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Centre Hospitalier Universitaire - 4, rue Larrey- 49933 Angers Cedex 9, France.
Arch Pediatr. 2024 Oct;31(7):426-432. doi: 10.1016/j.arcped.2024.05.004. Epub 2024 Oct 2.
Acute bronchiolitis affects around 30 % of infants each winter in France. Breastfeeding (BF) is described as being protective against acute lower respiratory infections in developing countries, but this effect is more difficult to demonstrate in industrialized countries. Moreover, the effect of using a pacifier in the occurrence of bronchiolitis is not clearly established. In this context, the aim of the study was to investigate the link between BF and the use of a pacifier in the occurrence of bronchiolitis in children under 1 year of age who presented to five pediatric emergency centers in Pays de la Loire, France.
A questionnaire collecting data on diet, sociodemographic characteristics, and the reason for presentation was provided at the admission to pediatric emergency centers in five hospitals in Pays de Loire, France, between 2018 and 2020. Children with bronchiolitis were included in group 1, and children consulting for other reasons (except gastrointestinal infections or otitis) were included in group 2. Breastfeeding was classified as exclusive breastfeeding (EBF) and partial breastfeeding (PBF). Pacifier use was classified as frequent and during sleep or not used.
The study included 671 children under 1 year of age, including 174 (25.8 %) who were admitted with bronchiolitis. In univariate analysis, a significantly smaller number of children in group 1 s were breastfed (EBF and PBF) at admission compared with children in group 2:21.8 % versus 32.8 %, respectively, (OR=0.57, 95 % CI: 0.38-0.86, p = 0.006); furthermore, children in group 1 used a pacifier more often than those in group 2: 84.5 % versus 75.8 % (OR=1.74, 95 % CI: 1.10-2.76, p = 0.017). In multivariate analysis, after adjusting for age, ongoing BF or EBF beyond 9 and 12 months of age remained a protective factor; however, the protective effect of BF disappeared with the introduction of a pacifier, and pacifier use was significantly associated with bronchiolitis.
The protective effect of BF against bronchiolitis was demonstrated independently of pacifier use. However, due to the strong association between pacifier use and bronchiolitis, the effect of BF weakened. The advice to be given to parents for BF and pacifier use is discussed.
在法国，每年冬季约有 30%的婴儿会患急性细支气管炎。母乳喂养（BF）被描述为对发展中国家急性下呼吸道感染具有保护作用，但在工业化国家，这种作用更难证明。此外，使用奶嘴在细支气管炎发生中的作用尚未明确。在这种情况下，该研究的目的是调查法国卢瓦尔河地区五个儿科急救中心收治的 1 岁以下儿童中 BF 和使用奶嘴与细支气管炎发生之间的关系。
在 2018 年至 2020 年期间，在法国卢瓦尔河地区的五家医院的儿科急救中心提供了一份收集饮食、社会人口特征和就诊原因数据的问卷。患有细支气管炎的儿童被纳入第 1 组，因其他原因就诊的儿童（除胃肠道感染或中耳炎）被纳入第 2 组。母乳喂养被分为纯母乳喂养（EBF）和部分母乳喂养（PBF）。奶嘴使用被分为频繁使用和睡眠时使用或不使用。
该研究纳入了 671 名 1 岁以下的儿童，其中 174 名（25.8%）因细支气管炎住院。在单因素分析中，第 1 组中接受母乳喂养（EBF 和 PBF）的儿童比例明显低于第 2 组：分别为 21.8%和 32.8%（OR=0.57，95%CI：0.38-0.86，p=0.006）；此外，第 1 组中使用奶嘴的儿童比第 2 组更频繁：84.5%比 75.8%（OR=1.74，95%CI：1.10-2.76，p=0.017）。在多因素分析中，在校正年龄后，9 个月和 12 个月后持续母乳喂养或 EBF 仍然是一个保护因素；然而，随着奶嘴的引入，BF 的保护作用消失了，奶嘴的使用与细支气管炎显著相关。
BF 对细支气管炎的保护作用是独立于奶嘴使用的。然而，由于奶嘴使用与细支气管炎之间的强烈关联，BF 的作用减弱了。讨论了应向父母提供的关于 BF 和奶嘴使用的建议。
