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,...

Aim: Bronchiolitis is a common condition in the paediatric population. Severe cases often receive respiratory support with high-flow nasal cannula (HFNC). Significant variation in the application of HFNC exists throughout Australia and internationally. This study aimed to determine if the flow rate used initially and when ceasing HFNC at the end of the illness alters clinical outcomes. Methods: A retrospective analysis was conducted of 251 children less than 12 months of age when admitted to the Women's and Children's Hospital Adelaide with bronchiolitis requiring HFNC therapy between the period of April 2016 to April 2019. The primary outcome was to determine if commencing HFNC therapy at different rates (1 L/kg/min, 1.5 L/kg/min and 2 L/kg/min) affected length of stay or treatment failure (escalation in physiological parameters or respiratory support). Results: Treatment failure occurred in 33%, 13% and 26% of those starting at 1 L/kg/min, 1.5 L/kg/min and 2 L/kg/min, respectively. Commencing HFNC therapy at 1 L/kg/min increased length of stay by an average of 30 h (P < 0.001) and the likelihood of treatment failure (P < 0.002) compared with starting at 1.5 L/kg/min. There was no statistical difference in outcomes between starting at 1.5 L/kg/min and 2 L/kg/min. There was no significant difference in the length of stay from the starting of weaning HFNC to time of discharge. Conclusions: The commencing flow rates of initial HFNC therapy impact individual patient's outcomes, including length of stay and rates of treatment failure. Clinicians should consider commencing HFNC at 1.5 L/kg/min or 2 L/kg/min in infants that have failed low-flow oxygen therapy.