Appendix A
Appendix A presents a compilation of abstracts of studies that address relationships of the mode of infant feeding with the infant's subsequent survival. Abstracts are presented in either tabular or narrative form and are arranged chronologically by type of study (mortality rates, relative risk, or both; case fatality; and miscellaneous). Table A-1 presents a chronological listing of the data and indicates the location of each abstract.
TABLE A-1 Chronological Listing of Estimated Relative Risk (RR) of Mortality in Industrialized Countries Among Children Fed Formula Only or Formula Plus Human Milk Compared with Breastfed Infants and Childrena
|
RRb |
Type of Study and Abstract Providing Detailed Description |
|
|
Period and Site of Study |
Bottle |
Mixed |
Reference |
|
1869–1910, Three German states |
NAc |
NA |
Correlation, A-21 |
Knodel and van de Walle, 1967 |
1885–1886 Berlin, Germany |
4.0– 10.8d |
NA |
Mortality rates, A-1 |
Thiemich and Bessau, 1930; reviewed in Mannheimer, 1955 |
1895–1896 Berlin, Germany |
4.1– 14.2d |
NA |
Mortality rates, A-1 |
Thiemich and Bessau, 1930; reviewed in Mannheimer, 1955 |
1900–1903, Derby, England |
2.83 |
1.41 |
Mortality rates, A-2 |
Howarth, 1905 |
1900–1904, Kingdom of Bavaria, Germany |
NA |
NA |
Correlation, A-22 |
Greenwood and Brown, 1912 |
1901–1905, Finsbury, London |
27.5 |
9.8 |
Case-control, A-3 |
Newman, 1906 |
NRe Liverpool, England |
Mortality rates, A-4 |
Armstrong, 1904 |
||
1903–1905, Brighton, England |
35.1 |
3.1 |
Case-control, A-5 |
Newsholme, 1906, reviewed in Newman, 1906 |
1906, Berlin, Germany |
2.6– 10.9d |
NA |
Mortality rates, A-1 |
Thiemich and Bessau, 1930; reviewed in Mannheimer, 1955 |
1910, Boston, Mass. |
6.06 |
NA |
Mortality rates, A-6 |
Davis, 1913 |
1924–1929, Chicago, Ill. |
5.6 |
4.6 |
Mortality rates, A-7 |
Grulee et al., 1934, 1935 |
NR, Birmingham, England |
4.59 |
1.55 |
Case-fatality, A-17 |
Smellie, 1939 |
NR, Toronto, Canada |
0.89 |
0.65 |
Case-fatality, A-18 |
Ebbs and Mulligan, 1942 |
1936–1942, Liverpool, England |
5.62 |
2.52 |
Mortality rates, A-8 |
Robinson, 1951 |
1941–1942, Belfast, Ireland |
5.15– 13.72d |
NA |
Mortality rates, A-9 |
Deeny and Murdock, 1944 |
1943–1947, Stockholm, Sweden |
1.34– 1.75f |
0.63– 0.66f |
Mortality rates, A-10 |
Mannheimer, 1955 |
1942 and 1943, Isleworth, England |
1.96 |
NA |
Case-fatality, A-19 |
Gaidner, 1945 |
1943–1946, Louisville, Ky. |
NA |
NA |
Case-fatality, A-20 |
Prince and Bruce, 1948 |
1946, Great Britain |
1.7h |
NA |
Mortality rates, A-11 |
Douglas, 1950 |
1956–1971, Copenhagen, Denmark |
NA |
NA |
Case-control, A-12 |
Biering-Sorensen et al., 1978 |
1959–1966, United States |
NA |
NA |
Mortality rates, A-13 |
Naeye et al., 1976 |
1962, Canada |
2.03 |
NA |
Mortality rates, A-14 |
Department of National Health and Welfare, Canada, 1963, as quoted in Gerard and Tan (1978) |
1973–1979, Sheffield, England |
NA |
NA |
Postnatal intervention, A-15 |
Carpenter et al., 1983 |
NR, United States |
NA |
NA |
Case-control, A-16 |
Arnon et al., 1982 |
