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Breast-Feeding and SIDS: Another Opportunity to Decrease Infant RiskSudden Infant Death Syndrome (also known as SIDS or crib death) is the leading cause of death in the first year of life in the developed world. A number of studies have identified factors that can be modified to reduce risk, and public health education has effectively spread their implementation. These include putting infants to sleep on their backs rather than on their bellies, decreasing maternal smoking during pregnancy, and avoiding excess clothing and bedding in the infant's crib. Although there has been a decrease in the rate, SIDS still remains a tragic possibility.
Now there is another protective strategy for parents to try: breastfeeding. New research studied the association between infant feeding practices and crib death in Germany. The study used a population-based case control study of 333 infants who died from SIDS and 998 age-matched controls that did not. The peak age of the SIDS victims was 2 to 5 months. All cases were evaluated by autopsy. Researchers found that breastfeeding reduced the risk of sudden infant death syndrome by about 50% at all ages throughout infancy.
Parents were administered a questionnaire asking the types of feeding for each month of life. Exclusive breast-feeding was defined as breast milk only and partial breast-feeding as breast milk plus any solids or any bottled formula. Statistical analyses controlled for other potentially contributory variables including maternal smoking during pregnancy, maternal family status, maternal age at delivery, socioeconomic status of the family, previous live births, birth weight of infant, types of infant bedding, sleep position and pacifier use.
The investigators found that fewer than 50% of the SIDS cases were breastfed at the age of two weeks while 83% of the same aged controls (living infants) were. The data supported that partial breast-feeding was associated with a decreased risk of SIDS but when it was adjusted for confounding influences, it was not statistically significant.
But they found that at one month, less than 40% of the SIDS cases were exclusively breastfed compared to 72% of the age-matched, living controls. Partial breastfeeding at one month was also associated with a reduced risk of SIDS.
In the month preceding death, only 10.2% of the SIDS victims were breastfed, while more than 40% of the living controls remained exclusively breastfed.
Fifty-nine percent of the infants died between two and five months of age and 73% died before six months. This time frame suggests that following the WHO, 6 month exclusive breastfeeding recommendation would parallel the highest risk period for SIDS.
The World Health Organization recommends breast-feeding exclusively for the first six months of life citing advantages such as a decrease in respiratory and gastrointestinal illnesses requiring hospitalization, a decrease in ear infections, and a decrease in atopic (allergic) conditions such as eczema. Adding a decrease in SIDS to the benefits should provide an additional, compelling reason for parents and infants' medical care providers to encourage breastfeeding.
It is not clear why breast-feeding is protective, although the researchers offer immunogenic properties in breast milk, or the easier arousability of breastfed babies as possibilities requiring further study. The research was published in the March issue of Pediatrics.
In an era when SIDS has already been decreased by policies such as the Back-to-Sleep program, the potential for breastfeeding practices to continue to decrease this tragic occurrence gives parents, doctors, nurses, and public health workers an additional reason to stress its importance. Health care providers should give appropriate support to breastfeeding mothers and be aware of community and hospital-based sources of breastfeeding support. Practices that undermine breastfeeding such as early formula supplementation should be discouraged. Women who return to work should educate themselves about their company's policies and their rights as breastfeeding others and identify a quiet, and clean location to pump and safely store breast milk, so they continue to produce and provide breast milk for their babies even while at work.
April 14, 2009
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