Breastfeeding is associated with less severe respiratory syncytial virus (RSV)-associated acute lower respiratory infections (ALRI) and decreased hospitalization among infants, according to a study in BMJ Global Health.

Previous research has suggested that breastfeeding may have a protective effect against RSV infection. Researchers therefore conducted a systematic review to analyze the association of breastfeeding with the frequency and severity of RSV-associated ALRI among infants aged less than 12 months.

The reviewers conducted a literature search in 6 English-language health-related databases for relevant studies published between 2000 and 2021. Eligible studies included infants aged less than 12 months, regardless of gestational age at birth, who developed clinical ALRI with laboratory-confirmed RSV infection after having received either: (1) exclusive or partial breastfeeding, irrespective of duration; (2) their own mother’s milk (at breast or expressed), banked donor human milk, or both. The final analysis included 19 publications that collectively recruited or analyzed the data of infants from 31 countries, including the US.

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An analysis of the research found that, with respect to RSV bronchiolitis: (1) in 5 of the 6 studies reporting incidence rates, RSV bronchiolitis episodes in breastfed infants were significantly lower compared with those in infants who were not breastfed; (2) in a cross-sectional study of 175 infants, breastfeeding for less than 1 month increased the rate of RSV bronchiolitis; and (3) in a retrospective review of 411 infants, breastfeeding was protective against the frequency and severity of RSV bronchiolitis and subsequent development of wheezing.

With respect to hospitalization, the reviewers found: (1) breastfeeding was associated with a decreased risk of hospitalization for polymerase chain reaction-confirmed RSV bronchiolitis in infants in 15 (83.3%) of the 19 studies reviewed; (2) lack of breastfeeding and breastfeeding for less than 2 months were significant risk factors for RSV-related hospital admissions in 9 studies; (3) breastfeeding was significantly associated with a reduced rate of RSV-associated ALRI hospital admissions in 4 studies; and (4) the probability of hospitalization for bronchiolitis was 4% in breastfed infants vs greater than 8% in those who never received breast milk in a multicenter study of 2154 newborns from 30 centers in Italy.

Overall, 18 of the 19 studies suggested that breastfeeding significantly reduced the risk of hospitalization, length of stay, and duration of supplemental oxygen use. In addition, breastfeeding was associated with a decrease in bronchiolitis-associated health care use, including emergency department presentation and intensive care unit admission.

The size and scope of this review were limited by reviewers’ inclusion criteria (ie, using only studies from 2000 to 2021 published in English involving infants aged less than 12 months). Another limitation of this review is the differing interventions related to breastfeeding assessed in the included studies (eg, exclusive breastfeeding for 6 months, exclusive breastfeeding for 4 months, and mixed or combined breast and formula) as well as the varying durations of these interventions.

“With both exclusive and partial breastfeeding benefiting infants who develop RSV-associated ALRI, breastfeeding should be promoted globally as an adjunct primary prevention; in addition to emerging immunoprophylaxis and maternal immunisation strategies,” the review authors concluded.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Mineva GM, Purtill H, Dunne CP, Philip RK. Impact of breastfeeding on the incidence and severity of respiratory syncytial virus (RSV)-associated acute lower respiratory infections in infants: a systematic review highlighting the global relevance of primary prevention. BMJ Glob Health. 2023;8(2):e009693. doi:10.1136/bmjgh-2022-009693

This article originally appeared on Pulmonology Advisor