Breastfeeding mitigates long-term infectious disease outcomes in individuals with a history of surgical disease as a neonate: a case-control cohort study.

PURPOSE: Breast milk is the recommended nutrition for infants and provides protection against infection. We evaluated whether similar benefits extend to individuals with congenital surgical anomalies.

METHODS

We compared infectious events in patients with necrotizing enterocolitis or one of eight congenital surgical anomalies with age-matched controls from the general population. Feeding at discharge was categorized as exclusive breast milk, partial breast milk, or exclusive formula. Outcomes included gastroenteritis, respiratory infections, meningitis, and sepsis. Odds ratios (OR) for each outcome were estimated for cases and controls, and effect modification by case status was assessed.

RESULTS

A total of 1168 cases (165 exclusively breast milk-fed) and 11,648 controls (6084 exclusively breast milk-fed) were included. Among cases, exclusive formula-feeding increased the odds of gastroenteritis (OR = 3.71, p = 0.008) and respiratory infections (OR = 2.04, p = 0.003), but not meningitis or sepsis. Among controls, formula-feeding increased the odds of all outcomes (gastroenteritis: OR = 1.78, respiratory infections: OR = 2.46, meningitis: OR = 4.22, sepsis: OR = 2.84; all p ≤ 0.003). Protective effects of breast milk were greater in controls.

CONCLUSIONS

Exclusive breast milk feeding decreases the odds of long-term infectious disease outcomes, including in individuals with congenital surgical anomalies. These findings underscore the importance of supporting maternal and donor milk programs for vulnerable surgical populations.