Posted by sarah kertin
Introduction
Breastfeeding ensures the best possible start to a baby’s health, growth and development. It provides valuable short and long-term health benefits for babies and mothers. Breastfeeding protects against gastrointestinal and respiratory illnesses, as well as ear infections, which can affect a baby’s ability to thrive in the earliest months of life. The health advantages of breastfeeding also translate into benefits for the health system. Evidence shows that breastfeeding positively affects the incidence of chronic disease, including obesity rates, at the population level and is therefore of great significance to public health policy.
Infant outcomes
The positive effects of breastfeeding on the infant and the mother have been noticed in both the developed and the developing countries. In fact, data indicate that breastfeeding can save lives in countries with poor conditions or hygiene. It has been estimated that 1.3 to 1.45 million deaths in 42 high-mortality countries could be prevented by increased levels of breastfeeding. In a recent analysis of the health consequences of child under-nutrition, it was estimated that sub-optimal breastfeeding was responsible for 1.4 million child deaths and 44 million disability-adjusted life years, equivalent to 10% of the disability-adjusted life years in children younger than 5 years. The improved health outcomes of breastfeeding in developed countries have been emphasized in studies that compare breastfeeding and infant formula. The most comprehensive publication on this subject that one can refer to is the report titled Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries issued by the Evidence-based Practice Centers of the Agency for the Healthcare Research and Quality (AHRQ) of the US Department of Health Human Services.
Health benefits
Prevention of infections
The preventive effect on infections is by far the most important health benefit in relation to breastfeeding. Human milk feeding decreases the incidence and/or severity of a wide range of 13 Journal of Pediatric and Neonatal Individualized Medicine Open Access Human milk benefits and breastfeeding infectious diseases. The risk of hospitalization for lower respiratory tract infections in the first year is reduced 72% if infants breastfed exclusively for more than 4 months. Infants who exclusively breastfed for 4 to 6 months had a fourfold increase in the risk of pneumonia compared with infants who exclusively breastfed for more than 6 months. The severity (duration of hospitalization and oxygen requirements) of respiratory syntactical virus bronchiolitis is reduced by 74% in infants who breastfeed exclusively for 4 months compared with infants who never or only partially breastfed. Any breastfeeding compared with exclusive commercial infant formula feeding will reduce the incidence of Otis media (OM) by 23%. Also, any breastfeeding is associated with a 64% reduction in the incidence of nonspecific gastrointestinal tract infections, and this effect lasts for 2 months after cessation of breastfeeding. Last, human milk has been shown to be protective against necrotizing enterocolitis (NEC) by down-regulating the damaging inflammatory reaction. A recent study comparing preterm infants fed human milk exclusively with those fed human milk supplemented with cow-milk formula showed a 77% decrease in NEC.
Immune protection
Regarding allergies, exclusive breastfeeding for 3 to 4 months can result in a lower incidence of asthma, atopic dermatitis and eczema (27% in a low risk population and up to 42% with positive family history). Whatever this protective effect, women with a family history of allergy should breastfeed their infants like everyone else, and, in this targeted population, exclusive breastfeeding is recommended until the age of 6 months.
Malignant disease
Breast milk may have a role in the prevention of malignant disease by stimulating or modulating the immune response and promoting its development in early life [16]. This protection of having been breastfed for 6 months or longer includes a 20% lower risk for a cure lymphatic leukemia and a 15% lower risk for acute myeloid leukemia.
Overweight obesity and diabetes
Numerous studies have investigated whether or not breastfeeding can reduce the risk of obesity. It seems that with any breastfeeding there is a 15% to 30% reduction of obesity rates in adolescence and adulthood. Therefore, the first step of any national campaign aiming to combat obesity should be the support of breastfeeding. Some studies also suggest reduction in incidence of insulin – dependent (type 1) (up to 30% for infants who exclusively breastfed for 3 months) and non-insulin dependent (type 2) diabetes mellitus (40%, possibly reflecting the long-term positive effect of breastfeeding on weight control and feeding self-regulation).
