Breastfeeding and wheeze-related outcomes in high-risk infants: A systematic review and meta-analysis

• Published in: The American journal of clinical nutrition Vol. 113; no. 6; pp. 1609 - 1618
• Main Authors: Harvey, Soriah M, Murphy, Vanessa E, Whalen, Olivia M, Gibson, Peter G, Jensen, Megan E
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2021; Oxford University Press; American Society for Clinical Nutrition, Inc
• Subjects: Asthma; Asthma - prevention & control; Atopy; Breast Feeding; breastfeeding; Breastfeeding & lactation; Bronchopneumonia; Croup; early life; Genetics; Health care; Health risks; health-care use; high-risk; Humans; Infant; Infants; Meta-analysis; nutrition; pediatrics; respiratory; Respiratory Sounds; Respiratory tract; Respiratory tract diseases; Risk Factors; Risk groups; Systematic review; wheeze; Wheezing; aRR; nutrition; NOS; wheeze; pediatrics; early life; LRTI; breastfeeding; high-risk; health-care use; infant; respiratory
• ISSN: 0002-9165; 1938-3207
• DOI: 10.1093/ajcn/nqaa442

The risk of wheezing is high in infancy and is heightened in infants with a family history of asthma/atopy. The role of breastfeeding in influencing respiratory health for these high-risk infants is unclear. To systematically appraise evidence for the association between breastfeeding and wheeze incidences and severity in high-risk infants. Studies identified through electronic databases and reference lists were eligible if they assessed breastfeeding and respiratory outcomes in infants with a family history of asthma/atopy. The primary outcome was wheeze incidences in the first year of life. Secondary outcomes were wheeze incidences in the first 6 months of life, indicators of wheeze severity (recurrent wheeze, health-care utilization, and medication use), and other wheeze-related outcomes [bronchiolitis, pneumonia, croup, and incidence of lower respiratory tract infection (LRTI)] up to 12 months old. Meta-analyses were conducted where possible. Of 1843 articles screened, 15 observational studies met the inclusion criteria. Breastfeeding was associated with 32% reduced odds of wheezing during the first year of life (ever vs. never: OR, 0.68; 95% CI: 0.53, 0.88; n = 9 studies); this association was even stronger in the first 6 months (OR, 0.45; 95% CI: 0.27, 0.75; n = 5 studies). Breastfeeding for a “longer” versus “shorter” time (approximately longer vs. shorter than 3 months) was associated with 50% reduced odds of wheezing at the age of 6 months (OR, 0.50; 95% CI: 0.39, 0.64; n = 3 studies). Breastfeeding was associated with reduced odds of wheezing in high-risk infants, with the strongest protection in the first 6 months. More research is needed to understand the impact of breastfeeding intensity on wheezing and to examine additional respiratory outcomes, including wheeze severity. This review was registered at PROSPERO as CRD42019118631.