Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
Clin Infect Dis. 2011 Aug;53(4):388-95. doi: 10.1093/cid/cir413.
We assessed morbidity rates during short intervals that accompanied weaning and cumulative mortality among HIV-exposed, uninfected infants enrolled in the postexposure prophylaxis of infants in Malawi (PEPI-Malawi) trial.
Women were counseled to stop breastfeeding (BF) by 6 months in the PEPI-Malawi trial. HIV-uninfected infants were included in this analysis starting at age 6 months. Breastfeeding and morbidity (illness and/or hospital admission and malnutrition [weight-for-age Z-score, ≤2]) were assessed during age intervals of 6-9, 9-12, and 12-15 months. BF was defined as any BF at the start and end of the interval and no breastfeeding (NBF) was defined as NBF at any time during the interval. The association of NBF with morbidity at each mutually exclusive interval was assessed using Poisson regression models controlling for other factors. Cumulative mortality among infants aged 6-15 months with BF and NBF was assessed using an extended Kaplan-Meier method.
At age 6 months, 1761 HIV-uninfected infants were included in the study. The adjusted rate ratios for illnesses and/or hospital admission for NBF, compared with BF, was 1.7 (P < .0001) at 6-9 months, 1.66 (P = .0001) at 9-12 months, and 1.75 (P = .0008) at 12-15 months. The rates of morbidity were consistently higher among NBF infants during each age interval, compared with BF infants. The 15 months cumulative mortality among BF and NBF children was 3.5% and 6.4% (P = .03), respectively.
Cessation of BF is associated with acute morbidity events and cumulative mortality. Prolonged BF should be encouraged, in addition to close monitoring of infant health and provision of support services.
我们评估了在马拉维婴儿暴露后预防试验（PEPI-Malawi）中接受暴露后预防的无感染艾滋病毒婴儿中，伴随断奶的短期间隔内发病率和累积死亡率。
在 PEPI-Malawi 试验中，建议妇女在 6 个月时停止母乳喂养（BF）。本分析纳入了从 6 个月龄开始的 HIV 未感染婴儿。在 6-9、9-12 和 12-15 个月的年龄间隔内评估母乳喂养和发病率（疾病和/或住院和营养不良[体重年龄 Z 评分，≤2]）。BF 定义为间隔开始和结束时的任何 BF，NBF 定义为间隔内任何时间的 NBF。使用泊松回归模型控制其他因素，评估 NBF 与每个互斥间隔发病率的相关性。使用扩展的 Kaplan-Meier 方法评估 6-15 个月龄有 BF 和 NBF 的婴儿的累积死亡率。
在 6 个月时，1761 名 HIV 未感染婴儿纳入研究。与 BF 相比，NBF 在 6-9 个月、9-12 个月和 12-15 个月的疾病和/或住院的调整率比分别为 1.7（P<0.0001）、1.66（P=0.0001）和 1.75（P=0.0008）。与 BF 婴儿相比，NBF 婴儿在每个年龄间隔内的发病率均较高。BF 和 NBF 儿童的 15 个月累积死亡率分别为 3.5%和 6.4%（P=0.03）。
停止 BF 与急性发病事件和累积死亡率相关。应鼓励延长 BF，并密切监测婴儿健康状况和提供支持服务。
