title: Breast-feeding initiation time and neonatal mortality risk among newborns in South India.
abstract: OBJECTIVE
  To examine the association between breast-feeding initiation time and neonatal mortality in India, where breast-feeding initiation varies widely from region to region.
  
  
  METHODS
  Data were collected as part of a community-based, randomized, placebo-controlled trial of the impact of vitamin A supplementation in rural villages of Tamil Nadu, India. Multivariate binomial regression analysis was used to estimate the association between neonatal mortality and breast-feeding initiation time (<12 h, 12 to 24 h, >24 h) among infants surviving a minimum of 48 h.
  
  
  RESULTS
  Among 10 464 newborns, 82.1% were first breast-fed before 12 h, 13.8% were breast-fed between 12 and 24 h, and 4.1% were breast-fed after 24 h. After adjusting for birth weight, gestational age and other covariates, late initiators (>24 h) were at ∼78% higher risk of death (relative risk=1.78 (95% confidence interval (CI)=1.03 to 3.10)). There was no difference in mortality risk when comparing babies fed in the first 12 h compared with the second 1  h after birth.
  
  
  CONCLUSIONS
  Late (>24 h) initiation of breast-feeding is associated with a higher risk of neonatal mortality in Tamil Nadu. Emphasis on breast-feeding promotion programs in low-resource settings of India where early initiation is low could significantly reduce neonatal mortality.
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: C R
authors.initials: CR
authors.lastname: Garcia
authors.forename: L C
authors.initials: LC
authors.lastname: Mullany
authors.forename: L
authors.initials: L
authors.lastname: Rahmathullah
authors.forename: J
authors.initials: J
authors.lastname: Katz
authors.forename: R D
authors.initials: RD
authors.lastname: Thulasiraj
authors.forename: S
authors.initials: S
authors.lastname: Sheeladevi
authors.forename: C
authors.initials: C
authors.lastname: Coles
authors.forename: J M
authors.initials: JM
authors.lastname: Tielsch
mesh_terms: D001942:Breast Feeding / Q000453:epidemiology*; D003906:Developing Countries; D005260:Female; D006801:Humans; D007194:India; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D011446:Prospective Studies; D012306:Risk; D012424:Rural Population; D013997:Time Factors; D014801:Vitamin A / Q000008:administration & dosage
chemical_list: D014801:Vitamin A