BMJ 1999;318:1316-1320 ( 15 May )

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Impact of breast feeding on admission for pneumonia during postneonatal period in Brazil: nested case-control study

Editorial by Latham

Juraci A César, assistant professor, ^a Cesar G Victora, professor, ^b Fernando C Barros, professor, ^b Iná S Santos, associate professor, ^b José A Flores, senior radiologist. ^c

^a Departamento Materno Infantil, Fundação Universidade do Rio Grande, Rio Grande do Sol, Brazil, ^b Departamento de Medicina Social, Universidade Federal de Pelotas, Rio Grande do Sol, ^c Hospital Pediátrico Santo Antônio, Porto Alegre, Rio Grande do Sol

Correspondence to: Professor J A César, Maternal and Child Epidemiology Unit, London School of Hygiene and Tropical Medicine, 49-51 Bedford Square, London WC1B 3DP juraci.cesar{at}lshtm.ac.uk

Objective: To determine whether breast feeding protects infants against pneumonia and whether the protection varies with age.
Design: Nested case-control study.
Setting: Pelotas, southern Brazil.
Subjects: Cases were 152 infants aged 28-364 days who had been admitted to hospital for pneumonia. Controls were 2391 cases in a population based case-control study.
Main outcome measure: Odds ratio of admission for pneumonia according to type of milk consumed (breast milk alone, breast and formula milk, or formula milk and other fluids only), use of fluid supplements apart from formula milk, and use of solid supplements.
Results: Infants who were not being breast fed were 17 times more likely than those being breast fed without formula milk to be admitted to hospital for pneumonia (95% confidence interval 7.7 to 36.0). This relative risk was 61 (19.0 to 195.5) for children under 3 months old, decreasing to 10 (2.8 to 36.2) thereafter. Supplementation with solids was associated with a relative risk of 13.4 (7.6 to 23.5) for all infants and 175 (21.8 to 1405.1) for those under 3 months old.
Conclusion: Breast feeding protects young children against pneumonia, especially in the first months of life. These results may be used for targeting intervention campaigns at the most vulnerable age groups.

Key messages Pneumonia is the leading cause of death in children under 5 years old across the world In Brazil infants who were not breast fed were 17 times more likely than those receiving breast milk alone to be admitted for pneumonia The relative risk of admission was 61 for children under 3 months of age, decreasing to 10 thereafter Supplementation with solids was associated with a relative risk of 13.4 for all infants Mothers must be encouraged to breast feed very young infants and be advised of the right time to introduce supplementary foods

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