Increases in breastfeeding, decreases in parental smoking, and vaccination against pneumonia and influenza were linked to the reduced incidence of ear infections among U.S. babies in their first year of life, researchers said.

Rates of acute otitis media (AOM) have dropped significantly since the 1980s and 1990s, reported Tasnee Chonmaitree, MD, of the University of Texas Medical Branch in Galveston, and colleagues.

Nearly half (46%) of the 367 babies followed between 2008 and 2014 had an ear infection in their first year of life, compared with around three out of five babies in studies conducted 2 and 3 decades ago, they wrote in Pediatrics.

Breastfeeding exclusively for 6 months or more was associated with a significantly lower risk for upper respiratory infection, while day care attendance and having multiple siblings were both associated with an increased risk for the infections in the study.

Ear infections remain the leading cause of physician visits, antibiotic use, and surgery among babies and young children. The findings suggest that factors such as the introduction of pneumococcal conjugate vaccines for infants, increased breastfeeding, and declines in infant secondhand smoke exposure have all contributed to lower ear infection incidence, Chonmaitree told MedPage Today.

"These findings are reassuring," she said. "Breastfeeding specifically was shown to be associated with a lower risk for common cold, which leads to ear infections."



The study included 367 healthy infants enrolled shortly after birth and followed until their first episode of AOM, or until 12 months. Collection of nasopharyngeal specimens were collected from the babies at months 1 through 6, and then at 9 months, and during viral upper respiratory tract infections.

Parents were instructed to notify the research team when their baby showed signs of upper respiratory infection or AOM. They were also questioned about key risk factors for ear infections, including family history of AOM, their baby's exposure to cigarette smoke, and breast versus formula feeding.

When upper respiratory infections occurred, the babies were seen by a study physician and a follow-up visit occurred 3 to 5 days later.

From October 2008 and March of 2014, a total of 887 upper respiratory infections (305 infants) and 180 AOM episodes (143 infants) were documented among the babies included in the study.

The prevalence of upper respiratory infection, lower respiratory infection, and AOM during the first year of life was 3.2, 0.25, and 0.67 per child-year, respectively.

"Cumulative AOM incidence by ages 3, 6, and 12 months was 6%, 23%, and 46%. Infants with and without AOM had 4.7 and 2.3 upper respiratory infection episodes per child-year, respectively (P<0.002)," the researchers wrote.

Higher pathogenic bacterial colonization was found to be an independent risk factor for AOM (P<0.005), while breastfeeding reduced both upper respiratory infection and AOM risk (P<0.05).

"Data from studies in the late 1980s and 1990s reported 18% AOM incidence at age 3 months, 30% to 39% at 6 months, and 60% to 62% at one year," the researches wrote ..."More recent reports from population birth cohort studies using questionnaire or parental interview have reported even lower otitis media incidences (e.g., 5%-16% at six months and 23% at one year of age)."

Chonmaitree said the introduction of the pneumococcal conjugate vaccine almost 2 decades ago, and the recent recommendation that babies receive the influenza vaccine starting at the age of 6 months, may have had the biggest impact on AOM incidence.

Reduced exposure to secondhand smoke from parents is also a likely contributor to lower AOM rates, although the study was too small to show this, she added.

"Parents can help prevent ear infections among their children by breastfeeding, making sure their infants receive the recommended bacterial and viral vaccines, and reducing their baby's exposure to cigarette smoke and those who are sick with a cold," she said.

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