a The bases for the estimates of relative risk are shown in Abstracts A-1 through A-19. Relative risks computed for these studies represent somewhat different comparisons. For example, mortality might be compared for infants at different ages or for infants hospitalized with diarrhea. b Relative risk for breastfed infants = 1.0. c NA = Data not available for estimating relative risk. d Range covers values from 1 to 12 months of age. e NR = Period not reported. f To age 1 year. g To age 2 weeks. h To age 2 years, comparison of infants breastfed for 8 weeks or longer with those breastfed for less than 8 weeks. |
MORTALITY RATES AND RELATIVE RISK OF MORTALITY
ABSTRACT A-1 Infant Deaths/1,000 Births and Relative Risk (RR) of Death, by Feeding Method and Month of Age, Berlin, Germany, Between 1885 and 1906a,b
|
|
Number of Infant Deaths/1,000 Births by Feeding Method |
||
Years |
Age of Mortality, mo |
Breast |
Bottle |
RRc |
1885–1886 |
1 |
22.4 |
142.0 |
6.3 |
|
2 |
9.0 |
82.7 |
9.2 |
|
3 |
6.8 |
72.2 |
10.6 |
|
4 |
6.4 |
61.8 |
9.7 |
|
5 |
5.3 |
57.1 |
10.8 |
|
6 |
4.9 |
50.7 |
10.3 |
|
7 |
4.7 |
46.5 |
9.9 |
|
8 |
4.5 |
40.8 |
9.1 |
|
9 |
5.3 |
33.3 |
6.3 |
|
10 |
5.4 |
29.5 |
5.5 |
|
11 |
6.3 |
24.9 |
4.0 |
|
12 |
NAd |
NA |
NA |
1895–1896 |
1 |
19.6 |
111.9 |
5.7 |
|
2 |
7.3 |
58.7 |
8.0 |
|
3 |
4.3 |
49.7 |
11.6 |
|
4 |
3.6 |
46.6 |
12.9 |
|
5 |
2.6 |
37.0 |
14.2 |
|
6 |
2.5 |
31.0 |
12.4 |
|
7 |
2.5 |
27.7 |
11.1 |
|
8 |
2.3 |
24.1 |
10.5 |
|
9 |
2.0 |
21.3 |
10.7 |
|
10 |
3.8 |
19.1 |
5.0 |
|
11 |
3.1 |
16.7 |
5.4 |
|
12 |
3.6 |
14.6 |
4.1 |
1906 |
1 |
22.4 |
59.1 |
2.6 |
|
2 |
7.9 |
31.3 |
4.0 |
|
3 |
4.3 |
27.3 |
6.3 |
|
4 |
2.4 |
22.1 |
9.2 |
|
5 |
1.7 |
18.5 |
10.9 |
|
6 |
2.2 |
16.1 |
7.3 |
|
7 |
1.4 |
14.1 |
10.1 |
|
8 |
1.8 |
12.2 |
6.8 |
|
9 |
2.1 |
10.2 |
4.9 |
|
10 |
1.5 |
9.2 |
6.1 |
|
11 |
1.3 |
8.0 |
6.2 |
|
12 |
1.5 |
8.0 |
5.3 |
a From Thiemich and Bessau (1930), as quoted in Mannheimer (1955). b Data on feeding practices were collected for all deaths and during census for survivors. c Relative risk for breastfed infants = 1.0. d NA = Not available. |
ABSTRACT A-2 Infant Deaths/1,000 Births and Relative Risk (RR) of Mortality by Feeding Method, Derby, England, 1900 to 1903a
|
Number of Infant Deaths/1,000 Births (RR) by Feeding Method |
||
Specific Causes of Mortality |
Breast |
Bottle |
Mixed |
All causes |
69.8 |
197.5 (2.83)b |
98.7 (1.41) |
Respiratory diseases |
14.1 |
26.5 (1.84) |
12.6 (0.88) |
Gastrointestinal diseases |
9.9 |
57.8 (5.84) |
25.0 (2.53) |
Marasmus |
12.5 |
39.4 (3.15) |
18.8 (1.50) |
Tuberculosis |
3.4 |
13.5 (3.97) |
5.6 (1.65) |
Convulsions |
15.0 |
25.9 (1.73) |
20.9 (1.39) |
a From Howarth (1905). b Relative risk for breastfed infants = 1. COMMENTS: Feeding history was obtained during infant's life; of the 8,343 infants studied, 63.3% were breastfed, 27.3% were mixed fed, and 19.5% were formula fed. |
ABSTRACT A-3 Feeding Practices and Relative Risk (RR) of Death from Diarrhea in a Case-Control Study of Infants Aged 0 to 3 Months, Finsbury, London, England, 1901 to 1905a
ABSTRACT A-4 Infant Deaths/1,000 Births and Relative Risk (RR) of Mortality by Feeding Method, Liverpool, Englanda,b
|
Number of Infant Deaths/1,000 Births (RR), by Feeding Method |
||
Specific Ages of Mortality |
Breast |
Bottle |
Mixed |
Up to age 1 yr |
84 |
228 (2.71)b |
134 (1.59) |
