Impact of Breastfeeding Duration on Adenoid Hypertrophy, Snoring and Acute Otitis Media: A Case-Control Study in Preschool Children
Abstract
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
FNE | flexible nasopharyngoscopy examination |
A/C ratio | adenoid-to-choanae ratio |
MASNA | mucus of adenoid scale by nasopharyngoscopy assessment |
rURTI | recurrent upper respiratory tract infections |
ICSD-3 | International Classification of Sleep Disorders |
AOM | acute otitis media |
BDM | breast-derived microbiota |
References
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Characteristic | All Patients (n = 145) | Breastfeeding Groups | p Value | ||
---|---|---|---|---|---|
≥6 Months (n = 100) | <6 Months (n = 45) | ||||
Age (years) | mean ± SD | 3.9 ± 0.8 | 3.9 ± 0.8 | 3.9 ± 0.8 | 0.981 |
Gender | female | 60 (41.4%) | 41 (41.0%) | 19 (42.2%) | 0.890 |
male | 85 (58.6%) | 59 (59.0%) | 26 (57.8%) | ||
Breastfeeding (months) | mean ± SD | 13.0 ± 11.2 | |||
0–3 | 26 (17.9%) | - | - | - | |
3–6 | 14 (9.7%) | ||||
6–12 | 31 (21.4%) | ||||
12–18 | 21 (14.5%) | ||||
18–24 | 16 (11.0%) | ||||
>24 | 37 (25.5%) | ||||
Adenoid size (A/C ratio, %) | mean ± SD | 65.3 ± 18.8 | 64.4 ± 19.0 | 67.3 ± 18.5 | |
<75 | 90 (62.1%) | 66 (66.0%) | 24 (53.3%) | 0.146 | |
≥75 | 55 (37.9%) | 34 (34.0%) | 21 (46.7%) | ||
Adenoid mucus coverage (MASNA scale) | 0 | 40 (27.6%) | 27 (27.0%) | 13 (28.9%) | 0.615 |
1 | 36 (24.8%) | 28 (28.0%) | 8 (17.8%) | ||
2 | 40 (27.6%) | 26 (26.0%) | 14 (31.1%) | ||
3 | 29 (20.0%) | 19 (19.0%) | 10 (22.2%) | ||
0 | 40 (27.6%) | 27 (27.0%) | 13 (28.9%) | 0.814 | |
1–3 | 105 (72.4%) | 73 (73.0%) | 32 (71.1%) | ||
Tympanogram | AA | 65 (44.8%) | 48 (48.0%) | 17 (37.8%) | 0.602 |
AB/BA | 6 (4.1%) | 5 (5.0%) | 1 (2.2%) | ||
AC/CA | 15 (10.3%) | 10 (10.0%) | 5 (11.1%) | ||
BB | 34 (23.4%) | 23 (23.0%) | 11 (24.4%) | ||
BC/CB | 6 (4.1%) | 4 (4.0%) | 2 (4.4%) | ||
CC | 19 (13.1%) | 10 (10.0%) | 9 (20.0%) | ||
A | 65 (44.8%) | 48 (48.0%) | 17 (37.8%) | 0.306 | |
B | 46 (31.7%) | 32 (32.0%) | 14 (31.1%) | ||
C | 34 (23.4%) | 20 (20.0%) | 14 (31.1%) | ||
Allergy | yes | 24 (16.6%) | 14 (14.0%) | 10 (22.2%) | 0.137 |
no | 25 (17.2%) | 21 (21.0%) | 4 (8.9%) | ||
not tested | 96 (66.2%) | 65 (65.0%) | 31 (68.9%) | ||
Snoring | yes | 106 (73.1%) | 68 (68.0%) | 38 (84.4%) | 0.039 |
