Infants in the complementary Regorafenib chemical structure food group crawled later than those that were exclusively breastfed from 4 to 6 months (P = .007). Among normal birth weight infants, those who were randomized to complementary foods before 6 months were less likely to be walking at 12 months (39 vs 60%; P = .02). Kramer and colleagues33 similarly found differences in neurodevelopment with shorter breastfeeding in the PROBIT study. At age 6.5 years, verbal IQ scores were 7.5 points lower (95% CI, ?0.8 to ?14.3) among children in the usual care group than among children in the breastfeeding support group. Kramer��s results suggest that hospital policies that support breastfeeding can impact neurodevelopment at school age.

These studies were conducted prior to use of formula supplemented with long-chain polyunsaturated fatty acids (LCPUFA), which had been added to infant formula with the goal of improving neurocognitive outcomes. However, a recent Cochrane meta-analysis concluded that most well-conducted randomized trials showed no benefit of LCPUFA versus control formula on visual acuity or neurodevelopment among term infants.34 These findings make it unlikely that LCPUFA-supplemented formula would reduce the differences in outcomes between children in intervention and control groups in these studies. SIDS Case-control studies suggest that formula feeding is associated with a 1.6-(95% CI, 1.2�C2.3)1 to 2.1-fold (95% CI, 1.7�C2.7)35 increased odds of SIDS compared with breastfeeding. These associations persisted after adjustment for sleeping position, maternal smoking, and socioeconomic status.

In reviewing the evidence, the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome concluded that factors associated with breastfeeding, but not breastfeeding per se, were associated with a lower incidence of SIDS.36 Infant Mortality After adjusting for maternal age, education, smoking status, infant race, gender, birth weight, congenital malformation, birth order, plurality, and Women, Infants and Children Nutrition Program status, formula feeding is associated with a 1.3-fold (95% CI, 1.1�C1.5) higher risk of infant mortality in the United States compared with ever breastfeeding.37 In a subgroup analysis, the association was limited to SIDS and injury-related death. Role of Exclusive Breastfeeding in Infant Health Outcomes Early feeding plays a central role in development and maturation of the infant immune system.

Compared with human milk-fed infants, formulafed infants have higher pH stools and greater colonization with pathogenic bacteria, including Dacomitinib E coli, Clostridium difficile, and Bacteroides fragilis.38 Bioactive factors in human milk appear to facilitate the more favorable gut colonization in breastfed infants. These oligosaccharides, cytokines, and immunoglobulins regulate gut colonization and development of gut-associated lymphoid tissue and govern differentiation of T cells that play a role in host defense and tolerance.