Effectiveness of Interventions to Manage Difficulties with Breastfeeding for Mothers of Infants under Six Months with Growth Faltering: A Systematic Review Update
Abstract
:1. Introduction
2. Materials and Methods
2.1. Protocol and Ethics
2.2. Eligibility Criteria
2.3. Information Source and Search Strategy
2.4. Data Collection and Analysis
2.5. Data Extraction and Management
2.6. Assessment of Risk of Bias
2.7. Measures of Treatment Effect
2.8. Assessment of Reporting Biases
2.9. Data Synthesis
2.10. Certainty of Evidence and Evidence Profiles
3. Results
3.1. Study Flow
3.2. Characteristics of Included Studies
- (1)
- Breastfeeding outcomes: LATCH (Latch, Audible swallowing, Type of nipple, Comfort, Hold) total score; PIBBS (Preterm Infants Breastfeeding Behaviour Scale) total score; EBF at discharge, at one week, at six weeks, at three months, and at six months; breastfeeding at six months; and time to transition to full breastfeeding.
- (2)
- Anthropometric outcomes: daily weight gain, weight gain in first 7 days, weight gain from birth until transition to breastfeeding; and weight at discharge, at the 7th day, and at the 14th day.
3.3. Risk of Bias of Included Studies
3.4. Synthesis of Results
3.4.1. Non-Nutritive Sucking (NNS) on Breast
3.4.2. Alternative Supplemental Feeding Techniques
4. Discussion
4.1. Summary of Key Findings
4.2. Current Evidence, Implications for Guidelines, and Need for Future Studies
4.3. Strengths and Limitations of the Review
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
References
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Author (Year) | Study Design (Duration) | Population, Setting, Country | Intervention (Number) | Comparator (Number) | Eligible Outcomes Reported |
---|---|---|---|---|---|
Non-nutritive suckling (n = 2) | |||||
John (2019) [31] | RCT (January–April 2015) | Mother infant pair; GA < 32 wks, BW ≤ 1250 g, NICU, India | NNS on emptied breast 5–10 m, 3 times a day + standard care (n = 7) | NNS on finger (standard care) (n = 7) | Breastfeeding, Anthropometric |
Fucile (2021) [30] | RCT (Not reported) | Mother infant pair; GA < 34 wks, BW ~1250–1600 g, NICU, Canada | NNS on emptied breast once a day for 15 m (n = 17) | NNS on a pacifier (standard care) once a day for 15 m (n = 16) | Breastfeeding |
Alternative supplementary feeding techniques (n = 5) | |||||
Çalıkuşu (2021) [32] | RCT (August 2016–September 2017) | Mother infant pair; GA < 34 wks, BW ≤ 1250 g, NICU, Turkey | Supplemental feeding tube device, mothers breastfeed their infant for 20 m (n = 23) | Bottle feeding by mothers for 20 m (n = 23) | Breastfeeding, Anthropometric |
Kumar (2010) [28] | RCT (March–October 2003) | GA ≥ 32 wks, BW 1250–1600 g, NICU, India | Spoon feeding by mother/nurse in hospital (n = 40) | Nasogastric tube feeding by nurse only (n = 39) | Breastfeeding, Anthropometric |
Yilmaz (2014) [29] | RCT (April 2006–February 2008) | Mother infant pair; GA 32–35 wks BW ~1500 g, NICU, Turkey | Cup feeding using medicine cup, 15 mL of breast milk/formula (n = 308) | Bottle feeding using a bottle with a teat/nipple, breast milk/formula (n = 299) | Breastfeeding, Anthropometric |
Abouelfettoh (2008) [27] | NRCT (December 2003–August 2004) | Mother infant pair; GA 34–37 wks BW ~2000–2300 g, NICU, Egypt | Cup feeding was given by researcher or nurse (n = 30) | Bottle feeding was given by researcher nurse or (n = 30) | Breastfeeding |
