A Quality Initiative to Improve Mother's Own Milk Feeding in Preterm Neonates

Bagga, Nitasha; Kurian, Simi; Mohamed, Ashik; Pradeep, Reddy; Chirla, Dinesh

doi:10.1089/bfm.2020.0033

Cited by 9 publications

(12 citation statements)

References 19 publications

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“…There were no differences in length of stay in eight studies ( 17 , 20 , 21 , 23 , 26 , 28 , 29 , 31 ). Three studies ( 21 , 27 , 31 ) reported that the time of reaching full enteral feeding was not statistically different, other than the study by Liu et al ( 25 ). Only one study reported decreased risk of feeding intolerance ( 25 ).…”

Section: Resultsmentioning

confidence: 86%

“…Eleven studies ( 17 – 21 , 23 , 24 , 27 – 30 ) reported the rate of any breastfeeding at discharge, involving 3,207 infants in the QI group and 3,739 infants in the control group; the combined results showed a significantly positive relation between QI bundles and the proportion of any breastfeeding ( RR = 1.23, 95% CI: 1.14–1.32, P < 0.00001) ( Figure 2 ). As the heterogeneity between studies was large ( I 2 = 53%), we examined the effect of each study on overall risk estimates by excluding one study at a time.…”

Section: Resultsmentioning

confidence: 99%

“…After removing duplicates, the titles/abstracts of 69 articles were screened, and 49 articles were excluded. We reviewed the full text of 20 studies; 16 studies (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) were included in systematic review and four studies (33)(34)(35)(36) were excluded because of insufficient primary outcomes or same study cohort; 13 studies were included in the meta-analysis for the primary outcome (17-21, 23, 24, 27-32), another 3 studies were excluded due to insufficient dichotomous data. Figure 1 shows the detailed flow chart.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies (17,21) showed that the risk of NEC decreased significantly after implementation of the QI bundle, but four studies (26,27,30,31) showed no statistical differences. Five studies (21,26,27,30,31) showed that QI did not affect the LOS rate, and three studies (23,25,26) showed that the QI bundle did not affect weight gain during hospitalization or risk of extrauterine growth retardation (EUGR). There were no differences in length of stay in eight studies (17,20,21,23,26,28,29,31).…”

Section: The Balancing Outcomesmentioning

confidence: 99%

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

Fang¹,

Wu²,

Han

et al. 2021

Front. Pediatr.

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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.

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Section: Resultsmentioning

confidence: 86%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: The Balancing Outcomesmentioning

confidence: 99%

See 2 more Smart Citations

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

Fang¹,

Wu²,

Han

et al. 2021

Front. Pediatr.

View full text Add to dashboard Cite

show abstract

“…39,40 Studies have shown that multimodal approaches to breastfeeding, including peer counseling, breastfeeding teams, and hospital policy changes, yield better results than singular interventions in overcoming barriers to breastfeeding and improving infant health outcomes. [26][27][28][29][30][31][32][33][34][35]39,40 AA mothers face unique barriers to breastfeeding. Support from family, specifically fathers and maternal grandmothers, and friends; attendance of childbirth classes; and community support during prenatal and postnatal periods have been shown to be effective in improving breastfeeding rates among AA mothers.…”

Section: Discussionmentioning

confidence: 99%