Beneficial influence of breastfeeding on Respiratory Syncytial Virus (RSV)-associated acute lower respiratory infections in children – a systematic literature review

The Respiratory Syncytial Virus (RSV) poses a significant risk of serious infection in children worldwide, in particular in children in low-income and middle-income countries. However, previous studies indicated that breastfeeding could be a protective factor as it strengthens the immune system and protects against other serious childhood infections. A current systematic review summarises the available evidence on breastfeeding and its effects on acute lower respiratory infections which are associated with RSV.

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Breastfeeding is officially recommended to be started within the first hour of birth and at least continued in the first 6 months of the baby’s life. It has a positive effect on the baby’s immune system and protects the baby from childhood infections which can become serious. One of these serious childhood infections are viral lower respiratory tract infections (LRTI), caused by RSV. RSV is one of the main causes for hospital admission in children under five years of age, particularly in middle-income and low-income countries. Generally, a severe course can affect all infants, however, prominent risk factors for viral lower respiratory tract infections (LRTI) are being born preterm, low income, presence of school-age siblings and lack of breastfeeding, among others.

The systematic review of Mineva et al. aims to find out whether breastfeeding, compared to formula feeding, protects children under twelve months of age of acute lower respiratory infections associated with RSV and if exclusive and/or partial breastfeeding has also an influence on the hospitalisation rate, length of stay in hospital and need for medical interventions.

In total, nineteen studies from 12 countries, including almost 17000 infants from 31 countries were used for the analysis. Interestingly, the findings of this systematic literature search indicated that the severity of acute lower respiratory tract infections related to RSV, hospitalisation rate, length of hospital stay and additional oxygen support with or without intensive care unit visits are reduced when babies are exclusively or partially breastfed. Exclusive breastfeeding for more than 4-6 months had an even stronger effect in reducing the mentioned issues.

As especially in middle-income and low-income countries primary prevention measures are often not available and breastfeeding provides an inexpensive, environmentally friendly prevention method, mothers should be supported and encouraged to breastfeed as it brings also a great number of other benefits with it.

Paper available at: BMJ Global Health

Full list of authors: Gabriela M Mineva, Helen Purtill, Colum P Dunne, Roy K Philip

DOI: 10.1136/bmjgh-2022-009693