Say (2019) [33] | NRCT (January 2013–January 2015) | GA < 32 wks, BW ≤ 1500 g, NICU, Turkey | Syringe feeding with breast milk or formula (n = 47) | Bottle feeding with nipple (n = 56) | Breastfeeding, Anthropometric |
Certainty Assessment | No. of Patients | Effect | Certainty | Importance | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
No. of Studies | Study Design | Risk of Bias | Inconsistency | Indirectness | Imprecision | NNS Breast | NNS Finger | Relative (95% CI) | Absolute (95% CI) | ||
PIBBS total score (Breastfeeding outcome) | |||||||||||
1 [31] | RCT | very serious a | not serious | Serious b | not serious | 4 | 5 | - | MD 4 higher (0.12 higher to 7.88 higher) | ⊕◯◯◯ Very low | Critical |
EBF at 6 weeks (Breastfeeding outcome) | |||||||||||
1 [31] | RCT | very serious a | not serious | Serious b | Serious c | 3/4 (75.0%) | 5/5 (100.0%) | RR 0.76 (0.41 to 1.42) | 240 fewer per 1000 (from 590 fewer to 420 more) | ⊕◯◯◯ Very low | Critical |
EBF at 3 months (Breastfeeding outcome) | |||||||||||
1 [31] | RCT | very serious a | not serious | Serious b | Serious d | 2/4 (50.0%) | 5/5 (100.0%) | RR 0.55 (0.22 to 1.35) | 450 fewer per 1000 (from 780 fewer to 350 more) | ⊕◯◯◯ Very low | Critical |
EBF at 6 months (Breastfeeding outcome) | |||||||||||
1 [31] | RCT | very serious a | not serious | Serious b | Serious e | 1/4 (25.0%) | 3/5 (60.0%) | RR 0.42 (0.07 to 2.63) | 348 fewer per 1000 (from 558 fewer to 978 more) | ⊕◯◯◯ Very low | Critical |
Weight at discharge/2 months (g) (Anthropometric outcome) | |||||||||||
1 [31] | RCT | very serious a | not serious | Serious b | extremely serious f | 4 | 5 | - | MD 25 lower (203.7 lower to 153.7 higher) | ⊕◯◯◯ Very low | Important |
Certainty Assessment | No. of Patients | Effect | Certainty | Importance | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
No. of Studies | Study Design | Risk of Bias | Inconsistency | Indirectness | Imprecision | NNS Breast | NNS Pacifier | Relative (95% CI) | Absolute (95% CI) | ||
EBF at discharge/1.5 months (Breastfeeding outcome) | |||||||||||
1 [30] | RCT | Serious a | not serious | Serious b | not serious | 10/16 (62.5%) | 4/17 (23.5%) | RR 2.66 (1.04 to 6.78) | 391 more per 1000 (from 9 more to 1000 more) | ⊕⊕◯◯ Low | Critical |
Certainty Assessment | No. of Patients | Effect | Certainty | Importance | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
No. of Studies | Study Design | Risk of Bias | Inconsistency | Indirectness | Imprecision | SFTD | Bottle Feeding | Relative (95% CI) | Absolute (95% CI) | ||
LATCH Score (Breastfeeding outcome) | |||||||||||
1 [32] | RCT | Serious a | not serious | Serious b | Serious c | 23 | 23 | - | MD 0.13 higher (0.13 lower to 0.39 higher) | ⊕◯◯◯ Very low | Critical |
Time to transition to full breastfeeding (days) (Breastfeeding outcome) | |||||||||||
1 [32] | RCT | Serious a | not serious | Serious b | Serious d | 23 | 23 | - | MD 1.3 lower (3.25 lower to 0.65 higher) | ⊕◯◯◯ Very low | Critical |
Daily weight gain (g) (Anthropometric outcome) | |||||||||||
1 [32] | RCT | Serious a | not serious | Serious b | Serious e | 23 | 23 | - | MD 3.08 lower (12.6 lower to 6.44 higher) | ⊕◯◯◯ Very low | Important |
Certainty Assessment | No. of Patients | Effect | Certainty | Importance | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
No. of Studies | Study Design | Risk of Bias | Inconsistency | Indirectness | Imprecision | Spoon Feeding | Nasogastric Feeding | Relative (95% CI) | Absolute (95% CI) | ||
Time to transition to breastfeeding (days) (Breastfeeding outcome) | |||||||||||