no | 39 (26.9%) | 32 (32.0%) | 7 (15.6%) | ||
Sleeping with an open mouth | yes | 72 (49.7%) | 53 (53.0%) | 19 (42.2%) | 0.394 |
periodic | 50 (34.5%) | 31 (31.0%) | 19 (42.2%) | ||
no | 23 (15.9%) | 16 (16.0%) | 7 (15.6%) | ||
Hypoacusis (stated by parents) | yes | 35 (24.3%) | 25 (25.3%) | 10 (22.2%) | 0.579 |
periodic | 25 (17.4%) | 15 (15.2%) | 10 (22.2%) | ||
no | 84 (58.3%) | 59 (59.6%) | 25 (55.6%) | ||
History of acute otitis media | yes | 84 (57.9) | 50 (50.0%) | 11 (24.4%) | 0.004 |
no | 61 (42.1%) | 50 (50.0%) | 34 (75.6%) | ||
rURTIs | yes | 120 (82.8%) | 83 (83.0%) | 37 (82.2%) | 0.909 |
no | 25 (17.2%) | 17 (17.0%) | 8 (17.8%) | ||
Rhinitis (weeks in a month) | mean ± SD | 1.8 ± 1.0 | 1.9 ± 1.0 | 1.6 ± 0.9 | 0.072 |
Cough | yes | 48 (33.1%) | 37 (37.0%) | 11 (24.4%) | 0.237 |
no | 97 (66.9%) | 63 (63.0%) | 34 (75.6%) | ||
Blocked nose | yes | 11 (7.6%) | 7 (7.0%) | 4 (8.9%) | 0.739 |
no | 134 (92.4%) | 93 (93.0%) | 41 (91.1%) |
Characteristic | History of Acute Otitis Media | p Value | Snoring | p Value | |||
---|---|---|---|---|---|---|---|
Yes (n = 84) | No (n = 61) | Yes (n = 106) | No (n = 39) | ||||
Age (years) | mean ± SD | 4.0 ± 0.8 | 3.8 ± 0.9 | 0.345 | 4.0 ± 0.8 | 3.8 ± 0.8 | 0.211 |
Gender | female | 41 (48.8%) | 19 (31.1%) | 0.033 | 46 (43.4%) | 14 (35.9%) | 0.416 |
male | 43 (51.2%) | 42 (68.9%) | 60 (56.6%) | 25 (64.1%) | |||
Breastfeeding (months) | mean ± SD | 11.8 ± 11.5 | 14.8 ± 10.5 | 0.107 | 12.5 ± 11.3 | 14.6 ± 10.7 | 0.318 |
≥1 | 66 (78.6%) | 57 (93.4%) | 0.018 | 87 (82.1%) | 36 (92.3%) | 0.128 | |
<1 | 18 (21.4%) | 4 (6.6%) | 19 (17.9%) | 3 (7.7%) | |||
≥3 | 59 (70.2%) | 55 (90.2%) | 0.004 | 78 (73.6%) | 36 (92.3%) | 0.021 | |
<3 | 25 (29.8%) | 6 (9.8%) | 28 (26.4%) | 3 (7.7%) | |||
≥6 | 50 (59.5%) | 50 (82.0%) | 0.004 | 68 (64.2%) | 32 (82.1%) | 0.039 | |
<6 | 34 (40.5%) | 11 (18.0%) | 38 (35.8%) | 7 (17.9%) | |||
≥12 | 38 (45.2%) | 33 (54.1%) | 0.292 | 49 (46.2%) | 22 (56.4%) | 0.277 | |
<12 | 46 (54.8%) | 28 (45.9%) | 57 (53.8%) | 17 (43.6%) | |||
≥24 | 18 (21.4%) | 19 (31.1%) | 0.185 | 26 (24.5%) | 11 (28.2%) | 0.652 | |
<24 | 66 (78.6%) | 42 (68.9%) | 80 (75.5%) | 28 (71.8%) | |||
Mother’s milk feeding | mean ± SD | 12.3 ± 11.2 | 15.0 ± 10.3 | 0.139 | 12.9 ± 11.0 | 14.9 ± 10.5 | 0.329 |
≥1 | 71 (84.5%) | 58 (95.1%) | 0.060 | 87 (82.1%) | 36 (92.3%) | 0.236 | |
