Improved Estimation of Breastfeeding Rates Using a Novel Breastfeeding and Milk Expression Survey

Can Breastfeeding Protect from Multi-System Inflammatory Syndrome in Children (MIS-C)? A Preliminary Study

Background: Breastfeeding prevents Kawasaki disease (KD), as well as several autoimmune disorders. Since there is an overlap between the Multi-System Inflammatory Syndrome in children following SARS-CoV-2 infection (MIS-C) and KD, this case series aims to analyze the association between breastfeeding and MIS-C. Methods: A series of 16 cases of children with MIS-C admitted to three pediatric facilities between January 2021 and May 2022 were conducted. Breastfeeding rate was estimated through the Brief Breastfeeding and Milk Expression Recall Survey. Results: Out of 16 children, 9 (56%) had been breastfed at birth. Discussion: Our breastfeeding rate is below the median Spanish rate for initial breastfeeding. These findings do not clearly support the hypothesis that breastfeeding might prevent MIS-C. Conclusion: Contrary to the role of breastfeeding in KD prevention, our case series cannot answer with certainty the question about whether or not breastfeeding does protect children against MIS-C. These findings require confirmation in larger studies.

Does breastfeeding protect children from COVID-19? An observational study from pediatric services in Majorca, Spain

BACKGROUND

It has been demonstrated that children who had been breastfed remain better protected against various infections, and notably respiratory tract infections, well beyond infancy. Since the role of breastfeeding to explain why children are less affected by COVID-19 has not been studied until now, the aim of this study was to determine whether any history of breastfeeding reduces the incidence rate of COVID-19 in children.

METHODS

This was a secondary analysis of an observational study on clinical and epidemiological characteristics of pediatric COVID-19 in Majorca. A total of 691 children were recruited during the 5 months of August-December 2020. Eligible participants were children under 14 who were tested for SARS-CoV-2 in pediatric emergency services. The independent explanatory variable was any breastfeeding. Bivariate analyses were conducted through the Chi-square test, the Fisher's Exact test or the Student's T test. All children had the same demographic, epidemiological and clinical data collected through a study team member interview and via the participants medical records.

RESULTS

Within the sample of children who visited emergency services with symptoms of potential COVID-19, we found higher prevalence of positive SARS-CoV-2 RT-PCR test results among those who were exclusively formula fed compared with those who were ever breastfed (OR 2.48; 95% CI 1.45, 3.51; P = 0.036).

CONCLUSIONS

The present study suggests that ever breastfeeding reduces the risk of COVID-19 among children, as documented for other infections.

Reliability of Maternal Recall of Feeding at the Breast and Breast Milk Expression 6 Years After Delivery

Background: The reliability of long-term maternal recall of breastfeeding has been assessed previously, but not maternal milk expression (pumping) and child consumption of expressed milk. Objective: To examine the reliability of maternal recall of feeding at the breast, maternal milk expression, and child consumption of expressed milk 6 years after delivery using the Brief Breastfeeding and Milk Expression Recall Survey (BaByMERS). Methods: At 12 months postpartum, women who delivered a singleton, live-born infant at >24 weeks of gestation at a major U.S. academic hospital completed BaByMERS. Five years later, they were recontacted to complete the same questionnaire. Kappa statistics (κ), intraclass correlation coefficient (ICC), and Bland/Altman plots examined agreement. Sociodemographics were examined through stratified comparisons. Results: Of 299 women who completed both questionnaires, 35% had a postgraduate education and 82% identified as white/Caucasian. Kappa statistics showed substantial agreement for ever breastfeeding or feeding breast milk (combined) (κ = 0.71, 95% confidence interval [CI]: 0.44-0.98) and ever feeding at the breast (κ = 0.76, 95% CI: 0.62-0.89). Recall for duration of feeding at the breast was excellent (ICC = 0.96, 95% CI: 0.95-0.97), and of maternal milk expression was slightly less so (ICC = 0.83, 95% CI: 0.80-0.97). Maternal minority race/ethnicity, lower educational attainment, unmarried marital status, public/no health insurance, and smoking were associated with lower reliability; these differences were usually small and not consistent across all feeding practices. Conclusions: Maternal recall of contemporary lactation and infant feeding using BaByMERS was strongly reliable 6 years after delivery. BaByMERS may be useful to collect recall data, with attention to subpopulations that may exhibit lower recall reliability.