Age 1–2 yr |
40 |
99 (2.49) |
36 (0.92) |
a From Armstrong (1904). Period of study not reported. b Relative risk for breastfed infants = 1. COMMENTS: Data from 1,000 children of 224 mothers attending the Infirmary for Children; 68.9% were breastfed, 18.4% were bottle fed, and 12.7% were mixed fed to age 6 months. |
ABSTRACT A-5 Feeding Practices and Relative Risk (RR) of Epidemic Diarrhea Infant Death in a Case-Control Study in Brighton, England, 1903 to 1905a
|
Infants Fed by Each Method, % |
||
Feeding Method |
Infants Who Died (N = 121) |
Surviving Infants (N = 1,259) |
RR |
Breast |
6.5 |
62.3 |
1.0 |
Bottle |
80.3 |
21.9 |
35.1 |
Mixed |
5.0 |
15.3 |
3.1 |
Unknown |
8.2 |
0.5 |
NAb |
a From Newsholme (1906), as reviewed in Newman (1906). b NA = Not applicable. |
ABSTRACT A-6 Deaths/1,000 Births and Relative Risk (RR) of Mortality for Infants Aged 2 Weeks to 1 Year, by Feeding Method, Boston, 1910 a
|
Number of Infant Deaths/ 1,000 Births, by Feeding Method |
||
Cause of Mortality |
Breast |
Bottle |
RRb |
All causes |
36 |
218 |
6.06 |
Diarrhea |
9 |
98 |
12.25 |
a From Davis (1913). A case-control study of 1,600 deaths, plus mail questionnaires from mothers of 736 controls. It was unclear how mixed feeding was classified. b Relative risk for breastfed infants = 1. |
ABSTRACT A-7 Death Rates/1,000 Births and Relative Risk (RR) of Death for 20,061 Infants up to 1 Year of Age Served by Welfare Clinics in Chicago, 1924 to 1929a
Feeding Method |
Death Rate/ 1,000 Births |
RR |
Breast |
1.5 |
1.0 |
Bottle |
8.4 |
5.6 |
Mixed |
6.9 |
6.9 |
a From Grulee et al. (1934, 1935). |
ABSTRACT A-8 Death Rates/1,000 Births and Relative Risk (RR) of Death for 3,266 Infants Aged 7 Months or Less, Liverpool, England, 1936 to 1942a
ABSTRACT A-9 Infant Deaths/1,000 Births and Relative Risk (RR) of Death, by Feeding Method and Age, Belfast, Ireland, June 1941 to June 1942a
|
Number of Infant Deaths/1,000 Births by Feeding Method |
||
Age of Mortality, mo |
Breast |
Bottle |
RRb |
<1 |
7.5 |
103.0 |
13.72 |
1–2 |
5.0 |
38.0 |
7.68 |
2–3 |
3.4 |
43.5 |
12.76 |
3–6 |
5.7 |
43.4 |
7.57 |
6–12 |
7.1 |
36.8 |
5.15 |
a From Deeny and Murdock (1944). Results were estimated from authors' data. Based on 554 infant deaths plus 477 survivors (every fifth child during first 6 months of age). b Relative risk for breastfed infants = 1.0. |
ABSTRACT A-10 Deaths/1,000 Births and Relative Risk (RR) of Death for 67, 738 Infants Who Survived the First Month, by Feeding Method, Age, and Cause of Death, 1943 to 1947, Stockholm, Swedena
|
Death Rate/1,000 Births (RR) by Feeding Method |
||
Age or Cause of Mortality |
Breastb |
Bottle |
Mixed |
Age 2–12 mo |
4.63 |
8.12 (1.75) |
3.08 (0.66) |
Age 3–12 mo |
3.19 |
6.48 (2.03) |
2.90 (0.91) |
Congenital disease |
NRc |
NR (1.73) |
NR |
Infections |
NR |
NR (1.28) |
NR |
Respiratory disease |
NR |
NR (2.55) |
NR |
Intestinal disease |
NR |
NR (6.79) |
NR |
Other causes |
NR |
NR (4.79) |
|
