哺餵母乳可以減少半數SIDS風險

作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

March 10, 2009 — 根據 3月份小兒科期刊中一篇案例控制研究報告，哺餵母乳可以降低嬰兒期各年齡嬰兒之嬰兒猝死症(sudden infant death syndrome，SIDS)風險達50%。
　　
　　德國慕尼黑大學的M. M. Vennemann博士以及德國嬰兒猝死症研究團體的同僚寫道，在過去20年，減少嬰兒猝死症的預防活動相當成功。在一些國家，活動中也納入哺餵母乳的訊息，但是一些國家則沒有。
　　
　　這項研究的目標是評估嬰兒哺餵類型與SIDS之間的關係；德國嬰兒猝死研究中，333例死於SIDS（案例組），對照組則是998名年齡相仿的嬰兒。案例組嬰兒中，兩週大時哺餵母乳的比率有49.6%，對照組則有82.9%。
　　
　　一個月大時，全母乳之嬰兒的SIDS風險只有一半。一個月大時，哺餵部份母乳之嬰兒的SIDS風險也較低，但校正後並不顯著。
　　
　　在訪視前最後一個月報告屬於全母乳或者部份母乳者，與SIDS風險較低有關。根據哺餵母乳存活曲線，全母乳和部份母乳都與降低SIDS風險有關。
　　
　　研究作者寫道，本研究顯示，哺餵母乳降低嬰兒期各年齡嬰兒猝死症風險達將近50%。我們建議，將哺餵母乳直到六個月的建議納入，以降低嬰兒猝死症風險。
　　
　　研究限制包括對照組的回覆差強人意；研究對象中，特別是對照組，比非研究對象者更具社會經濟優勢；可能有其他錯誤；資料屬回溯式蒐集，可能有偏差。
　　
　　研究作者結論表示，在我們的研究中，73%的嬰兒在六個月大前死亡。我們的研究發現意味著，應持續哺餵母乳直到六個月大，則SIDS風險較低。因為社會弱勢階層的母乳哺餵率低，應有特殊計畫鼓勵低社經地位之婦女以母乳哺餵嬰兒，不只因為哺餵母乳對母嬰有一些已知的好處，也為了降低嬰兒的SIDS風險。
　　
　　德國聯邦科學與教育部於1998-2003年支持本研究。共同作者、E. A. Mitchell, FRACP, DSc接受紐西蘭兒童健康研究基金會的贊助。其他作者宣告無相關財務關係。

Breast-Feeding May Reduce Risk for SIDS by Half Throughout Infancy

By Laurie Barclay, MD
Medscape Medical News

March 10, 2009 — Breast-feeding reduces the risk for sudden infant death syndrome (SIDS) by approximately 50% at all ages throughout infancy, according to the results of a case-control study reported in the March issue of Pediatrics.

"In the last 20 years, the prevention campaigns to reduce the risk of sudden infant death syndrome were very successful," write M. M. Vennemann, MD, MPH, PD, from University of Munster in Munster, Germany, and colleagues from the German Study of Sudden Infant Death Study Group. "In some countries the advice to breastfeed is included in the campaigns' messages, but in other countries it is not."

The goal of this study was to evaluate the association between type of infant feeding and SIDS. In the German Study of Sudden Infant Death, 333 infants who died of SIDS (cases) were matched by age with 998 control infants. Breast-feeding at age 2 weeks was reported by 49.6% of case infants and by 82.9% of control infants.

Exclusive breast-feeding at age 1 month was associated with half the risk for SIDS. Although partial breast-feeding at age 1 month was also associated with lower risk for SIDS, this risk was not significant after adjustment.

Reporting exclusive or partial breast-feeding in the last month of life before the interview was associated with a lower risk for SIDS. Both partial breast-feeding and exclusive breast-feeding were linked to a reduced risk for SIDS, based on breast-feeding survival curves.

"This study shows that breastfeeding reduced the risk of sudden infant death syndrome by ~50% at all ages throughout infancy," the study authors write. "We recommend including the advice to breastfeed through 6 months of age in sudden infant death syndrome risk-reduction messages."

Limitations of this study include less-than-ideal response rate of controls; participants, especially controls, more likely to be socioeconomically advantaged vs those who did not participate; possible residual confounding; and retrospective collection of data, creating possible recall bias.

"In our study, 73% of the infants died before 6 months of age," the study authors conclude. "The implication of our findings is that breastfeeding should be continued until the infant is 6 months of age and the risk of SIDS is low. Because breastfeeding rates are low in the socially deprived sections of our population, there should be special programs to encourage mothers of low socioeconomic status to breastfeed their infants not only for the established benefits of breastfeeding for the mother and infant but also to reduce the risk of SIDS in their infants."

The German Federal Ministry for Science and Education supported this study from 1998 to 2003. Coauthor E. A. Mitchell, FRACP, DSc, was supported by the Child Health Research Foundation in New Zealand. The other study authors have disclosed no relevant financial relationships.

Pediatrics. 2009;123:e406-e410.