Sánchez-Sánchez, M., García, T.L., Heredia, D. et al. Effect of a light-darkness cycle on the body weight gain of preterm infants admitted to the neonatal intensive care unit. Sci Rep 12, 17569 (2022). https://doi.org/10.1038/s41598-022-22533-1
Below is a selection of recent research on the effects of breastfeeding and breastmilk on neonatal outcomes. For more information on embedding Baby Friendly care in the neonatal unit, see our dedicated guidance document.
Oxytocin Levels Increase and Anxiety Decreases in Mothers Who Sing and Talk to Their Premature Infants during a Painful Procedure
Maternal stress experiences with neonatal intensive care unit admissions
This prospective analytical study was conducted in NICU of a tertiary care hospital over a period of 12 months after obtaining permission from the institutional ethics committee. The study summarises the overall impact of NICU environmental stressors affecting mothers in a developing country and also emphasises the need for further studies in this area for identification of factors that contribute to maternal stress. It may enable health professionals to facilitate mothers’ adaptation, thereby promoting optimal mother–infant relationships and subsequent infant development.
Ansari, T.F., Wade, P., Singh, V. et al. Maternal stress experiences with neonatal intensive care unit admissions. Egypt Pediatric Association Gaz 70, 47 (2022). https://doi.org/10.1186/s43054-022-00138-7
Bovine-based breast milk fortifier and neonatal outcomes in premature infants <32 weeks’ gestational age
To examine if the use of bovine-based breast milk fortifier (BMF) in preterm infants plays a role in the development of necrotising enterocolitis (NEC), or an increase in all-cause mortality. Findings showed that use of bovine BMF was not associated with adverse outcomes in this study. BMF use was associated with a decreased rate of adverse outcomes in the most clinically vulnerable infants.
Provision of positive oral experiences for premature infants by offering milk drops: A clinical practice change initiative
The objective of this clinical practice change was to provide positive oral experiences to premature infants by offering droplets of human milk or formula orally during gavage feedings, subsequently referred to as the Milk Drop Intervention. The pre- and post-implementation quasi-experimental study included a total of 198 premature infants born at 24 to 33 + 6 weeks’ gestation. Conclusions found that offering milk drops during gavage feedings is a simple, low-cost, intervention that may provide positive oral experiences for the smallest and most fragile of premature infants.
O Rourke, B. Provision of positive oral experiences for premature infants by offering milk drops: A clinical practice change initiative, Journal of Neonatal Nursing, 2022,, ISSN 1355-1841, https://doi.org/10.1016/j.jnn.2022.11.014.
Babies before business: protecting the integrity of health professionals from institutional conflict of interest
This article explores how the commercial milk formula industry’s duty to maximise profits conflicts with the health system’s duty to protect health and to support breastfeeding, and how the marketing tactics and relationships with the commercial milk formula industry including financial or material support, sponsorship of training or research and advertising in journals or at events contribute to conflicts of interest within the health system.
Family-centred care and breastfeeding self-efficacy determined how ready mothers were for their infants to be discharged from a neonatal intensive care unit
Breastfeeding and human milk bank in a neonatal intensive care unit: impact of the COVID-19 pandemic in an Italian cohort of very low birth weight infants
This single-centre retrospective analysis explored two cohorts of very low birth weight infants born in a hospital in Italy. Babies fed with maternal milk at the achievement of full enteral feeding was compared with the rate of those exclusively breastfed at discharge in the two groups, alongside the impact of donated human milk availability on infant formula use. Findings concluded that pandemic-induced stress imapcted on the availability of expressed maternal milk in NICU. However, the presence of human donated milk was fundamental in preventing increased use of infant formula during NICU stays. This underlines how strategies to implement the widespread establishment of donor milk banks on a national level are warranted.
Bresesti I, Morlacchi L, Cazzaniga C, Sangiorgio C, Bertù L, Bolis ME, Bossi A, Agosti M. Breastfeeding and human milk bank in a neonatal intensive care unit: impact of the COVID-19 pandemic in an Italian cohort of very low birth weight infants. Int Breastfeed J. 2022 Dec 29;17(1):94. doi: 10.1186/s13006-022-00529-x. PMID: 36581945; PMCID: PMC9798351.
