Effect of Neonatal Unit Interventions Designed to Increase Breastfeeding in Preterm Infants: An Overview of Systematic Reviews.

Neonatology Pub Date : 2024-01-01 Epub Date: 2024-03-21 DOI:10.1159/000536660

Cathie Hilditch, Alice R Rumbold, Amy Keir, Philippa Middleton, Judith Gomersall

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Abstract

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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旨在增加早产儿母乳喂养的新生儿科干预措施的效果：系统综述》。

导言：本综述旨在系统回顾新生儿科为增加早产儿母乳喂养而采取的干预措施效果的相关证据：方法：我们采用 Cochrane 方法。方法：我们采用 Cochrane 方法，纳入了截至 2022 年 10 月 31 日发表的系统综述，这些综述报告了对新生儿科旨在提高母乳喂养率的干预措施对早产儿母乳喂养率的原始研究效果进行的荟萃分析：在建立母乳喂养过程中避免使用奶瓶（比较母乳喂养与奶瓶喂养），有明确证据显示出院时任何母乳喂养和出院后3个月纯母乳喂养均可获益，有可能证明出院时纯母乳喂养和出院后任何母乳喂养均可获益。袋鼠妈妈护理（Kangaroo Mother Care，KMC）（比较方案为常规护理）有明确证据表明，出院时进行任何母乳喂养和纯母乳喂养均可获益，出院后进行任何母乳喂养均可获益。促进母乳喂养的质量改进（QI）捆绑包（比较者：常规护理）显示，可能有证据表明出院时母乳喂养对任何母乳喂养都有益处。杯状喂养（比较者：其他补充性肠内喂养形式）有证据显示出院时纯母乳喂养和出院 3 个月后的任何母乳喂养均有可能获益。早期 KMC（出生后 24 小时开始）、口腔刺激和口咽初乳喂养均无获益证据。没有荟萃分析报告胎龄或出生体重亚组的汇总效应：有充足的证据支持投资 KMC、在建立母乳喂养时避免使用奶瓶、杯式喂养以及旨在更好地支持新生儿病房母乳喂养的 QI 捆绑计划，以提高早产儿的母乳喂养率并促进母乳的平等获取。按相关亚群对效果进行分层是研究的当务之急。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Neonatology

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