Interventions to Improve Breastfeeding Outcomes in Late Preterm and Early Term Infants

Background: Late preterm infants (LPIs; born at 34^0/7 to 36^6/7 gestational weeks) and early term infants (ETIs; 37^0/7 to 38^6/7 gestational weeks) are at higher risk of morbidity and mortality compared with more mature infants. Breastfeeding can reduce these risks, but feeding difficulties are common among these infants and breastfeeding rates are low. We conducted a systematic review to identify the interventions available to improve any breastfeeding, exclusive breastfeeding, or breast milk yield. Methods: A literature search was performed up to February 23, 2022, using MEDLINE, CINAHL, Embase, and Google Scholar, and nine articles were included. Only one article was a randomized controlled trial, and only one included ETIs. The remaining articles were quasi-experimental and included only LPIs. Outcomes included breastfeeding duration, breastfeeding exclusivity, and/or breast milk production (volume) before 6 months actual age. Results: Professional support significantly improved exclusive breastfeeding rates. A breastfeeding education program delivered at the hospital with weekly telephone follow-up postdischarge significantly increased breastfeeding rates. Neither cup feeding nor early discharge (with in-home lactation support) improved breastfeeding rates, whereas rooming-in (versus direct admission to the neonatal intensive care unit) worsened exclusive breastfeeding rates. Discussion: This is the first systematic review to identify interventions available for both LPIs and ETIs. Overall, there are limited studies that investigate interventions promoting breastfeeding in these populations. However, breastfeeding support delivered by health care professionals seems to improve breastfeeding rates. The main limitations are the lack of randomization, blinding, and adjustment for confounding variables. Experimental studies with robust methodological design are needed.