What evidence‐based strategies have been shown to improve breastfeeding rates in preterm infants?

Abstract

Breast milk is the preferred form of nutrition for all infants and has been shown to reduce morbidity and improve health outcomes in preterm infants. However, mothers of preterm infants face many challenges initiating and sustaining breastfeeding within the neonatal unit. This scoping review examines evidence-based practices which aim to improve breastfeeding rates in preterm infants at the time of hospital discharge. A literature review identified 17 articles which are included in this review. Supporting evidence was found for the implementation of kangaroo mother care and/or skin-to-skin care, peer counsellors, provision of oropharyngeal colostrum in early infancy and use of donor human milk banks. However, overall it is apparent that high quality research including systematic review and data synthesis in the form of meta-analysis is required in this area to reach sound conclusions regarding recommendations of different interventions. This scoping review provides an important foundation for further research into this area.Key words: breastfeeding or breast milk or growth; clinical improvement or quality improvement or gold standard or guideline; intensive care units, neonatal; nutritional outcome.Human breast milk is the recommended source of nutrition for all infants. 1 Breast milk contains nutrients and immune factors which promote growth and overall long-term health 2,3 Breastfed infants are less susceptible to inflammatory disorders, infection and may have reduced incidence of cardiovascular disease in adult life. 4-7 Benefits specific to preterm infants 8 include the promotion of intestinal maturation, improved feed tolerance, improved growth 7 and reduced severity of complications of prematurity such as necrotising enterocolitis. [9][10][11] Despite the overwhelming evidence that breast milk is beneficial for preterm infants, breastfeeding rates within Australian neonatal units remain low. 7 The neonatal unit environment presents unique challenges to breastfeeding, with mothers often having to establish and maintain a breast milk supply without the direct assistance of their babies. Other barriers to breastfeeding success include limited support from health-care professionals, perceived lack of breast milk supply, lack of privacy for expressing milk, and the stress of having a preterm infant in neonatal intensive care and inadequate information regarding the benefits of breast milk. 12,13 Multiple evidence-based interventions to improve breastfeeding rates have been explored.In this narrative review, we considered the structured clinical question 'In a preterm infant (born <37 weeks' gestation) admitted to a neonatal unit, what evidence-based practices, compared to standard care, have been shown to improve the use of breast milk and breastfeeding rates upon discharge and up to 6 months of age?' DefinitionsBreastfeeding was defined as any administration of breast milk by any method (tube, breast, alternative, such as bottle or syringe). Search Strategy and OutcomeMedline, Embase, Maternity and Infant Care,...

Demographic, Social, and Personal Factors Associated With Lactation Cessation by 6 Weeks in Mothers of Very Low Birth Weight Infants

“…We found that participants who continued lactating over 6 weeks engaged in skin-to-skin care nearly three times longer than those who ceased lactation. These findings are consistent with previous reports of prolonged lactation when mothers of preterm infants engage in skin-to-skin care (Hilditch et al, 2019). Because skin-to-skin care may increase lactation duration, NICUs should develop evidence-based protocols and educational programs to provide nurses with guidance regarding safe and effective procedures for skin-toskin care (Kalluri et al, 2019).…”

Evaluación de un protocolo de calostro para prematuros de muy bajo peso de nacimiento

“…Como se ha descrito en la literatura, la extracción y administración muy precoz de leche en madres de prematuros se asocia a mejor mantención de la lactancia durante la hospitalización 7,10 . No es el único factor ya que se requiere el compromiso materno para continuar con extracción cada 3 a 4 horas y transportar a la unidad de neonatología, contribuyen también el realizar contacto piel a piel diario durante la hospitalización, la colocación precoz al pecho, el uso de doble sistema de extracción y el apoyo de consejeras de lactancia para lograr un buen volumen de leche de su madre para prematuros de MBPN [11][12][13] .…”

Compliance With the “Baby-Friendly Hospital Initiative for Neonatal Wards” in Russian Hospitals

“…Among the 36 countries in the International Neo-BFHI survey, high-income countries had the highest scores for GP 2 (Maastrup & Haiek, 2019). This could be because the introduction of familycentered care in neonatal wards, as well as the implementation of early, continuous, and prolonged skin-to-skin contact/ KMC, requires special training of medical staff, changing the model of care, and creating conditions in the wards to facilitate their implementation (Conde-Agudelo & Díaz-Rossello, 2016;Hernández-Aguilar et al, 2018;Hilditch et al, 2019;WHO & UNICEF, 2020). To successfully promote breastfeeding in maternity hospitals and children's hospitals, it is necessary to have specially trained lactation consultants, preferably IBCLCs.…”