Breast-Feeding Patterns, Time to Initiation, and Mortality Risk among Newborns in Southern Nepal

Abstract

Initiation of breast-feeding within 1 h after birth has been associated with reduced neonatal mortality in a rural Ghanaian population. In South Asia, however, breast-feeding patterns and low birth weight rates differ and this relationship has not been quantified. Data were collected during a community-based randomized trial of the impact of topical chlorhexidine antisepsis interventions on neonatal mortality and morbidity in southern Nepal. In-home visits were conducted on d 1-4, 6, 8, 10, 12, 14, 21, and 28 to collect longitudinal information on timing of initiation and pattern of breast-feeding. Multivariable regression modeling was used to estimate the association between death and breast-feeding initiation time. Analysis was based on 22,838 breast-fed newborns surviving to 48 h. Within 1 h of birth, 3.4% of infants were breast-fed and 56.6% were breast-fed within 24 h of birth. Partially breast-fed infants (72.6%) were at higher mortality risk [relative risk (RR) = 1.77; 95% CI = 1.32-2.39] than those exclusively breast-fed. There was a trend (P = 0.03) toward higher mortality with increasing delay in breast-feeding initiation. Mortality was higher among late (> or = 24 h) compared with early (< 24 h) initiators (RR = 1.41; 95% CI = 1.08-1.86) after adjustment for low birth weight, preterm birth, and other covariates. Improvements in breast-feeding practices in this setting may reduce neonatal mortality substantially. Approximately 7.7 and 19.1% of all neonatal deaths may be avoided with universal initiation of breast-feeding within the first day or hour of life, respectively. Community-based breast-feeding promotion programs should remain a priority, with renewed emphasis on early initiation in addition to exclusiveness and duration of breast-feeding.

Breast-feeding initiation time and neonatal mortality risk among newborns in South India

“…8 The previous studies analyzing breast-feeding practices found that infants partially or predominantly breast-fed had an increased risk of neonatal mortality compared with infants exclusively breast-fed. 14,15 Further analyses of the breast-feeding practices in Southern India, including duration and exclusivity could provide more accurate information on the proportion of neonatal deaths that could be prevented.…”

“…As with previous studies, 14,15 infants who died within the first 48 h of birth were excluded to minimize the potential for reverse causation bias. Additionally, to reduce likelihood of recall bias for time of breast-feeding initiation, only infants for whom the first visit occurred within 7 days after birth were included in the analysis.…”

“…Analyses of data collected in large community-based trials of maternal vitamin A supplementation in Ghana 14 and newborn chlorhexidine antisepsis in Nepal 15 showed that delaying the initiation of breast-feeding beyond the first hour or first day of life significantly increased the risk of neonatal mortality. Given the observed relative risks and available country-specific data on coverage of breast-feeding within the first 24 h after birth, these studies estimated that 16 and 8% of neonatal mortality could be attributed to delayed initiation of breast-feeding.…”

Early breastfeeding initiation and incidence of neonatal sepsis in Chipinge District Zimbabwe

“…On the contrary, delay in initiating breastfeeding beyond 24 hours of birth is associated with 85 % risk of dying. 3 It also reported in the same study that only 50% of the world infants initiate breastfeeding within an hour thus leaving a 50 % practice gap.…”

“…1 Several studies have proven the protective effect of colostrum against varied pathogenic microorganisms that have detrimental effects to the survival of the newborn baby especially during the immediate postpartum period. 2,3 Delayed breastfeeding is consequently associated with high neonatal morbidity and mortality especially during the first week of life. 2 In one multicentre study conducted in Ghana, India, Nepal and Tanzania, EBFI was found curb risk of neonatal deaths by 33 % if commenced within an hour of birth.…”