WHO recommendations for care of the preterm or low-birth-weight infant
Despite substantial progress over the last 10 years, the survival, health, growth and neurodevelopment of preterm and LBW infants remains concerning in many countries. Reasons include the complexities of caring for these vulnerable infants and preventing complications. The recommendations in this guideline are intended to inform the development of national and subnational health policies, clinical protocols and programmatic guides. They include information on key information on what matters to families; early initiation of kangaroo care; family involvement, including zero separation policies; and the importance of mother’s own milk and donor human milk.
Neonatal outcomes from a quasi-experimental clinical trial of Family Integrated Care versus Family-Centered Care for preterm infants in U.S. NICUs
Psychosocial Difficulties Experienced By Parents Of Babies Treated In A Neonatal Intensive Care Unit During The Coronavirus Pandemic
Service and Quality Standards for Provision of Neonatal Care in the UK
This document provides a consensus view of Service and Quality Standards for the provision of neonatal care in the UK. It is the amalgamation of two documents: the BAPM Service Standards and Neonatal Service Quality Indicators documents.
Breastmilk Exposure is Associated With Cortical Maturation in Preterm Infants
Breastmilk exposure is associated with improved neurocognitive outcomes following preterm birth, but the neural substrates linking breastmilk with outcome are uncertain. This study tested the hypothesis that high versus low breastmilk exposure in preterm infants results in cortical morphology that more closely resembles that of term-born infants. Data was collected from a total of 135 preterm (<32 weeks’ gestation) and 77 term infants and compared between preterm infants who received exclusive breast milk for <75% of inpatient days, preterm infants who received exclusive breast milk for ≥75% of inpatient days and term-born controls. Findings indicated that high breastmilk exposure following preterm birth is associated with a cortical imaging phenotype that more closely resembles the brain morphology of term-born infants and effects appear to be dose-dependent.
Sullivan, G., Vaher, K., Blesa, M., Galdi, P., Stoye, D.Q., Quigley, A.J., Thrippleton, M.J., Norrie, J., Bastin, M.E. and Boardman, J.P. (2022), Breast Milk Exposure is Associated With Cortical Maturation in Preterm Infants. Ann Neurol. https://doi.org/10.1002/ana.26559
This study assessed forty-two studies enrolling 89,638 infants to explore the effects of feeding preterm or low birth weight infants with infant formula compared with mother’s own milk. In preterm and low birth weight infants, low to very low-certainty evidence indicates that feeding with infant formula compared with mother’s own milk has little effect on all-cause mortality, infection, growth, or neurodevelopment, and a higher risk of developing necrotizing enterocolitis.
Natalie A. Strobel, Claire Adams, Daniel R. McAullay, Karen M. Edmond; Mother’s Own Milk Compared With Formula Milk for Feeding Preterm or Low Birth Weight Infants: Systematic Review and Meta-analysis. Pediatrics August 2022; 150 (Supplement 1): e2022057092D. 10.1542/peds.2022-057092D
Advantages of Side-Lying Position. A Comparative Study of Positioning During Bottle-Feeding in Preterm Infants (≤34 Weeks GA)
Optimal positioning is a key factor in safe, high-quality bottle feeds for premature infants. This study found that a side-lying position was effective in reducing the number of choking episodes and led to a higher proportion of milk consumption compared to semi-elevated position.
Raczyńska, Anna, Gulczyńska, Ewa and Talar, Tomasz. “Advantages of Side-Lying Position. A Comparative Study of Positioning During Bottle-Feeding in Preterm Infants (≤34 Weeks GA)” Journal of Mother and Child, vol.0, no.0, 2022, pp.-. https://doi.org/10.34763/jmotherandchild.20212504.d-22-00008
Effect of Breast Milk Oral Care on Mechanically Ventilated Preterm Infants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
This meta-analysis of randomised controlled trials involving 1,046 preterm infants demonstrates the effects of breastmilk oral care on reducing the incidence of ventilator-associated pneumonia and necrotizing enterocolitis, and shortening mechanical ventilation time and length of stay for preterm infants.