<1 | 13 (15.5%) | 3 (4.9%) | 19 (17.9%) | 3 (7.7%) | |||
≥3 | 63 (75.0%) | 56 (91.8%) | 0.009 | 78 (73.6%) | 36 (92.3%) | 0.014 | |
<3 | 21 (25.0%) | 5 (8.2%) | 28 (26.4%) | 3 (7.7%) | |||
≥6 | 54 (64.3%) | 51 (83.6%) | 0.010 | 68 (64.2%) | 32 (82.1%) | 0.059 | |
<6 | 30 (35.7%) | 10 (16.4%) | 38 (35.8%) | 7 (17.9%) | |||
≥12 | 40 (47.6%) | 34 (55.7%) | 0.334 | 49 (46.2%) | 22 (56.4%) | 0.246 | |
<12 | 44 (52.4%) | 27 (44.3%) | 57 (53.8%) | 17 (43.6%) | |||
≥24 | 18 (21.4%) | 19 (31.1%) | 0.185 | 26 (24.5%) | 11 (28.2%) | 0.652 | |
<24 | 66 (78.6%) | 42 (68.9%) | 80 (75.5%) | 28 (71.8%) | |||
Adenoid size (A/C ratio, %) | mean ± SD | 66.6 ± 19.0 | 63.4 ± 18.6 | 0.320 | 68.2 ± 18.7 | 57.4 ± 17.2 | 0.002 |
<75 | 47 (56.0%) | 43 (70.5%) | 0.075 | 56 (52.8%) | 34 (87.2%) | <0.001 | |
≥75 | 37 (44.0%) | 18 (29.5%) | 50 (47.2%) | 5 (12.8%) | |||
Adenoid mucus coverage (MASNA scale) | 0 | 22 (26.2%) | 18 (29.5%) | 0.888 | 23 (21.7%) | 17 (43.6%) | 0.060 |
1 | 22 (26.2%) | 14 (23.0%) | 29 (27.4%) | 7 (17.9%) | |||
2 | 22 (26.2%) | 18 (29.5%) | 30 (28.3%) | 10 (25.6%) | |||
3 | 18 (21.4%) | 11 (18.0%) | 24 (22.6%) | 5 (12.8%) | |||
0 | 22 (26.2%) | 18 (29.5%) | 0.659 | 23 (21.7%) | 17 (43.6%) | 0.009 | |
1–3 | 62 (73.8%) | 43 (70.5%) | 83 (78.3%) | 22 (56.4%) | |||
Tympanogram | AA | 29 (34.5%) | 36 (59.0%) | 0.054 | 50 (47.2%) | 15 (38.5%) | 0.486 |
AB/BA | 3 (3.6%) | 3 (4.9%) | 3 (2.8%) | 3 (7.7%) | |||
AC/CA | 9 (10.7%) | 6 (9.8%) | 11 (10.4%) | 4 (10.3%) | |||
BB | 25 (29.8%) | 9 (14.8%) | 26 (24.5%) | 8 (20.5%) | |||
BC/CB | 5 (6.0%) | 1 (1.6%) | 3 (2.8%) | 3 (7.7%) | |||
CC | 13 (15.5%) | 6 (9.8%) | 13 (12.3%) | 6 (15.4%) | |||
A | 29 (34.5%) | 36 (59.0%) | 0.011 | 50 (47.2%) | 15 (38.5%) | 0.643 | |
B | 33 (39.3%) | 13 (21.3%) | 32 (30.2%) | 14 (35.9%) | |||
C | 22 (26.2%) | 12 (19.7%) | 24 (22.6%) | 10 (25.6%) | |||
Allergy | yes | 15 (17.9%) | 9 (14.8%) | 0.295 | 17 (16.0%) | 7 (17.9%) | 0.402 |
no | 11 (13.1%) | 14 (23.0%) | 21 (19.8%) | 4 (10.3%) | |||
not tested | 58 (69.0%) | 38 (62.3%) | 68 (64.2%) | 28 (71.8%) | |||
Sleeping with an open mouth | yes | 44 (52.4%) | 28 (45.9%) | 0.709 | 61 (57.5%) | 11 (28.2%) | <0.001 |
periodic | 28 (33.3%) | 22 (36.1%) | 37 (34.9%) | 13 (33.3%) | |||
no | 12 (14.3%) | 11 (18.0%) | 8 (7.5%) | 15 (38.5%) | |||
