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The protective effect of breastfeeding on febrile seizures: a systematic review with meta-analysis

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Abstract

Several potential risk factors have been identified in the etiopathogenesis of febrile seizures (FS), including the type and extent of breastfeeding (BF). Given the lack of conclusive data, this study aims to systematically evaluate the evidence on the association between BF and FS. We conducted a systematic review and meta-analysis according to PRISMA guidelines. The search was conducted using descriptors for FS, BF, and formula feeding in MEDLINE, Embase, and Web of Science databases. We included observational studies that compared the incidence of FS between those who had ever breastfed and those who were formula fed. The study protocol was registered on the PROSPERO platform under the number CRD42023474906. A total of 1,893,079 participants from 8 datasets were included. Our main analysis showed no significant association of any type of BF on the incidence of FS compared with formula-fed children (OR: 0.84; CI: 0.67–1.04; I2 = 78%; Cochran’s Q = 0.0001), although meta-regression showed that BF was associated with a lower incidence of FS in preterm infants. Our secondary outcome showed a significantly reduced incidence of FS in children who received BF exclusively (OR: 0.80; CI: 0.65–0.99; I2 = 70%; Cochran’s Q = 0.02).

    Conclusion: There was no significant reduction in the incidence of FS in those who were breastfed compared to formula feeding. However, our meta-regression analysis indicated an association between BF and a lower incidence of FS in preterm infants. Additionally, children who exclusively received BF had a significantly reduced incidence of FS. These findings should be further investigated in prospective cohorts.

What is Known:

• Breastfeeding can modify risk factors for febrile seizures, such as susceptibility to viral and bacterial infections, micronutrient deficiencies, and low birth weight.

• However, studies have shown conflicting results regarding the impact of breastfeeding on febrile seizures.

What is New:

• When comparing any breastfeeding pattern with no breastfeeding, there is no significant difference in the incidence of febrile seizures.

• When comparing exclusive breastfeeding with no breastfeeding, there may be a decrease in the occurrence of febrile seizures.

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Data availability

This meta-analysis only includes data from previously published research that is available in the public domain. The authors of this meta-analysis did not have access to patient-level data from the individual studies. Researchers who are interested in individual-level data from the studies included in this meta-analysis can contact the corresponding author of each study to make such requests. For any clarifications regarding this article analysis, researchers may contact our corresponding author.

Abbreviations

AAP:

American Academy of Pediatrics

BF:

Breastfeeding

CNS:

Central nervous system

FS:

Febrile seizure

MEDLINE:

Medical Literature Analysis and Retrieval System Online

NOS:

Newcastle‒Ottawa Scale

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

UNICEF:

United Nations Children’s Fund

WHO:

World Health Organization

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Acknowledgements

The other authors of the manuscript thank Dr. Ana Nery for her professional and inspiring approach to practicing medicine and teaching pediatrics. We would like to express our gratitude to Mr. Gordon Philip Cox for his valuable feedback on the manuscript.

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Authors and Affiliations

  1. Department of Medicine, University of Fortaleza, Av. Washington Soares, 1321 - Edson Queiroz, Fortaleza - CE, Ceara, 60811-905, Brazil

    Maria Carolina Rocha Muniz, Rian Vilar Lima, Víctor Queirós Calheiros Campelo Maia, Arthur Meneses Bezerra, Isabela Franco Freire, Manuela Cavalcante Coling Lima, Yuri Marques Teixeira Matos, Letícia Pinheiro Pontes & Ana Nery Melo Cavalcante

  2. PhD in Collective Health By the University of Fortaleza, Neonatologist Pediatrician at Dr. César Cals de Oliveira General Hospital, Fortaleza, Ceara, Brazil

    Ana Nery Melo Cavalcante

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  1. Maria Carolina Rocha Muniz
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Contributions

All authors contributed to the study conception and design. R. V. L. drafted the first version of the manuscript; M. C. R. M. wrote the final version of the manuscript; V. Q. C. C. M., A. M. B., I. F. F., M. C. C. L., Y. M. T. M., and L. P. P. performed the literature search and data analysis; and A. N. M. C. critically revised the manuscript. All authors reviewed and approved the final manuscript.

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Correspondence to Rian Vilar Lima.

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Muniz, M.C.R., Lima, R.V., Maia, V.Q.C.C. et al. The protective effect of breastfeeding on febrile seizures: a systematic review with meta-analysis. Eur J Pediatr 183, 2049–2058 (2024). https://doi.org/10.1007/s00431-024-05501-x

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