Breastfeeding and risk of hospitalisation in children under five years – A systematic review and meta-analysis

Sushmita Kerketta¹Pritimayee Sethy¹Sasmita Swain¹Satyabrata Pradhan¹Sameer Sahu¹Rutusmita Sahoo¹Mahipal Munda¹Srikanta Kanungo^1*Manikandan Srinivasan^2*Sanghamitra Pati³

• ¹ICMR - Regional Medical Research Centre Bhubaneswar, Bhubaneswar, India
• ²Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
• ³Indian Council of Medical Research, New Delhi, India

Objective: To evaluate the association between breastfeeding duration and risk of diarrhoea- and respiratory infection-related, infection-related and all-cause hospitalisation in under-five children from cohort studies. Methods: This systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We conducted a systematic literature search across PubMed, Embase, CINAHL, Scopus and Google Scholar for studies related to breastfeeding and hospitalisation in early childhood. Three authors independently screened titles and abstracts, followed by full texts assessment as per eligibility criteria. Data abstracted were pooled using random effects model, and estimates were presented as odds ratios. Odds of hospitalisation were reported across various exposure categories - exclusively breastfed, predominantly breastfed, partially breastfed and never breastfed under age strata of < 1 year, 1 – 2 years and 2 – 5 years. The New Castle Ottawa scale for cohort studies was used for risk of bias assessment. Findings: Total 16 cohort studies, including 27,80,195 children, across global settings, were included in this systematic review, and the majority (13, 81.25%) of studies were performed in high-income country settings. Children under one year of age who were exclusively breastfed had an insignificant reduction in odds of hospitalisation due to gastrointestinal infections compared to those never breastfed, with pooled OR of 0.79 (0.57 - 1.09), I2 – 53%. In the case of respiratory infection-specific hospitalisation, a significant reduction in odds of hospitalisation was noted in children across the age bands of < 1, 1-2 and 2-5 years with pooled ORs of 0.88 (0.82 - 0.95), I2 – 96%; 0.82 (0.70 - 0.97), I2 – 61% and 0.73 (0.56 - 0.95), I2 – NA, respectively. Children < 1 year with EBF significantly reduced odds of all-cause hospitalisation compared to those never breastfed with pooled OR of 0.97 (0.97 - 0.97), I2 – NA. Conclusion: This meta-analysis estimated that exclusive breastfeeding practice in children is associated with a significant reduction in odds of hospitalisation due to respiratory infections, and not in the case of gastrointestinal diseases, with greater benefits in the first year of life, based on studies with considerable heterogeneity.