Hypoacusis (stated by parents) | yes | 24 (28.9%) | 11 (18.0%) | 0.315 | 26 (24.8%) | 9 (23.1%) | 0.830 |
periodic | 14 (16.9%) | 11 (18.0%) | 17 (16.2%) | 8 (20.5%) | |||
no | 45 (54.2%) | 39 (63.9%) | 62 (59.0%) | 22 (56.4%) | |||
Snoring | yes | 65 (77.4%) | 41 (67.2%) | 0.173 | - | - | - |
no | 19 (22.6%) | 20 (32.8%) | - | - | |||
History of acute otitis media | yes | - | - | - | 41 (38.7%) | 20 (51.3%) | 0.173 |
no | - | - | 65 (61.3%) | 19 (48.7%) | |||
rURTIs | yes | 72 (85.7%) | 48 (78.7%) | 0.269 | 91 (85.8%) | 29 (74.4%) | 0.104 |
no | 12 (14.3%) | 13 (21.3%) | 15 (14.2%) | 10 (25.6%) | |||
Rhinitis (weeks in a month) | mean ± SD | 1.8 ± 0.9 | 1.8 ± 1.1 | 0.711 | 1.9 ± 0.9 | 1.6 ± 1.1 | 0.176 |
Cough | yes | 30 (35.7%) | 18 (29.5%) | 0.433 | 35 (33.0%) | 13 (33.3%) | 0.972 |
no | 54 (64.3%) | 43 (70.5%) | 71 (67.0%) | 26 (66.7%) | |||
Blocked nose | yes | 7 (8.3%) | 4 (6.6%) | 0.761 | 9 (8.5%) | 2 (5.1%) | 0.498 |
no | 77 (91.7%) | 57 (93.4%) | 97 (91.5%) | 37 (94.9%) |
Characteristic | Adenoid Size (A/C Ratio) | p Value | ||
---|---|---|---|---|
n | Mean ± SD | |||
Gender | female | 60 | 67.5 ± 18.0 | 0.234 |
male | 85 | 63.7 ± 19.4 | ||
Breastfeeding (months) | 0–3 | 31 | 66.0 ± 21.1 | 0.753 |
3–6 | 14 | 70.4 ± 10.6 | ||
6–12 | 29 | 61.6 ± 20.0 | ||
12–18 | 18 | 63.1 ± 20.4 | ||
18–24 | 16 | 67.5 ± 17.3 | ||
>24 | 37 | 65.8 ± 18.8 | ||
Mother’s milk feeding | 0–3 | 26 | 66.5 ± 19.4 | 0.742 |
3–6 | 14 | 70.4 ± 10.6 | ||
6–12 | 31 | 62.1 ± 19.6 | ||
12–18 | 21 | 62.4 ± 23.1 | ||
18–24 | 16 | 67.5 ± 17.3 | ||
>24 | 37 | 65.8 ± 18.8 | ||
Adenoid mucus coverage (MASNA scale) | 0 | 40 | 53.5 ± 19.9 | <0.001 |
1 | 36 | 65.3 ± 19.6 | ||
2 | 40 | 70.1 ± 14.5 | ||
3 | 29 | 74.8 ± 13.3 | ||
0 | 40 | 53.5 ± 19.9 | <0.001 | |
1–3 | 105 | 69.8 ± 16.4 | ||
Tympanogram | AA | 65 | 58.8 ± 20.6 | 0.010 |
AB/BA | 6 | 75.8 ± 12.8 | ||
AC/CA | 15 | 67.7 ± 13.7 | ||
BB | 34 | 70.1 ± 18.7 | ||
BC/CB | 6 | 72.5 ± 12.1 | ||
CC | 19 | 71.1 ± 13.0 | ||
A | 65 | 58.8 ± 20.6 | <0.001 | |
B | 46 | 71.2 ± 17.2 | ||
C | 34 | 69.6 ± 13.2 | ||
Allergy | yes | 24 | 64.4 ± 19.3 | 0.904 |
no | 25 | 64.2 ± 17.7 | ||
not tested | 96 | 65.8 ± 19.2 | ||
Sleeping with an open mouth | yes | 72 | 71.9 ± 15.7 | <0.001 |
periodic | 50 | 60.2 ± 19.8 | ||
no | 23 | 55.4 ± 18.8 | ||
Hypoacusis (stated by parents) | yes | 35 | 69.1 ± 18.0 | 0.283 |
periodic | 25 | 61.8 ± 22.8 | ||
