Impact of prelacteal feeds and neonatal introduction of breast milk substitutes on breastfeeding outcomes: A systematic review and meta‐analysis

Abstract

The introduction of fluids other than breast milk during the first few days of life or later neonatal period has been identified as a risk factor for suboptimal breastfeeding (BF) outcomes in numerous studies using varying study designs. However, the relationship between early introduction of fluids other than breast milk and BF outcomes has not been systematically assessed using only prospective studies that can establish temporality, which is critical for determining whether observed associations are causal. We conducted a systematic review and meta-analysis of prospective studies to assess if there is a difference in BF outcomes as a result of the introduction of: (a) milk-based prelacteals, (b) water-based prelacteals and (c) breast milk substitutes (BMS) between 4 days and 4 weeks postpartum. We searched PubMed, Lilacs, Web of Science and other repositories for original research investigating the relationship between early introduction of prelacteals and/or BMS and BF outcomes. Forty-eight studies met the inclusion criteria for the systematic review. Of the 39 prelacteal feeding studies, 27 had the prerequisite statistical information for inclusion in the meta-analysis. Findings from the meta-analysis showed a relationship between prelacteals and exclusive BF cessation (RR 1.44; 1.29-1.60) and any BF cessation (2.23; 1.63-3.06) among infants under 6 months old. Nine studies focusing on the introduction of BMS during the neonatal period identified this practice as a statistically significant risk factor for a shorter BF duration. Effective interventions are needed to prevent the introduction of unnecessary milk-based prelacteals and BMS during the perinatal and neonatal periods to improve BF outcomes.

Early initiation of breastfeeding is inversely associated with public and private c-sections in 73 lower- and middle-income countries

“…Many studies reported that children who were prelacteal fed are less likely to be exclusively breastfed under six months or to continue breastfeeding throughout the first year of life. Therefore, prelacteal feeding is a risk factor for suboptimal breastfeeding practices worldwide 29 . Importantly, the prevalence of EIBF and prelacteal feeding is inversely correlated in LMICs 30 .…”

Exclusive breastfeeding: Measurement to match the global recommendation

“…Infants under 6 months of age who are not exclusively breastfed are at significantly higher risk of allcause mortality and infection-related mortality compared to exclusively breastfed infants (Sankar et al, 2015). Prelacteal feeding, that is feeding an infant anything other than breast milk in the first 3 days of life, is associated with higher morbidity and mortality in the first year of life and also earlier cessation of breastfeeding (Nguyen et al, 2020;Pérez-Escamilla et al, 2022).…”

“…Infants under 6 months of age who are not exclusively breastfed are at significantly higher risk of all‐cause mortality and infection‐related mortality compared to exclusively breastfed infants (Sankar et al, 2015 ). Prelacteal feeding, that is feeding an infant anything other than breast milk in the first 3 days of life, is associated with higher morbidity and mortality in the first year of life and also earlier cessation of breastfeeding (Nguyen et al, 2020 ; Pérez‐Escamilla et al, 2022 ). Acknowledging the benefits, the WHO and United Nations Children's Fund (UNICEF) recommend initiation of breastfeeding within the first hour of birth, exclusive breastfeeding for the first 6 months of life, and continued breastfeeding until 2 years of age or beyond (WHO & UNICEF, 2003 ).…”

What will it take to increase breastfeeding?

“…Findings call for urgently addressing the need for well‐trained health providers and counseling programmes to provide guidance to parents and caregivers on common baby behaviours and how to properly cope with them while protecting breastfeeding. Pérez‐Escamilla and colleagues (Pérez‐Escamilla et al, 2022), assessed whether introduction of prelacteals (either milk‐based or water‐based fluids introduced during the first 3 days of life) and BMS nowadays also referred to as commercial milk formulas (WHO & UNICEF, 2022) between 4 days and 4 weeks postpartum undermine breastfeeding success. The authors carried out a systematic review and meta‐analysis, including only prospective studies, allowing them to determine the temporal directionality of the associations.…”

“…The aim of this supplement is to bring together the most updated evidence on challenges to improve breastfeeding practices worldwide and to identify promising policies and programmes to protect, promote and support breastfeeding on a large scale. New evidence on the influence of baby behaviours and caregiver's infant feeding decisions during the first 6 months of life, is described by Vilar-Compte and colleagues in a systematic review (Vilar-Compte, Pérez-Escamilla, et al, 2022). The systematic review which included studies with different designs (descriptive, crosssectional, prospective, and quasi-experimental), provided consistent evidence that baby behaviours such as infant crying and fussiness are critical in shaping caregiver's decisions on infant feeding practices.…”