Cai M, Lin L, Peng Y, Chen L, Lin Y. Effect of Breast Milk Oral Care on Mechanically Ventilated Preterm Infants: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Pediatr. 2022 Jul 7;10:899193. doi: 10.3389/fped.2022.899193. PMID: 35874566; PMCID: PMC9301042.
Global neonatal care and access to human milk
A crucial component of global neonatal care is access to human milk, which requires skilled lactation support for the breastfeeding dyad and the existence of human milk banks that can provide safe donor human milk to medically vulnerable populations. This study reports impressive growth in lactation support in the last decade in Brazil, including a 52% increase in the number of milk banks/collection stations.
The role of skin-to-skin contact in exclusive breastfeeding: a cohort study
This systematic review and realist synthesis explores the barriers and facilitators in the implementation of kangaroo mother care (KMC) in the UK and calls for improvements in staff training, parental support, and promotion of KMC as a potential cost-effective alternative to reduce incubator use in the UK.
Randomised controlled trial of human derived breast milk fortifier versus bovine milk fortifier on body composition in very preterm babies
Findings from this study which compared the effects of exclusive human milk-based diet with a diet containing cow milk products on body composition in infants born below 30 weeks gestation identified no clinically relevant differences in body composition in preterm babies <30 weeks gestation receiving a macronutrient-equivalent exclusive human milk diet compared with a diet containing cow milk products.
Sabita Uthaya, Suzan Jeffries, Izabela Andrewsjewska, Vimal Vasu, Nicholas D Embleton, Neena Modi, Randomised controlled trial of human derived breast milk fortifier versus bovine milk fortifier on body composition in very preterm babies, Early Human Development, Volume 171, 2022, 105619, ISSN 0378-3782, https://doi.org/10.1016/j.earlhumdev.2022.105619.
Source of human milk (mother or donor) is more important than fortifier type (human or bovine) in shaping the preterm infant microbiome
A total of 586 infants born at less than 33 weeks’ gestation at 5 Australian perinatal centres were evaluated at a corrected age of 7 years as part of this prospective cohort study, with findings demonstrating positive cognitive, academic, and behavioral outcomes relating to maternal milk feeding after very preterm birth.
Belfort MB, Knight E, Chandarana S, et al. Associations of Maternal Milk Feeding With Neurodevelopmental Outcomes at 7 Years of Age in Former Preterm Infants. JAMA Netw Open. 2022;5(7):e2221608. doi:10.1001/jamanetworkopen.2022.21608
Parent-infant interaction quality is related to preterm status and sensory processing
This study examined the effects of thawing and warming on the secretory immunoglobulin A (SIgA) level and lysozyme activity in frozen human milk (HM) to identify optimal methods for preserving immune factors in frozen HM. Findings indicated that the thawing of HM in the refrigerator overnight has the potential to preserve the SIgA concentration and lysozyme activity to a greater extent than heating immediately after removal from the freezer.
Li, X., Siviroj, P., Ruangsuriya, J. et al. Effects of the thawing rate and heating temperature on immunoglobulin A and lysozyme activity in human milk. Int Breastfeed J 17, 52 (2022). https://doi.org/10.1186/s13006-022-00487-4
Hypernatremia in Newborns: A Practical Approach to Management
Hypernatremia is a potentially serious condition in both term and preterm babies, which can lead to severe and permanent neurological damage. Understanding this physiological process, early anticipation of hypernatremia and familiarization with the neonatal management of hypernatremia can prevent mortality and long-term morbidity associated with this condition. This review aims to provide a practical and understandable approach to the diagnosis and management of hypernatremia in neonates.
