Impact of breastfeeding on ICU admissions and need for mechanical ventilation in infants younger than 6 months with RSV+ bronchiolitis. An observational study

Call to include breastfeeding as a synergistic approach to vaccines for prevention of respiratory syncytial virus disease

BACKGROUND

Infections with respiratory syncytial virus (RSV) in infancy and early childhood are very common. RSV is the leading cause of bronchiolitis and pneumonia and substantially contributes to the morbidity and mortality of infants and young children worldwide. Until very recently, there have been no vaccines available for prevention and there are no curative treatments for RSV. Two novel pharmaceutical approaches for RSV prevention became available in 2024 namely immunization of mothers during pregnancy and immunoprophylaxis of infants. Since then, a series of scientific papers as well as national and international guidance have been published to encourage parents to vaccinate themselves or their children. Despite strong evidence that breastfeeding is an important non-pharmacological approach for prevention of severe RSV outcomes, recent scientific papers and public health communications have neglected breastfeeding as a core RSV-preventive strategy. This commentary highlights epidemiological evidence of the protective effects of breastfeeding as a key non-pharmacological intervention, discussing its synergistic role in RSV prevention and supportive role in the care of sick infants.

BREASTFEEDING AND RSV

Breastfeeding has been shown to reduce the rate and severity of RSV-associated outcomes, including hospitalization and mortality. While exclusive breastfeeding is most protective, even one month of breastfeeding was associated with a reduced likelihood of Intensive Care Unit admission and the need of mechanical ventilation in RSV-infected infants. The benefits of breastfeeding for RSV prevention and supportive care have been demonstrated in epidemiological studies in low-, middle- and high-income settings and are especially important for small, premature and sick infants.

CONCLUSION

Breastfeeding is an overlooked sustainable strategy for the universal prevention of severe outcomes and serves as supportive care of RSV-associated disease in infancy, especially in vulnerable population groups. Breastfeeding should be encouraged alongside vaccines in all public health communication, by health providers during pre- and postnatal immunization visits and during infant check-ups. Further, the role of breastfeeding as supportive care of RSV-infected and critically-ill infants should not be overlooked.