Neurodevelopmental outcomes
Available evidence suggests that breastfeeding may be associated with a small but measurable advantage in cognitive development that persists into adulthood. Although the effect size of cognitive benefits may not be of major importance for an individual, it could provide a significant advantage on a population basis.
Preterm infants
The evidence demonstrates that breastfeeding is associated with a reduced risk of NEC and sepsis. This indicates that human milk contributes to the development of the preterm infant’s immature host defense. The benefits of feeding human milk to preterm infants are realized not only in the neonatal intensive care unit (NICU) but also in the fewer Open Access Journal of Pediatric and Neonatal Individualized readmissions for illness in the year after NICU discharge. Furthermore, the implications for a reduction in incidence of NEC include not only lower mortality rates but also lower long-term growth failure and neurodevelopmental disabilities. Neurodevelopmental outcomes include better brainstem maturation, increased scores on cognitive and developmental tests and better visual development. Clinical feeding tolerance is also improved and the attainment of full enteral feeding is hastened by a diet of human milk. Consequently, interventions to increase human milk consumption in the NICU are critical. Compared with other frequently high-tech NICU treatments, interventions to improve breastfeeding rates are relatively simple and low cost. The potent benefits of human milk are such that all preterm infants should receive human milk. However, for infants weighing less than 1.5 kg, it is advisable to fortify mother’s own milk – fresh or frozen – with protein, minerals and vitamins so that the best possible nutrient intake is achieved. Alternatively, if mother’s own milk cannot be provided or there are contraindications, with proper fortification, pasteurized donor human milk can be used. Also, methods and training protocols for manual and mechanical milk expression must be available to mothers. Last, to ensure the best administration of human milk, neonatal intensive care units should possess evidence-based protocols for collection, storage and labeling of human milk.
Maternal health outcomes
Important health benefits of breastfeeding and lactation are also described for mothers. The benefits include decreased postpartum bleeding and more rapid uterine involution attributable to increased concentrations of oxytocin, decreased menstrual blood loss and increased child spacing attributable to lactational amenorrhea, decreased risk of breast cancer and decreased risk of ovarian cancer. Furthermore, according to prospective cohort studies, mothers who do not breastfeed or who wean early are prone to postpartum depression. There are studies suggesting an earlier return to pre pregnancy weight, but they are inconclusive given the large numbers of confounding factors on weight loss (diet, activity, baseline BMI, ethnicity).
Community benefits
In addition to specific health advantages for infants and mothers, economic, family and environmental benefits have been described. These benefits include the potential for decreased annual heath care costs, decreased costs for public health programs, decreased parental employee absenteeism and associated loss of family income, more time for attention to siblings and other family matters as a result of decreased infant illness, decreased environmental burden for disposal of formula cans and bottles and decreased energy demands for production and transport of artificial feeding products. As a result, any policy that can encourage mothers to exclusively breastfeed for 6 months can significantly benefit the national economy.
Supplementation of breastfed infants
Vitamin D deficiency/insufficiency and rickets has increased in all infants as a result of decreased sunlight exposure secondary to changes in lifestyle, dress habits and use of topical sunscreen preparations. It has been suggested that in order to ensure adequate concentrations of vitamin D, all breastfed infants should receive an oral supplement of vitamin D, 400 U per day, after leaving hospital. Food sources of iron and zinc should be initiated at about 6 months of age. In addition, oral supplementation with iron drops before 6 months may be necessary. When it comes to premature infants, a multivitamin and oral iron supplements are recommended until they have a varied diet and both their growth and hematologic status are satisfactory.
Conclusion
Research and practice have shown that breastfeeding and human milk can offer significant nutritional and no nutritional benefits to the infant and the mother and lay the foundations for optimal infant, child and adult health as well as child development. Therefore, the support of breastfeeding should be seriously viewed as a major public health issue. Interventions to reinforce breastfeeding are relatively simple and inexpensive. The enthusiastic support and involvement of pediatricians and system wide-support such as the Baby Friendly Hospital can be effective in promoting breastfeeding. Furthermore, strong legislation should be enacted to review and restrict the use of chemical substances found in breast milk, so that the confidence in this low-tech life saver is not undermined in any way.
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