title: Effect of early infant feeding practices on infection-specific neonatal mortality: an investigation of the causal links with observational data from rural Ghana.
abstract: BACKGROUND
  Strong associations between delayed initiation of breastfeeding and increased neonatal mortality (2-28 d) were recently reported in rural Ghana. Investigation into the biological plausibility of this relation and potential causal pathways is needed.
  
  
  OBJECTIVE
  The objective was to assess the effect of early infant feeding practices (delayed initiation, prelacteal feeding, established neonatal breastfeeding) on infection-specific neonatal mortality in breastfed neonates aged 2-28 d.
  
  
  METHODS
  This prospective observational cohort study was based on 10 942 breastfed singleton neonates born between 1 July 2003 and 30 June 2004, who survived to day 2, and whose mothers were visited in the neonatal period. Verbal autopsies were used to ascertain the cause of death.
  
  
  RESULTS
  One hundred forty neonates died from day 2 to day 28; 93 died of infection and 47 of noninfectious causes. The risk of death as a result of infection increased with increasing delay in initiation of breastfeeding from 1 h to day 7; overall late initiation (after day 1) was associated with a 2.6-fold risk [adjusted odds ratio (adj OR): 2.61; 95% CI: 1.68, 4.04]. Partial breastfeeding was associated with a 5.7-fold adjusted risk of death as a result of infectious disease (adj OR: 5.73; 95% CI: 2.75, 11.91). No obvious associations were observed between these feeding practices and noninfection-specific mortality. Prelacteal feeding was not associated with infection (adj OR: 1.11; 95% CI: 0.66, 1.86) or noninfection-specific (adj OR: 1.33; 95% CI: 0.55, 3.22) mortality.
  
  
  CONCLUSIONS
  This study provides the first epidemiologic evidence of a causal association between early breastfeeding and reduced infection-specific neonatal mortality in young human infants.
authors.affiliation: Kintampo Health Research Centre, Ghana Health Service, Kintampo, Brong Ahafo Region, Ghana. karen.edmond@lshtm.ac.uk
authors.forename: Karen M
authors.initials: KM
authors.lastname: Edmond
authors.forename: Betty R
authors.initials: BR
authors.lastname: Kirkwood
authors.forename: Seeba
authors.initials: S
authors.lastname: Amenga-Etego
authors.forename: Seth
authors.initials: S
authors.lastname: Owusu-Agyei
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Hurt
mesh_terms: D001942:Breast Feeding / Q000453:epidemiology / Q000706:statistics & numerical data*; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D005247:Feeding Behavior; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007225:Infant Food; D007226:Infant Mortality; D007227:Infant Nutritional Physiological Phenomena / Q000502:physiology*; D007231:Infant, Newborn; D007239:Infections / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008895:Milk, Human / Q000276:immunology*; D016017:Odds Ratio; D011204:Poverty Areas; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors