Анализ взаимосвязи между грудным вскармливанием и тонзиллэктомией у детей

Актуальность: Одной из наиболее распространенных хирургических операций, проводимых детям, особенно в возрасте до пятнадцати лет, является тонзиллэктомия. Существует два основных показания к тонзиллэк- томии: рецидивирующие тонзиллярные инфекции или обструктивное апноэ сна. Грудное вскармливание является одним из факторов, который играет важную роль в снижении частоты рецидивирующих респира- торных инфекций и повышении иммунитета, и этот эффект может пролонгироваться в детском возрасте.

Цель: Изучить частоту тонзиллэктомии в детском возрасте с учетом продолжительности грудного вскар- мливания в младенчестве.
Методы: Экспериментальная группа данного исследования включала 150 пациентов в возрасте 1-12 лет, перенесших тонзиллэктомию в учебном госпитале Альфайхаа в период с января 2017 года по июль 2018 года. Родителей этих пациентов спрашивали о поле ребенка, характере кормления в младенчестве, типе родов, числе детей в семье, причине тонзиллэктомии и статусе курения отца. В качестве контроля были включены 300 детей, посещавших госпиталь по другим причинам. Анализ данных проводился с использо- ванием отношения шансов, критерия хи-квадрат и значения вероятности.
Результаты: Основными причинами тонзиллэктомии были рецидивирующие респираторные инфекции (66%), на втором месте — обструктивные респираторные симптомы (30%), и самой редкой причиной была рецидивирующая ушная инфекция (4%). Различия в зависимости от пола, способа родов, очередности ре- бенка в семье и статуса курения отца при грудном вскармливании были незначительными. Другие группы по сравнению с теми, кто находился на грудном вскармливании более 6 месяцев, никогда и 0-3 месяца, показали слабую связь. Выводы: Мы обнаружили, что младенцы, находящиеся на грудном вскармливании более 6 месяцев, реже подвергаются тонзиллэктомии в детстве.
Ключевые слова: Грудное вскармливание, тонзиллэктомия, детский возраст

Конфликт интересов. Авторы заявляют об отсутствии конфликта интересов.
Финансирование. Работа выполнена без спонсорской поддержки.

Background: One of the most common surgical operations carried out on children especially those under the age of fifteen is tonsillectomy. There are two main indications for tonsillectomy either recurrent tonsillar infections or obstructive sleep disorder. Breastfeeding is one of the factors that play a major impact on decreasing recurrent respiratory infections and improving immunity, this effect may prolong during childhood.
Objective: To study the rate of tonsillectomy during childhood concerning the duration of breastfeeding during their infancy.
Methods: In this study, 150 cases underwent tonsillectomy as a case group in Alfayhaa Teaching Hospital in the period from January 2017 to July 2018 to children aged 1–12 years. Parents of those patients asked about the sex of the child, the feeding habit during infancy, type of delivery, order of the child in the family, the cause of tonsillectomy, and paternal smoking. 300 controls had been taken including those children attending the hospital for other reasons. Analysis of data was done using odds ratio, chi-square test, and probability value.
Results: The main reasons for tonsillectomy were recurrent respiratory infections (66%), followed by obstructive respiratory symptoms (30%) and the least one was a recurrent ear infection (4%). The difference was not significant between sex, mode of delivery, order of the child in the family, and paternal smoking with breastfed. Other groups as compared with those who complete more than 6 months, never and 0-3 months showed weak relation. Conclusions: We found that breastfed infants for more than 6 months are less likely to have tonsillectomy during their childhood. Keywords: Breastfeeding, Tonsillectomy, Childhood
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study

Introduction
One of the most common surgical operations carried out on children especially those under the age of fifteen is tonsillectomy [1–3]. Decide to do a tonsillectomy, there are two main reasons which are either recurrent tonsillar infections or obstructive sleep disorder [4–6].
The tonsillar disease has multifactorial pathogenesis and interactions among the anatomy, immunology, and microbiology of these structures may be important [7].

Breastfeeding is one of the factors that play a major impact on decreasing recurrent respiratory infections and improving immunity, this effect may prolong during childhood [8, 9]. Human breast milk is the natural and optimum food for newborn infants [10, 11]. It is constantly available at a suitable temperature and requires no preparation time [12, 13]. Besides it provides complete nutrition and many bioactive health substances (protein, fat, minerals, vitamins, enzymes, growth factors, and hormones), it is free of contaminating bacteria and thereby decreasing the incidences of gastrointestinal disturbances. It is associated with improved infant health and immune development [14–17]. Antimicrobial immunoglobulins of the mother transmit via her breast milk and provide passive immunity to the breastfed child while his immune system is growing [18, 19].
Patients and methods
This work is a prospective case-control study of 150 patients aged below 13 years (the case group) who were admitted for tonsillectomy at Alfayhaa Teaching Hospital from January 2017 to July 2018. Questionnaires were obtained from the parents of those children about the sex of the child, the feeding habit during infancy, type of delivery, order of the child in the family, the cause of tonsillectomy, and paternal smoking. The duration of breastfeeding was divided into four groups (never, 0-3, 3-6, and more than 6 months).
300 controls of the same age group had been randomly selected from those children who were attending the hospital for other reasons. Two controls were taken for each case, and their parents also asked the same questions mentioned above. Results were statistically analyzed using odds ratio (OR), chi-square (X2) test, and probability (P) value and summarized into tables.
Results
Of 150 cases of tonsillectomy included in this study, the main reasons for tonsillectomy were recurrent respiratory infections (66%), followed by obstructive respiratory symptoms (30%) and the least one was a recurrent ear infection (4%).
Table 1 showed all variables which were comparable for both groups. The difference was not significant between those data where the P-value was less than 0.05 for sex, mode of delivery, order of the child in the family (whether the child is the first or second and more in order), and lastly paternal smoking.
In table 2, for more than 6 months of breastfed children, the P-value is more than 0.05 and so there is a significant association. Other groups as compared with those who complete more than 6 months, never and 0–3 months show weak relation and any relation respectively as shown in the same table, where those never breastfed odds ratio = 2.6 and the P-value is less than 0.05, that’s mean there is a relation but statistically not significant. Those who breastfed for 0 to 3 months show no relation with an odds ratio = 0.7 and a P-value is less than 0.05.
Discussion
Human milk can affect the immune system of breastfed infants [20]. Its protective effect against respiratory infection may persist for several years [21, 22]. This might be accompanied by more tolerant tonsillar lymphoid tissue because the infant’s immune system is programming [23].
In our study, there is a significant association between breastfeeding for 3 to 6 months and tonsillectomy more than those completed more than 6 months (as indicated by WHO [24]) and the P is more than 0.05. This is consistent with a finding of Alfredo Pisacane [25] who studied the relation between breastfeeding and tonsillectomy in children in Naples, Italy, in 1995. He found that children whose tonsils have been removed were less likely to have been breastfed. This is the only study we found about the same subject of our study. Many researchers studied the breastfeeding duration and associated decrease in respiratory tract infection. One of those studies is that of W. Wardhana et al [26] which concluded that children under the age of five had a lower risk of tonsillitis if they were exclusively breastfed. Although we didn’t ask whether the involved children were exclusively breastfed or not, the association is significant in both studies. Another one is that of Caroline J. Chantry [27] who found an increased risk of respiratory tract infections in children who were fully breastfed for 4 in comparison to those fed for 6 months. Another finding is those children who were never breastfed, there is an association with increased tonsillectomy rate but it is statistically not significant (P-value is less than 0.05) as seen in table 2. In contrast to the finding seen in those children who breastfed for 0 to 3 months where the percentage of tonsillectomy is lower than in those breastfed for more than 6 months, which may be due to sampling error of inadequate sample size.

Other parameters of cases (mode of delivery, order of the child in the family, and paternal smoking) had been taken in this study to see if there is any factor other than breastfeeding may have a role in increasing the tonsillectomy rate among cases in our sample, there was no significant association with tonsillectomy, these also constant with the finding of Alfredo Pisacane [25].