In the old days there was a massive excess post-neonatal mortality and morbidity in non-breastfed children.  This is still the case in parts of the world where IM is high.  Your observation was made about 90 y ago in a leading paediatric journal, by a doctor in one of the more affluent areas of the USA at a time there was high IM in inner cities from failure to breastfeed.  The solution to this apparent paradox is that it is not the type of milk fed that is relevant, but how the infant was fed.   Specifically, if infants are fed on their backs, from propped bottled for example, food runs into the ear, festers, then runs down into lungs and stomach causing gastroenteritis and pneumonia.

Access to clean, uncontaminated water is also relevant in the context of morbidity and mortality associated to infant feeding. Some authors argue that contamination is relevant to Westernized countries and not only to developing countries. 

There is a section of this document specific to mortality and morbidity associated to breastfeeding and infant-formula feeding:

León-Cava, N., Lutter, C., Ross, J., & Martin, L. (2002). Quantifying the benefits of breastfeeding: a summary of the evidence. Pan American Health Organization, Washington DC.

"Access to clean, uncontaminated water is also relevant in the context of morbidity and mortality associated to infant feeding. Some authors argue that contamination is relevant to Westernized countries and not only to developing countries..."

...and one author says clean water is quite irrelevant to postneonatal infant mortality anywhere!  I have asserted this many years ago in Lancet, Nature and JAMA, and am still awaiting evidence or references to support the role of contaminated water or foods.

Thank you @Anthony G Gordon and @Lynne A. Potvin for your valuable answer. Can anyone explain to me how much necessary this formula milk for the neonate. Best. PALASH

Please refer to WHO and ask for their literature on "Babyfriendly Hospital Initiative". You will find answers on any question relating to breastmilk or formular. Morbidity is higher with formular fed infants due to many reasons, not only contaminated water as such. But also lack of water or lack of money to buy formular in decent amount. Many families cut down on formular amounts and children starve more than breastfed with undernourished mothers. Breastmilk also provides (fresh) antibodies to many infections and last but not the least - more quality proteins for the brain, resulting in higher IQ for about 8 points. I translated the WHO training course material some 20 years ago into German but since not working as a lactation consultant any longer I have lost contact to latest studies or literature. Best of luck!

Dear @Sabine Kuse,

Greetings!

Thank you for shearing your knowledge regarding this issue. I shall go through the WHO literature.

With the best regards

Palash

There is no need to discuss  the superiority of breastmilk over any formulas. 

A mothers milk is the best for her baby, as long as it is available. 

(A fine looking baby at the moment does not mean much since we don't know or cannot predict the long term effects of formulas). 

The differences in nutrient value of breastmilk and infant formula definitely confers immense benefits on  the breastfed child over the formula fed child fed  and therefore reduces morbidity and mortality in the breastfed child. This is particularly true for low income countries where access to the formula may be limited and the child fed mainly on formula is likely to be malnourished and we know that malnutrition is associated with over half of deaths in young children.

In Banglasesh, Physicians are frequently prescribe to the morhers to use formula for baby insted of breast milk. May be it is due to their illigal earning from the Pharmacetuicals company. I want to know from you what is the situation from other countries.

"Morbidity is higher with formular fed infants due to many reasons, not only contaminated water as such."

I assert there is only one reason, the increased likelihood of supine feeding and resultant infections with formula-fed infants.  Occam would have approved this theory, so why is no one taking this seriously, or perhaps more to the point, producing data incompatible with this view?

"The differences in nutrient value of breastmilk and infant formula definitely confers immense benefits on  the breastfed child over the formula fed child fed"  

Primary sources, please, to support this, i.e. studies comparing the outcome of the two types of milk/formula where the method/mode of feeding is exactly comparable.

The constituents of breast milk are so very different from formula milk and breast milk contains lots of extras eg the presence of immunoglobulins, which cannot be replicated in formula milk.

There is a significant body of evidence, which clearly identifies the benefits of breastfeeding for both the mother and the neonate. Perhaps you should go onto the UNICEF Baby Friendly website and review the evidence-base - the medical journal 'The Lancet' in 2016 also identified how breast milk is best for mothers and babies.

Once you have reviewed the evidence, you will see that to compare breast milk with formula milk is like comparing apples and oranges - there is no comparison - breast milk is clearly superior.

Dear @Rowena Doughty

Greetings

Thank you for your valuable comments.

Best regards

Palash

Although your question asks only about neonatal mortality, we also know bottle fed babies have more long term obesity, which leads to increased mortality at a younger age,   and women who breast feed have decreased morbidity and mortality from female cancers. 

Dear @Judy Slome Cohain,

Greetings!

Thanks for the comments. Can you kindly share some literature related to bottole feeding and obesity.

With best regards

Palash

Go to PubMed.com and search : obesity formula fed

Here is the most recent:

Dietary patterns in infancy are associated with child diet and weight outcomes at 6 years.

Rose CM, et al. Int J Obes (Lond). 2017.u

Int J Obes (Lond). 2017 Feb 28. doi: 10.1038/ijo.2017.27. [Epub ahead of print]

Abstract

OBJECTIVE: To assess whether patterns of dietary exposures at 9 months are associated with child diet and weight at 6 years.

METHODS: Data for this study were from the Infant Feeding Practices Study II and Year 6 Follow-Up Studies. All data were self-reported monthly. Results of a previous latent class analysis revealed five dietary patterns varying in milk and solid food intake. These five infant dietary patterns were used in the current study to predict child diet and weight outcomes at 6 years, while controlling for confounding variables.

