Table 3. Summary of findings regarding the association between delayed breastfeeding association and neonatal mortality.
| Outcome | Population | Illustrative comparative risks (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE)3 | ||
|---|---|---|---|---|---|---|---|
| Assumed risk1 Early Breastfeeding |
Corresponding risk2 Delayed Breastfeeding |
||||||
| Neonatal Mortality | All infants, who ever initiated breastfeeding, surviving 2–4 days | 2–23 Hours: | High4 | ||||
| 6.9 per 1000 | (2–23 Hours): | ||||||
| <1 Hour: | (5.9 to 8.1) | 1.33 (1.13–1.56) | 136,047 | ||||
| 5.2 per 1000 | (5 studies) | ||||||
| >24 Hours: | (>24 Hours): | ||||||
| 11.4 per 1000 | 2.19 (1.73–2.77) | ||||||
| (9.0 to 14.4) | |||||||
| All infants, who ever initiated breastfeeding, surviving 2–4 days | <24 Hours: | ≥24 Hours: | 142,729 | Moderate5 | |||
| 7.7 per 1000 | 13.1 per 1000 | 1.70 (1.44–2.01) | (6 studies) | ||||
| (11.1 to 15.5) | |||||||
| Exclusively breastfeeding infants, who ever initiated breastfeeding, surviving 2–4 days | <24 Hours: | ≥24 Hours: | 65,215 | Moderate5 | |||
| 6.9 per 1000 | 12.4 per 1000 | 1.85 (1.29–2.67) | (4 studies) | ||||
| (8.9 to 18.4) | |||||||
| Low birthweight infants, who ever initiated breastfeeding, surviving 2–4 days |
<24 Hours: | ≥24 Hours: | 1.73 (1.38–2.18) | 21,258 | Moderate5 | ||
1 The assumed risk is the median risk in the 'early breastfeeding' group across all studies providing this information.
2 The corresponding risk is based on the assumed risk in the 'early breastfeeding' group and the relative effect of the intervention (and its 95% confidence interval).
3 GRADE Working Group grades of evidence description [17]: High quality: Further research is very unlikely to change our confidence in the estimate of effect.; Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.; Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.; Very low quality: We are very uncertain about the estimate.
4 All five studies are categorized as having a moderate risk of bias, but the overall strength of evidence is upgrade to 'High' because the studies are consistent, there is a large effect size (RR >2), and there is evidence dose response.
5 All studies are categorized as having a moderate risk of bias. There is no evidence of dose response (due to study design) and there is no large effect size