1 [28] | RCT | very serious a | not serious | Serious b | not serious | 40 | 39 | - | MD 2.08 higher (0.44 higher to 3.72 higher) | ⊕◯◯◯ Very low | Critical |
Weight at 7th day of life (g) (Anthropometric outcome) | |||||||||||
1 [28] | RCT | Serious c | not serious | Serious b | very serious d | 39 | 39 | - | MD 18.08 lower (68.11 lower to 31.95 higher) | ⊕◯◯◯ Very low | Important |
Weight at 14th day of life (g) (Anthropometric outcome) | |||||||||||
1 [28] | RCT | very serious e | not serious | Serious b | very serious f | 37 | 37 | - | MD 3.21 higher (50.03 lower to 56.45 higher) | ⊕◯◯◯ Very low | Important |
Weight gain from birth to transition to full breastfeeding (g/kg/d) (Anthropometric outcome) | |||||||||||
1 [28] | RCT | Serious c | not serious | Serious b | Serious g | 40 | 39 | - | MD 0.25 lower (2.01 lower to 1.51 higher) | ⊕◯◯◯ Very low | Important |
Certainty Assessment | No. of Patients | Effect | Certainty | Importance | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
No. of Studies | Study Design | Risk of Bias | Inconsistency | Indirectness | Imprecision | Cup Feeding | Bottle Feeding | Relative (95% CI) | Absolute (95% CI) | ||
EBF at discharge (Breastfeeding outcome) | |||||||||||
1 [29] | RCT | very serious a | not serious | Serious b | not serious | 184/254 (72.4%) | 123/268 (45.9%) | RR 1.58 (1.36 to 1.83) | 266 more per 1000 (from 165 more to 381 more) | ⊕◯◯◯ Very low | Critical |
EBF at 3 months (Breastfeeding outcome) | |||||||||||
1 [29] | RCT | very serious a | not serious | Serious b | not serious | 196/254 (77.2%) | 126/268 (47.0%) | RR 1.64 (1.42 to 1.89) | 301 more per 1000 (from 197 more to 418 more) | ⊕◯◯◯ Very low | Critical |
EBF at 6 months (Breastfeeding outcome) | |||||||||||
1 [29] | RCT | very serious a | not serious | Serious b | not serious | 146/254 (57.5%) | 113/268 (42.2%) | RR 1.36 (1.14 to 1.63) | 152 more per 1000 (from 59 more to 266 more) | ⊕◯◯◯ Very low | Critical |
Weight gain in first 7 days of study (g/d) (Anthropometric outcome) | |||||||||||
1 [29] | RCT | very serious a | not serious | Serious b | Serious c | 254 | 268 | - | MD 0.1 lower (0.36 lower to 0.16 higher) | ⊕◯◯◯ Very low | Important |
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Mohandas, S.; Rana, R.; Sirwani, B.; Kirubakaran, R.; Puthussery, S. Effectiveness of Interventions to Manage Difficulties with Breastfeeding for Mothers of Infants under Six Months with Growth Faltering: A Systematic Review Update. Nutrients 2023, 15, 988. https://doi.org/10.3390/nu15040988
Mohandas S, Rana R, Sirwani B, Kirubakaran R, Puthussery S. Effectiveness of Interventions to Manage Difficulties with Breastfeeding for Mothers of Infants under Six Months with Growth Faltering: A Systematic Review Update. Nutrients. 2023; 15(4):988. https://doi.org/10.3390/nu15040988
Chicago/Turabian StyleMohandas, Saranya, Ritu Rana, Barkha Sirwani, Richard Kirubakaran, and Shuby Puthussery. 2023. "Effectiveness of Interventions to Manage Difficulties with Breastfeeding for Mothers of Infants under Six Months with Growth Faltering: A Systematic Review Update" Nutrients 15, no. 4: 988. https://doi.org/10.3390/nu15040988
APA StyleMohandas, S., Rana, R., Sirwani, B., Kirubakaran, R., & Puthussery, S. (2023). Effectiveness of Interventions to Manage Difficulties with Breastfeeding for Mothers of Infants under Six Months with Growth Faltering: A Systematic Review Update. Nutrients, 15(4), 988. https://doi.org/10.3390/nu15040988