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

BMJ 1999; 318 doi: (Published 15 May 1999) Cite this as: BMJ 1999;318:1316
  1. Juraci A César, assistant professor (juraci.cesar{at},
  2. Cesar G Victora, professorb,
  3. Fernando C Barros, professorb,
  4. Iná S Santos, associate professorb,
  5. José A Flores, senior radiologistc
  1. aDepartamento Materno Infantil, Fundaçäo Universidade do Rio Grande, Rio Grande do Sol, Brazil
  2. bDepartamento de Medicina Social, Universidade Federal de Pelotas, Rio Grande do Sol
  3. cHospital Pediátrico Santo Antônio, Porto Alegre, Rio Grande do Sol
  1. 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
  • Accepted 26 January 1999


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 2391cases 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 (21.8to 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.

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