a From Mannheimer (1955). b Relative risk for breastfed infants = 1.0. c NR = Not reported. COMMENTS: RRs were 3.66 and 4.32 for infants fed cow's milk exclusively from age 2 months. The apparent advantage of mixed feeding lasted less than 4 months. The apparent disadvantage of bottle feeding decreased after 6 months and was gone after 9 months. Compared with breastfed infants, a smaller proportion of bottle-fed infants received care at child welfare centers (64 and 48%, respectively). Rates were lower for mixed-fed than for breastfed infants in all categories except intestinal disease, for which they were equal. Excess deaths in the bottle-fed group were observed only among infants weighing >2,500 g at birth. Feeding method was unrelated to income. |
ABSTRACT A-11 Death Rates/1,000 Births for 4,669 Infants Aged 8 Weeks to 2 Years and Relative Risk (RR) of Death by Duration of Breastfeeding, Great Britain, March 1946a
ABSTRACT A-12 Case-Control Study of Feeding Methods of Infants Developing Sudden Infant Death Syndrome (SIDS) and Control Infants, Copenhagen, 1956 to 1971a
|
Feeding Method,b % (no.) of Infants |
||
Study Group |
Breast |
Bottle |
Mixed |
Cases |
60.2 (74) |
20.3 (25) |
19.5 (24) |
Controls |
79.2c (412) |
7.7 (40) |
13.1 (68) |
a From Biering-Sørensen et al. (1978). b Feeding histories were derived from the notes of health visitors for both the sudden infant deaths and a selection of infants used as controls. c p < .0005. COMMENTS: Odds ratio for bottle feeding versus any breastfeeding at 2 weeks of age = 3.06. Authors review past work on SIDS and breastfeeding. Given that breastfeeding rates declined from 1956 to 1971, but SIDS incidence did not, authors conclude relationship is not causal. |
ABSTRACT A-13 Naeye and colleagues (1976) investigated feeding methods in a study of 125 infants with sudden infant death syndrome (SIDS) and 375 controls, using data from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke, 1959 to 1966. The odds ratio for bottle feeding compared with breastfeeding was 1.30. Infants with SIDS had frequent neonatal problems, including abnormal suck, need for gavage feeding, and late initiation of bottle feeding, suggesting that the choice of feeding method may have been secondary to neonatal problems.
ABSTRACT A-14 Deaths/1,000 Births and Relative Risk (RR) of Death for 3,684 Infants Aged 1 to 12 Months, by Feeding Method, American Indians in Canada, 1962a
|
Deaths/1,000 Births, by Feeding Method |
||
Cause of Death |
Breast |
Bottle |
RRb |
All causes |
26.6 |
53.8 |
2.03 |
Gastrointestinal or respiratory disease |
3.9 |
32.7 |
8.29 |
a From Department of National Health and Welfare Canada (1963), as quoted in Gerard and Tan (1978). b Relative risk for breastfed infants = 1.0. |
ABSTRACT A-15 Carpenter and colleagues (1983) used a complex analytic method in their investigation of infant death rates between 1973 and 1979 in Sheffield, England. During that time there was a program of postnatal intervention by health visitors for high-risk infants in Sheffield. Postneonatal mortality (deaths to infants 28 days to 1 year of age) fell far more steeply in the study group than it did in all of England and Wales. Among "preventable" deaths, rates fell from 5.2 to 1.9 per 1,000 births. (Among the study group, intention to breastfeed rose from 40 to 70%.) The authors attributed 24% of the fall in the death rate, or 0.8 deaths/1,000 births, to increased rates of breastfeeding.
