Breastfeeding and respiratory infections in the first 6 months of life: A case control study

Elisabetta Pandolfi, Francesco Gesualdo, Caterina Rizzo, Emanuela Carloni, Alberto Villani, Carlo Concato, Giulia Linardos, Luisa Russo, Beatrice Ferretti, Ilaria Campagna, Alberto Tozzi

Research output: Contribution to journalArticlepeer-review


Background: Viral respiratory tract infections (VRI) are a major reason for hospitalization in children younger than 5 years. A case control study was conducted to investigate the potential role of breastfeeding in protecting children < 1 year of age from VRI. Methods: Patients admitted for a respiratory tract infections routinely underwent a nasopharyngeal aspirate, which was tested with an RT-PCR for 14 respiratory viruses. Hospitalised infants positive for viruses were enrolled as cases; healthy controls were enrolled among patients admitted for ultrasound hip screening. The effect of breastfeeding on pertussis was investigated through multivariable analysis. Results: We enrolled a total of 496 patients: 238 cases and 258 healthy controls. Among cases, eighty-six patients (36.1%) had a rinovirus, 78 (32.8%) an RSV, 22 (9.2%) an adenovirus and 37 (15.5%) a coinfections with multiple viruses. The number of households was significantly higher in cases (mean in cases 4.5; mean 3.7 in controls, p<0,001) and the proportion of infants having siblings (79% in cases vs 43% in controls, p<0.001). Proportion of smoking mothers was higher in cases than in controls (21.4% vs 10.1%, p=0.001). Among cases 44.5% were exclusively breastfed at symptoms onset versus 48.8% of healthy controls. According to the multivariable analysis, being exclusively breastfed at symptom onset was associated with a higher risk of viral respiratory infection (3.7; 95% CI 1.64 - 8.41), however a longer breastfeeding duration was protective (OR 0.98; 95% CI 0.97 - 0.99). Also having at least one sibling was associated to a higher risk (OR 3.6; 95% CI 2.14 - 5.92) as well as having a smoking mother (OR 2.6; 95% CI 1.33 - 4.89). Conclusions: Breastfeeding remains a mainstay of prevention for numerous diseases and its protective role increases with duration. However, being breastfed when mothers carry a respiratory infection may increase the risk of transmission,acting as a proxy for closer contacts. In future studies, potential confounding variables as pattern of contacts with other individuals, should be taken into account.

Original languageEnglish
Article number152
JournalFrontiers in Pediatrics
Issue numberAPR
Publication statusPublished - Jan 1 2019


  • Breast milk
  • Breastfeeding
  • Pediatrics
  • Prevention
  • Respiratory infection
  • Viral infection

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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