RESULTS: Infants with dietary patterns higher in fruit and vegetable intake at 9 months had higher fruit and vegetable intake at 6 years. Similarly, infants with the dietary pattern characterized by foods high in energy density (that is, French Fries and sweet desserts) continued to have higher consumption of these foods at 6 years, and had a higher prevalence of overweight at 6 years (43%) compared with the other classes. Formula-fed infants had higher sugar-sweetened beverage intake and fewer met the dietary guidelines for fruit and vegetable intake at 6 years than breastfed infants, controlling for factors such as income.

CONCLUSIONS: Early decisions about milk-feeding, and the types of solid foods offered in infancy can foreshadow dietary patterns and obesity risk later in childhood. Infants who were offered energy-dense foods had higher intake of these foods at 6 years of age

Help

Thank you very much. It is a great help.

"The constituents of breast milk are so very different from formula milk and breast milk contains lots of extras eg the presence of immunoglobulins, which cannot be replicated in formula milk."

     True, but irrelevant unless these advantages can be shown in practice as well as theory..

"There is a significant body of evidence, which clearly identifies the benefits of breastfeeding for both the mother and the neonate. Perhaps you should go onto the UNICEF Baby Friendly website and review the evidence-base - the medical journal 'The Lancet' in 2016 also identified how breast milk is best for mothers and babies."

     Breastfeeding is clearly superior to the alternatives, especially under adverse conditions.  It does not follow that this is because breast milk is superior to alternative foods.

"Once you have reviewed the evidence, you will see that to compare breast milk with formula milk is like comparing apples and oranges - there is no comparison - breast milk is clearly superior."..

     ...so we don't need to test this out??

Thank you...

can any one kindly explain, how early initiation of breast helps to reduce neonatal mortality and morbidity?

Hi Palash,

There are two recent review studies that I think are relevant to your questions here.

First, 2016 Lancet study Victora et al http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2901024-7/abstract

This study finds that "The scaling up of breastfeeding to a near universal level could prevent 823 000 annual deaths in children younger than 5 years". It protects from death through a range of mechanisms, including short term such as reducing diahhorea and infections, and long term such as reducing obesity and non-infectious diseases including diabetes.

The second study worth reading is Khan et al 2015 https://www.ncbi.nlm.nih.gov/pubmed/24894730

Khan and colleagues systematically reviewed the evidence on timing of initiation of breastfeeding and they found that initiating breastfeeding later than the first hour of birth doubled the risk of neonatal mortality. They estimate that a fifth of all neonatal deaths could be prevented if breastfeeding were initiated within the first hour of birth for all babies.

Again the mechanisms for this benefit are complex. Among other things, early initiation of breastfeeding ensures babies receive colostrum, the first milk, which is dense in immune factors and is a thick fluid which coats the GI tract improving immunity early and life long. Also, early initiation of breastfeeding leads to better breastfeeding outcomes long term, such as greater milk volumes and longer duration of breastfeeding.

I hope this helps.

Kai

@Anthony G Gordon,

It is possible that bottle feeding position has an effect on infant morbiditity, particularly otitis media which is higher among formula fed than breast fed infants (though this may be due to the sucking mechanism of bottles which is different to at breast - this is not known).

However, you assert that clean water has no impact on neonatal mortality in formula fed infants, only feeding position. If this were true then we would expect to see the same rates of neonatal deaths among formula fed infants everywhere in the world, regardless of the access to clean water because as far as I know, nowhere has a regime of publicly promoting upright formula feeding. This is not the case. Formula fed infants in parts of the world without easy access to clean drinking waters, and post disasters are at far greater risk of GI infections than formula fed babies where clean water is accessible.

Dear Kai,

Greetings!

Thank you for shearing the useful link.

Best regards

Palash

"If this were true then we would expect to see the same rates of neonatal deaths among formula fed infants everywhere in the world, regardless of the access to clean water because as far as I know, nowhere has a regime of publicly promoting upright formula feeding."

  This assumes, incorrectly I think, that there are no differences in likelihood of supine feeding over time and place.  I think this is less common nowadays, as mothers have generally more time and energy to spend on infant feeding.   This could explain why some modern studies in developed countries now fail to find increased post-neonatal infections or lower IQ in the non-breastfed.   I think this was the point of the original question.

  The clearest illustration of this point is the case of old style infant institutions or foundling homes where the hygiene was often far better that in surrounding slums, yet infant mortality could be as high as 90%.  Staff were often of high quality, but in very short supply, hence supine feeding from propped bottles was standard and infants lay on their backs for long periods.

At the start of last century William Howarth, Medical Officer of Health, instituted a prospective study of feeding and mortality in over 9000 infants (Lancet 1905;2:211).  His conclusions have stood the test of time:

Thank you Sir @Anthony G Gordon, for your kind and informative information. I am very much delighted.

With the best regards

Palash

Can any expert kindly clear me that how early initiation and exclusive breast feeding help to reduce neonatal morbidity and mortality?  Some time in Bangladesh family members are use some other food first rather then breast milk like, honey, water etc. Thats why clostrum to baby not possible in time, can you tell me in this situation will early initiation and breast milk will work?

"Can any expert kindly clear me that how early initiation and exclusive breast feeding help to reduce neonatal morbidity and mortality?"

I am no expert, but do not recall from checking the old but extensive epidemiological data that breastfeeding has much effect on neonatal mortality.  Non-breastfeeding has, or at least had, large and well-documented detrimental effects on post-neonatal mortality.   Modern data is virtually useless since all the well-established old distinctions between mortality at different ages are now forgotten, and Under-5 mortality is considered a homogeneous lump.