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Table 5 Summary of included studies presenting estimates of association between early breastfeeding initiation and morbidity outcomes

From: Time to initiation of breastfeeding and neonatal mortality and morbidity: a systematic review

Study, Location Sample Size Study Design Def of BF Exposure Comment/Conclusions Grade
Malnutrition WAZ      
Appoh [29], Ghana, facility 110 case-control early vs. late Reported an association between early breastfeeding initiation and a reduction in underweight children LOW
Kumar [33], India, community 217 cross sectional survey <6h vs. >6h Reported an association between early breastfeeding initiation and a reduction in underweight children LOW
Malnutrition WLZ      
Engebretsen [32], Uganda, community 723 cross sectional survey <2h vs 2-24h<2h vs>24h There was no statistically significant relationship comparing >24hr&<24 hours to <2hours (reference) LOW
Kumar [33], India, community 217 cross sectional survey <6h vs. >6h The infant feeding practices studied were not significantly associated with wasting LOW
Malnutrition, LAZ      
Engebretsen [32], Uganda, community 723 cross sectional survey <2h vs 2-24h<2h vs>24h There was no statistically significant relationship comparing >24hr&<24 hours to <2hours (reference LOW
Kumar [33], India, community 217 cross sectional survey <6h vs. >6h Reported a significant association between early breastfeeding initiation and reduction in stunting LOW
Early Weight Loss      
Enzunga [23], Zaire, facility 330 prospective cohort early vs. late Reports a direct relationship between the delay in initiation of breast-feeding and subsequent weight loss LOW
Caglar [34], Turkey, facility 90 prospective matched case control mean time to bf initiation Infants with a weight loss of >10% were significantly more likely to have received their first breastfeeding later than controls MEDIUM
Diarrhea      
Badruddin [30], Pakistan, mixed facility/community 265 case-control early vs. late Reported a significant higher likelihood of late breastfeeding in cases (i.e. those with acute and/or persistent diarrhea) LOW
Clemens [19], Egypt, community 198 prospective cohort <72h vs. >72h Reported a significant association between early breastfeeding initiation and reduction in diarrhea in the first six months of life LOW
Acute Diarrhea      
Badruddin [30], Pakistan, mixed facility/community 265 case-control early vs. late Reported a significant higher likelihood of late breastfeeding in cases (i.e. those with acute diarrhea) LOW
Persistent Diarrhea      
Badruddin [30], Pakistan, mixed facility/community 265 case-control early vs. late Reported a significant higher likelihood of late breastfeeding in cases (i.e. those with persistent diarrhea) LOW
Omphalitis      
Mullany [26], Zanzibar, community 1653 prospective cohort <1h vs. >=1h Risk of omphalitis was 71% lower among babies breastfed within 1 hour MEDIUM
Mullany [25], Nepal, community 17,198 prospective cohort early vs. late There was no statistically significant evidence to suggest that early breastfeeding initiation is protective against omphalitis MEDIUM
Hypoglycemia      
Sasidharan [28], India, hospital 604 prospective cohort early vs. late Reported a significant association between early breastfeeding initiation and reduction in hypoglycemia LOW
Hypothermia      
Mullany [27], Nepal, community 23,240 prospective cohort early vs. late The adjusted prevalence rate of hypothermia was 16% lower among babies for whom bf was initiated w/in 24hours MEDIUM
Van den Bosch [35], Malawi, facility 160 randomized trial Immediate vs. mother’s choice of initiation time Reported a significant association between early initiation and a reduction in low body temperature LOW