no | 84 | 64.3 ± 17.7 | ||
Snoring | yes | 106 | 68.2 ± 18.7 | 0.002 |
no | 39 | 57.4 ± 17.2 | ||
History of acute otitis media | yes | 84 | 66.6 ± 19.0 | 0.320 |
no | 61 | 63.4 ± 18.6 | ||
rURTIs | yes | 120 | 66.3 ± 18.1 | 0.156 |
no | 25 | 60.4 ± 21.7 | ||
Cough | yes | 48 | 64.8 ± 17.1 | 0.829 |
no | 97 | 65.5 ± 19.7 | ||
Blocked nose | yes | 11 | 72.7 ± 13.3 | 0.173 |
no | 134 | 64.7 ± 19.1 |
Characteristic | p Value | OR | 95% CI |
---|---|---|---|
Model including breastfeeding with a 3-month cut-off point | |||
Sleeping with an open mouth, yes | 0.001 | 2.57 | 1.46–4.51 |
Adenoid mucus coverage (MASNA scale), 1–3 | 0.197 | 1.83 | 0.73–4.60 |
Adenoid size, A/C ratio ≥ 75% | 0.023 | 3.59 | 1.19–10.83 |
Breastfeeding, <3 months | 0.032 | 4.33 | 1.14–16.50 |
Model including breastfeeding with a 6-month cut-off point | |||
Sleeping with an open mouth, yes | <0.001 | 2.71 | 1.52–4.84 |
Adenoid mucus coverage (MASNA scale), 1–3 | 0.240 | 1.73 | 0.69–4.29 |
Adenoid size, A/C ratio ≥ 75% | 0.030 | 3.37 | 1.13–10.09 |
Breastfeeding, <6 months | 0.055 | 2.66 | 0.98–7.24 |
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Zwierz, A.; Domagalski, K.; Masna, K.; Walentowicz, P.; Burduk, P. Impact of Breastfeeding Duration on Adenoid Hypertrophy, Snoring and Acute Otitis Media: A Case-Control Study in Preschool Children. J. Clin. Med. 2023, 12, 7683. https://doi.org/10.3390/jcm12247683
Zwierz A, Domagalski K, Masna K, Walentowicz P, Burduk P. Impact of Breastfeeding Duration on Adenoid Hypertrophy, Snoring and Acute Otitis Media: A Case-Control Study in Preschool Children. Journal of Clinical Medicine. 2023; 12(24):7683. https://doi.org/10.3390/jcm12247683
Chicago/Turabian StyleZwierz, Aleksander, Krzysztof Domagalski, Krystyna Masna, Paweł Walentowicz, and Paweł Burduk. 2023. "Impact of Breastfeeding Duration on Adenoid Hypertrophy, Snoring and Acute Otitis Media: A Case-Control Study in Preschool Children" Journal of Clinical Medicine 12, no. 24: 7683. https://doi.org/10.3390/jcm12247683
APA StyleZwierz, A., Domagalski, K., Masna, K., Walentowicz, P., & Burduk, P. (2023). Impact of Breastfeeding Duration on Adenoid Hypertrophy, Snoring and Acute Otitis Media: A Case-Control Study in Preschool Children. Journal of Clinical Medicine, 12(24), 7683. https://doi.org/10.3390/jcm12247683