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Effect of Neonatal Unit Interventions Designed to Increase Breastfeeding in Preterm Infants: An Overview of
Cathie Hilditch1,2,3,4, Alice R Rumbold1,2, Amy Keir1,2,3,4
1SAHMRI Women and Kids, and Medical Research Institute, Adelaide, South Australia, Australia.
Insights
Interventions like Kangaroo Mother Care (KMC) and avoiding bottles significantly boost breastfeeding rates in preterm infants. Cup feeding and quality improvement bundles also show benefits for increasing breast milk access.
Area of Science:
- Neonatal care
- Infant nutrition
- Evidence-based practice
Background:
- Preterm infants often face challenges with breastfeeding.
- Neonatal unit interventions aim to improve breastfeeding success.
- Systematic reviews are crucial for evaluating intervention effectiveness.
Purpose of the Study:
- To systematically review evidence on neonatal unit interventions for increasing breastfeeding in preterm infants.
- To identify effective strategies for supporting breastfeeding in this vulnerable population.
Main Methods:
- Adherence to Cochrane methodology for systematic review.
- Inclusion of systematic reviews with meta-analyses published up to October 31, 2022.
- Focus on interventions within neonatal units aimed at increasing breastfeeding rates in preterm infants.
Main Results:
- Avoidance of bottles during breastfeeding establishment showed clear benefits for any and exclusive breastfeeding.
- Kangaroo Mother Care (KMC) demonstrated clear benefits for breastfeeding at discharge and post-discharge.
- Cup feeding and Quality Improvement (QI) bundles showed possible benefits for breastfeeding rates.
Conclusions:
- Kangaroo Mother Care (KMC), avoiding bottles, cup feeding, and QI bundles are supported by evidence to enhance breastfeeding in preterm infants.
- These interventions promote breastfeeding prevalence and equitable access to breast milk.
- Further research stratifying effects by subgroups is recommended.
Introduction:
This overview aims to systematically review evidence regarding effects of interventions undertaken in neonatal units to increase breastfeeding in preterm infants.
Methods:
We followed Cochrane methodology. Systematic reviews published to October 31, 2022, reporting meta-analysis of effects from original studies on breastfeeding rates in preterm infants of neonatal unit interventions designed to increase breastfeeding were included.
Results:
Avoidance of bottles during breastfeed establishment (comparator breastfeeds with bottle-feeds) demonstrated clear evidence of benefit for any breastfeeding at discharge and exclusive breastfeeding 3 months post-discharge, and possible evidence of benefit for exclusive breastfeeding at discharge, and any breastfeeding post-discharge. Kangaroo mother care (KMC) (comparator usual care) demonstrated clear evidence of benefit for any and exclusive breastfeeding at discharge and possible benefit for any breastfeeding post-discharge. Quality improvement (QI) bundle(s) to enable breastfeeds (comparator conventional care) showed possible evidence of benefit for any breastfeeding at discharge. Cup feeding (comparator other supplemental enteral feeding forms) demonstrated possible evidence of benefit for exclusive breastfeeding at discharge and any breastfeeding 3 months after. Early onset KMC (commenced <24 h post-birth), oral stimulation, and oropharyngeal colostrum administration, showed no evidence of benefit. No meta-analyses reported pooled effects for gestational age or birthweight subgroups.
Conclusion:
There is ample evidence to support investment in KMC, avoidance of bottles during breastfeed establishment, cup feeding, and QI bundles targeted at better supporting breastfeeding in neonatal units to increase prevalence of breastfeeding in preterm infants and promote equal access to breastmilk. Stratifying effects by relevant subgroups is a research priority.
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