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Association between exclusive maternal breastfeeding during the first 4 months of life and primary enuresis

By D.M. de Oliveira, P. Dahan, D.F. Ferreira, L.F. de Oliveira, L.I.D.S. de Paula, A.A. de Figueiredo, J. de Bessa, and J.M. Bastos Netto

Journal of Pediatric Urology, November 20, 2014, Article in press

Editor's comments:
The title of this publication caught our attention as it is, to be honest, not the first thing to think about, not the first thing to study: the association between the incidence of enuresis and the duration of breastfeeding. The authors have studied 200 children, 100 with nocturnal enuresis and 100 dry children. The number of study patients was calculated using a statistical power calculation, considering a 25% difference between the two groups. The authors have found that 72% of the enuretic children were breastfed for less than 3 months and 28% for more than 3 months; in the control group, however, “only” 42% were breastfed for less than 3 months and 58% for more than 3 months. Enuretic children also had more siblings, a positive family history and parents with a low education level. Several hypotheses are put forward, for example, that breastfeeding has beneficial effects on neurological development and cognitive function as well as the interaction with the mother. However, the mechanism still remains unclear.

This study is interesting as one can prove a lot with statistics and I hope that this finding can be repeated in another country and maybe in a larger cohort.

Summary      

Introduction

Although the relationship between enuresis and breastfeeding is still poorly documented in the literature, a possible association is speculated as both are strongly associated with children's development. Therefore, the main objective of this study was to evaluate whether there is an association between primary enuresis and the duration of exclusive breastfeeding.

Material and methods

This is an observational, case-control study, involving 200 children and adolescents from 6 to 14 years old, who were divided into two groups: the enuresis group (EG), composed of 100 children with primary enuresis; and the control group (CG) of 100 matched children without enuresis. The matching criteria were sex, age, and socioeconomic level. Adults responsible for each infant answered a structured questionnaire to identify biological and behavioral factor, as well as the duration of maternal breastfeeding. Children whose parents could not comprehend the questionnaire or children with neurological or psychiatric disorders or secondary enuresis were not included in the study.

Results and discussion

Evaluating the duration of exclusive breastfeeding, 72% of the subjects of the EG and 42% of the CG had been breastfed for less than 4 months (p < 0.001) (Figure). In bivariate analysis, there was a strong association between symptoms of enuresis with a positive family history of enuresis and duration of exclusive breastfeeding (p < 0.001), and also association with full breastfeeding duration (p = 0.044), number of children (p = 0.045), and parents' education (p = 0.045). After logistic regression, primary enuresis continued to be associated with duration of exclusive breastfeeding and family history of enuresis. The proportion of children that had been exclusively breastfed for more than 4 months was significantly higher in the CG 58% (58/100) than in the EG 28% (28/100) (p < 0.001, OR 4.35, 95% CI 1.99–9.50).

Conclusions

This study confirmed the association between primary enuresis and various factors that have already been studied, with the addition of a new factor, duration of exclusive breastfeeding for less than 4 months, which is strongly associated with primary enuresis.

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