ABSTRACT A-16 Feeding Methods of Infants Hospitalized with Infant Botulism, Infants with Sudden Infant Death Syndrome (SIDS), and Control Infants in California (1976 to 1979) and Elsewhere in the United States Through 1978a
|
|
Feeding Methods in Study Population, % |
||
Condition |
Subject |
Breast |
Formula |
Mixed |
Infant |
Cases (N = 50) |
66.0b |
24.0c |
10.0d |
botulism |
Controls (N = 125) |
43.2b |
33.6c |
23.2d |
SIDS |
Cases (N = 10) |
0 |
80.0 |
20.0 |
|
Controls (N = 20) |
30.0 |
35.0 |
35.0 |
a From Arnon et al. (1982). b Current breastfeeding. c Never breastfed. d Past breastfeeding. |
Case Fatality Studies
ABSTRACT A-17 Case Fatality and Relative Risk (RR) of Death by Method of Infant Feeding Among Infants Hospitalized with Diarrhea, Birmingham, Englanda
ABSTRACT A-18 Case Fatality and Relative Risk (RR) of Death Among 1,500 Infants Hospitalized with Infections, by Method of Infant Feeding, Toronto, Canadaa
Feeding Method |
Number of Infants Hospitalized |
Infant Deaths/ 1,000 Cases |
RR |
Breast |
227 |
185 |
1.0 |
Bottleb |
836 |
164 |
0.89 |
Mixed |
437 |
121 |
0.65 |
a From Ebbs and Mulligan (1942). b Never breastfed. COMMENTS: This study is exceptional, given that higher case-fatality rates were observed among breastfed infants. The reported results may imply lower case fatalities in bottle- and mixed-fed infants but could have arisen in other ways. For example, severity of infection was lower among breastfed infants: only the most severe cases might have been hospitalized. Furthermore, the results do not imply that death rates were higher among breastfed infants: if the incidence among them was lower, the opposite could have been true. Finally, the attending clinician may have been loathe to hospitalize breastfed infants, and this also would have possibly selected for higher severity among the breastfed infants. |
ABSTRACT A-19 Case Fatality and Relative Risk (RR) of Death of 216 Infants Hospitalized with Diarrhea, by Duration of Breastfeeding, Isleworth, England, 1942 and 1943a
Duration of Breastfeeding, mo |
No. of Infant Deaths/1,000 Cases |
RR |
>1 |
300 |
1.00 |
<1 |
550 |
1.86 |
a From Gairdner (1945). |
ABSTRACT A-20 Prince and Bruce (1948) investigated case fatalities among 570 infants hospitalized with diarrhea in Louisville, Ky., from 1943 to 1946. Although the overall case fatality was 11%, there were no deaths among infants still breastfed at the time of admission.
MISCELLANEOUS STUDIES
ABSTRACT A-21 Indices of Breastfeeding Correlated with Infant Mortality in Three German States, by Location, 1869 to 1910a
|
|
|
Correlation Coefficients Between Infant Mortality and the Breastfeeding Index (number of cases) |
|||
Breastfeeding Index |
Period of Breastfeeding Index |
Period of Infant Mortality |
State |
Rural |
Urban |
Total |
Proportion ever breastfed |
1904–1906 |
1869–1878 |
Bavaria |
-.80 (88) |
-.87 (15) |
-.81 |
|
1901–1905 |
Bavaria |
-.76 (91) |
-.7 (17) |
-.76 |
|
|
1878–1882 |
Baden |
-.54 (47) |
NRb |
-.54 (52) |
|
Proportion breastfed ≥6 mo |
1911 |
1873–1875 |
Hessen |
-.59 (19) |
NR |
-.55 (24) |
|
1906–1910 |
Hessen |
-.62 (19) |
NR |
-.61 (24) |
|
Duration of breastfeeding |
1904–1906 |
1869–1878 |
Bavaria |
-.83 (76) |
-.92 (14) |
-.83; -.70 |
|
1901–1905 |
Bavaria |
-.71 (79) |
-.68 (16) |
|
|
a From Knodel and van de Walle (1967). b NR = Not reported. |
ABSTRACT A-22 In a reanalysis of data of Groth and Hahn (1910), Greenwood and Brown (1912) reported a correlation of .76 ± 0.03 between the bottle-feeding rates and infant death rates from 92 districts of the Kingdom of Bavaria, Germany, between 1900 and 1904.
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