Breastfeeding and infant mortality

A new study published by the Journal of Pediatrics shows increased rates of implementation of hospital-based breastfeeding initiatives are associated with decreased rates of infant deaths in the first six days after birth, dispelling speculation that such practices might increase infant death.

The authors of the study examined trends in the percentage of births in baby-friendly hospitals between 2004-2016, as well as the implementation of skin-to-skin care in the first hour after birth in both the U.S. population and in Massachusetts. The authors looked at trends in Sudden Unexpected Infant Deaths (SUID), including deaths by asphyxia, in the first six days after birth during the same time period.

Despite marked increases in both the percentage of newborns being delivered in baby-friendly facilities and in the percentage of newborns experiencing skin-to-skin care, there has been a significant decrease in deaths due to SUID within the first six days after birth.

"These data come as welcome news and should reassure us that these initiatives are not resulting in any increase in infant deaths—in fact, just the opposite is true," said study lead author Melissa Bartick, Harvard Medical School assistant professor of medicine and an internist at Cambridge Health Alliance.

Bartick noted that widespread speculation had arisen on whether such interventions could be deadly after an opinion piece citing Massachusetts infant mortality data was published in medical literature in 2016, followed by a national study in 2018.

Both of these publications were controversial, and the related mainstream media attention they garnered characterized such deaths as being relatively common. The new study by Bartick and colleagues found that fewer than 1 percent of sudden unexpected infant deaths during the first month of life actually occur during those first six days.

Bartick noted that the peak occurrence for SUIDS is in the first two to four months of life. Rates of skin-to-skin care rose to nearly 100 percent in Massachusetts, yet there were zero deaths from suffocation or asphyxia.

"We now recognize that evidence-based maternity care practices to support breastfeeding are associated with a decreased risk of neonatal death," said study co-author Lori Feldman-Winter, professor of pediatrics at Cooper Medical School of Rowan University.

The authors noted that skin-to-skin care is now routine for all infants, regardless of feeding method.

An additional significant finding of the study was that deaths in the first six days of life occurred disproportionately among black infants, indicating that racial disparity in infant mortality begins as early as the first six days after birth.