Longitudinal studies on breastfeeding among preterm infants: a scoping review

This study aims to assess the exclusive breastfeeding rate among preterm infants, examine the factors influencing breastfeeding practices, and identify evidence-based interventions to enhance lactation support.

This scoping review was conducted following Arksey and O'Malley (2005) methodological framework and reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Review and Meta-analyses Extension for Scoping Review) guidelines. We comprehensively searched five English databases and three Chinese databases in September 2023. This systematic review incorporated longitudinal, cohort, and randomized controlled trials (RCTs) published between 2013 and 2023 in English or Chinese. It specifically investigated WHO-compliant exclusive breastfeeding practices (rates and duration) among mother-preterm infant dyads (< 37 weeks gestation), with observational studies requiring documented follow-up protocols for inclusion. Three reviewers independently screened records, selected relevant studies, and performed the data charting. Finally, discrepancies were resolved through consensus-based discussion and final adjudication by a third reviewer to ensure methodological transparency and minimize selection bias.

11 studies met the inclusion criteria and were included in this review. This scoping review observed a progressive decline in exclusive breastfeeding rates among preterm infants within one year postpartum, with challenges in the immediate postpartum period related to breastfeeding techniques and milk supply insufficiency. Factors such as maternal age, infant gestational age and health status, and hospital transfers also influence breastfeeding cessation at 6-12 months postpartum.

This scoping review study provides the complex and evolving breastfeeding challenges faced by preterm infants, shaped by physiological, social, and psychological factors. Key findings underscore the need for longitudinal, adaptive lactation support strategies that align with infants' developmental trajectories and parental psychosocial needs. To address critical gaps, future research should prioritize multicenter trials evaluating stepped-care interventions through standardized CONSORT-compliant protocols, while integrating machine learning models to predict individualized lactation failure risks based on dynamic NICU biometrics.