countries were explored for breastfeeding exposure measures and lower respiratory tract disease hospitalization rates. For summary statistics, we required 3 inclusion criteria: (1) a feeding contrast of a minimum of 2 months of exclusive breastfeeding (no formula supplementation) vs no breastfeeding and (2) study populations that excluded sick, low birth weight or premature infants and (3) reflected affluent regions; 27% of studies met these criteria.

Data Extraction  We abstracted data from all relevant reports.

Data Synthesis  Data from all primary material (33 studies) indicated a protective association between breastfeeding and the risk of respiratory disease hospitalization. Nine studies met all inclusion criteria, and 7 cohort studies were pooled. The feeding contrasts in these 7 studies were 4 or more months of exclusive breastfeeding vs no breastfeeding. The summary relative risk (95% confidence interval) was 0.28 (0.14-0.54), using a random-effects model. This effect remained stable and statistically significant after adjusting for the effects of smoking or socioeconomic status.

Conclusion  Among generally healthy infants in developed nations, more than a tripling in severe respiratory tract illnesses resulting in hospitalizations was noted for infants who were not breastfed compared with those who were exclusively breastfed for 4 months.

From the Division of General Internal Medicine (Dr Schwarz) and the Department of Pediatrics (Dr L. R. Bachrach), University of California, San Francisco.

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