Breastfeeding synthesis

Research gaps from Cochrane Reviews

(Cochrane Library Issue 3, 2006)

The faces indicate the direction of findings in each review:

JLikely to be effective

KBenefits and risks balanced

?Uncertain or limited effect

L Likely to be ineffective or potentially harmful

? Thus, important research implications are more likely to arise from reviews with uncertain findings.

JIf a review shows an intervention to be beneficial,

Kor that the risks and benefits are reasonably balanced, there may be less need for further research (at least for the major review question).

LIf a review indicates that the intervention is likely to be ineffective or potentially harmful, or has been superseded, then this will often indicate that these research questions are of lower importance.

Interventions during pregnancy

? Antenatal breast examination for promoting breastfeeding (Lee 2006)

Cochrane protocol, Cochrane review in progress

? Antenatal nipple care for increasing the duration of breastfeeding (Blyth 2004)

Cochrane protocol, Cochrane review in progress

? Interventions for preventing nipple pain in breastfeeding mothers (McCormick 2004)

Cochrane protocol, Cochrane review in progress

JInterventions for promoting the initiation of breastfeeding (Dyson 2005)

Further trials need to be adequately powered and carried out in diverse settings
The trials need to fully describe the nature of the educational interventions
Interventions that combine education and support need to be compared with those that offer education alone
Need further research into early mother-infant contact followed by rooming-in until hospital discharge

POSTNATAL INTERVENTIONS FOR BREASTFEEDING RATES AND/OR DURATION

?Influence of a policy of early discharge on breastfeeding rates (Brown 2002)

Since high attrition is likely, further studies of early discharge need to consider this when calculating sample sizes
The role of co-interventions (such as antenatal preparation or not) needs to be established

JInterventions for promoting the initiation of breastfeeding (Dyson 2005)

Further trials need to be adequately powered and carried out in diverse settings
The trials need to fully describe the nature of the educational interventions
Interventions that combine education and support need to be compared with those that offer education alone
Need further research into early mother-infant contact followed by rooming-in until hospital discharge

Interventions for women who are breastfeeding

? Antibiotics for mastitis in breastfeeding women (Ng 2005)

Cochrane protocol, Cochrane review in progress

? Commercial hospital discharge packs for breastfeeding women (Donnelly 2000)

Cochrane review has been withdrawn

? Interventions for treating nipple pain in breastfeeding women (McCormick 2004)

Cochrane protocol, Cochrane review in progress

? Medications for increasing milk supply in mothers expressing breastmilk for their hospitalised infants (Donovan 2005)

Cochrane protocol, Cochrane review in progress

? Support for breastfeeding mothers (Sikorski 2002)

Cochrane review has been withdrawn

?Treatments for breast engorgement during lactation (Snowden 2001)

Cochrane review has been withdrawn

?Treatments for suppression of lactation (Oladapo 2006)

Cochrane protocol, Cochrane review in progress

?Vitamin A supplementation for breastfeeding women (Oliveira 2006)

Cochrane protocol, Cochrane review in progress

Interventions for infants being breastfed

? Kangaroo mother care to increase rate of exclusive breastfeeding (Conde-Agudelo 2003)

Future studies need to address selection bias, attrition, completeness and length of follow-up, and bias in assessing outcomes

JExclusive breastfeeding for six months versus exclusive breastfeeding for three to four months with mixed breastfeeding (Kramer 2002)

Need large randomized trials of exclusive breastfeeding for six months to exclude differences in risk of malnutrition in developing countries, and to confirm or undermine the findings on infectious morbidity
Cluster randomization by clinic or even community may be the preferred research design
Longer-term impacts on child intelligence, neuromotor development, blood pressure, growth, and atopic disease and on maternal and child social and emotional need to be assessed

References

Blyth R, Smyth W, Flenady V. Antenatal nipple care for increasing the duration of breastfeeding. (Protocol) The Cochrane Database of Systematic Reviews 2004, Issue 1
Brown S, Small R, Faber B, Krastev A, Davis P. Early postnatal discharge from hospital for healthy mothers and term infants. The Cochrane Database of Systematic Reviews 2002, Issue 3
Conde-Agudelo A, Diaz-Rossello JL, Belizan JM. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. The Cochrane Database of Systematic Reviews 2003, Issue 2
Donnelly A, Snowden HM, Renfrew MJ, Woolridge MW. Commercial hospital discharge packs for breastfeeding women. The Cochrane Database of Systematic Reviews 2000, Issue 2
Donovan TJ, Buchanan K. Medications for increasing milk supply in mothers expressing breastmilk for their hospitalised infants. (Protocol) The Cochrane Database of Systematic Reviews 2005, Issue 4
Dyson L, McCormick F, Renfrew MJ. Interventions for promoting the initiation of breastfeeding. The Cochrane Database of Systematic Reviews 2005, Issue 2
Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. The Cochrane Database of Systematic Reviews 2002, Issue 1
Lee SJ, Thomas J.Antenatal breast examination for promoting breastfeeding. (Protocol) Cochrane Database of Systematic Reviews 2006, Issue 3
McCormick FM, Renfrew MJ. Interventions for preventing and treating nipple pain in breastfeeding mothers. (Protocol) The Cochrane Database of Systematic Reviews 2004, Issue 1
Ng C, Jahanfar S, Teng CL. Antibiotics for mastitis in breastfeeding women. (Protocol) The Cochrane Database of Systematic Reviews 2005, Issue 3
Oladapo OT, Fawole B. Treatments for suppression of lactation. (Protocol) Cochrane Database of Systematic Reviews 2006, Issue 2
Oliveira JM, Bergamaschi DP, East CE, Pai M. Vitamin A supplementation for breastfeeding mothers. (Protocol) Cochrane Database of Systematic Reviews 2006, Issue 2
Sikorski J, Renfrew M J, Pindoria S, Wade A. Support for breastfeeding mothers. The Cochrane Database of Systematic Reviews 2002, Issue 1
Snowden HM, Renfrew MJ, Woolridge MW. Treatments for breast engorgement during lactation. The Cochrane Database of Systematic Reviews 2001, Issue 2