Quality Improvement to Increase Breastfeeding in Preterm Infants: Systematic Review and Meta-Analysis

Abstract

Background and Objective: Due to its numerous health benefits, breast milk (BM) is recommended for preterm infants. Despite such recommendations, the rates of breastfeeding in preterm infants are lower than that in term infants. Quality improvement (QI) bundles increase breastfeeding in preterm infants, but their replication in neonatal intensive care units has had inconsistent outcomes.Methods: We used the Population or Problem, Intervention, Comparison, and Outcomes (PICO) framework to develop our search strategy, and searched MEDLINE, Embase, and the Cochrane Library from inception through January 15, 2021. Studies describing any active QI intervention to increase BM use in preterm infants were included. The primary outcome measure was the rate of any breastfeeding or exclusive mother's own milk (MOM) at discharge or during hospitalization.Results: Sixteen studies were eligible for inclusion and showed an acceptable risk of bias, and included 1 interrupted time series, study 3 controlled before-and-after studies, and 12 uncontrolled before-and-after studies; of these, 3 studies were excluded due to insufficient dichotomous data, 13 were included in the meta-analysis. In the meta-analysis, the rate of any breastfeeding was significantly improved at discharge and during hospitalization after QI [risk ratio (RR) = 1.23, 95% confidence interval (CI): 1.14–1.32, P < 0.00001 and RR = 1.89, 95% CI: 1.09–3.29, P = 0.02, respectively]. The rate of exclusive MOM after QI was also significantly increased at discharge (RR = 1.51, 95% CI: 1.04–2.18, P = 0.03), but not during hospitalization (RR = 1.53, 95% CI: 0.78–2.98, P = 0.22). However, after sensitivity analysis, the comprehensive results still suggested that QI could significantly improve the rate of exclusive MOM during hospitalization (RR = 1.21, 95% CI: 1.08–1.35, P = 0.001). Funnel plots and Egger's test indicated publication bias in the rate of any BF at discharge. We corrected publication bias by trim and fill analysis, and corrected RR to 1.272, 95% CI: (1.175, 1.369), which was consistent with the results of the initial model.Conclusions: A QI bundle appears to be effective for promoting BM use in preterm infants at discharge or during hospitalization.

Effects of maternal sound stimulation on preterm infants: A systematic review and meta‐analysis

“…Like human voice, music was one of the preferred auditory stimuli (Standley, 2002). The effects of music therapy on preterm infants have not been conclusively concluded (Chen et al, 2016;O'Toole et al, 2017;Standley, 2012;Yang et al, 2017). In this review, seven included studies compared MSS with music stimulation, and MSS was found to improve preterm infants' behavioural stability versus music stimulation, but there was no solid evidence for improved preterm infants' physiological stability.…”

Quality Initiative Program to Improve the Percentage of Very Preterm Neonates Receiving Expressed Breast Milk Within 24 Hours of Birth in a Tertiary Care (Level III-B) NICU

“…Using a QI Bundle having several interventions will help to attain desired goals. Systemic Review and Meta-analysis done by Fang et al 7 shows that a total of 12 interventions were used in the QI bundle. The most common is a multidisciplinary expert team developing evidence-based interventions and educating hospital staff and parents.…”