The impact of a Donor Human Milk Program on the provision of mothers’ own milk at discharge in very low birth weight infants
This single center retrospective analysis examines the effect of a donor human milk (DHM) program on mothers’ own milk feedings at discharge for very low birth weight infants. Both the percentage of mothers’ own milk feeds and percent of infants exclusively receiving mothers’ own milk at discharge were increased in the <1500 g and the ≥1500 g group respectively. Practice changes that accompany a donor milk program likely play a prominent role in the provision of mothers’ own milk and exclusivity of breastmilk feedings at discharge for very low birth weight infants.
Corallo J, Bieda A, Garland M, Dowling D, Timoney P, Bateman DA. The impact of a Donor Human Milk Program on the provision of mothers’ own milk at discharge in very low birth weight infants. J Perinatol. 2022 Jul 21. doi: 10.1038/s41372-022-01439-w. Epub ahead of print. PMID: 35864217.
Impact of Kangaroo Care on Premature Infants’ Oxygenation: Systematic Review
Kangaroo care (KC) is an effective method of promoting health and wellbeing of infants and their families. This systematic review analysed a total of 345 articles on KC, with 25 studies included. Physiological parameters monitored (heart rate, arterial oxygen saturation, regional cerebral oxygen saturation, and fractional oxygen extraction) showed no significant changes at different study periods: pre-KC, during KC, and post-KC. Findings concluded that stable preterm infants receiving or not respiratory support show no significant differences in heart rate, arterial oxygen saturation or fractional oxygen extraction during KC compared to routine incubator care. Regional cerebral oxygen saturation remains stable during KC with slight upward trend. Further studies with a higher level of methodological quality are needed to confirm these findings.
Solaz-García Á, Lara-Cantón I, Pinilla-González A, Montejano-Lozoya R, Gimeno-Navarro A, Sánchez-Illana Á, Marco-Piñol A, Vento M, Sáenz-González P. Impact of Kangaroo Care on Premature Infants’ Oxygenation: Systematic Review. Neonatology. 2022 Jun 22:1-10. doi: 10.1159/000525014. Epub ahead of print. PMID: 35732143.
Mother-Newborn Care Unit (MNCU) Experience in India: A Paradigm Shift in Care of Small and Sick Newborns
This multicountry, randomized, controlled trial co-ordinated by WHO addressed a research gap relating to evidence of the effect of initiating kangaroo mother care immediately after birth without waiting for babies to become stable was unavailable. This trial was conducted in five hospitals in Ghana, India, Malawi, Nigeria, and Tanzania. Implementation of this trial led to development of the mother–newborn care unit (MNCU), a facility where sick and small newborns are cared with their mothers 24/7 with all facilities of level II newborn care and provision for postnatal care to mothers. The study results show that intervention babies in MNCU had 25% less mortality at 28 days of life, 35% less incidence of hypothermia, and 18% less suspected sepsis as compared to control babies cared in conventional NICU.
Chellani, H., Arya, S., Mittal, P. et al. Mother-Newborn Care Unit (MNCU) Experience in India: A Paradigm Shift in Care of Small and Sick Newborns. Indian J Pediatr 89, 484–489 (2022). https://doi.org/10.1007/s12098-022-04145-9
Analysis of salivary cortisol levels in preterm infants and their mothers in this study found that skin-to-skin contact reduced experiences of stress. The study included 60 preterm infants with gestational age less than 32 weeks, who were treated in the neonatal intensive care unit, and their mothers. The overall design was a baseline-response design. Saliva was collected before (baseline) and after skin-to-skin contact to measure free cortisol by enzyme immunoassay method.
This study assessed whether kangaroo mother care (KMC) in infancy affects brain volumes in young adulthood. Bivariate analysis of 178 adults born preterm showed larger volumes of total grey matter, basal nuclei, cerebellum and white matter in the 97 participants who had received KMC, indicating that the neuroprotective effects of KMC for preterm infants persisted beyond childhood and improved their lifetime functionality and quality of life.
Preterm birth during the COVID-19 pandemic: Parental experience
Results of an online survey of 107 participants share insights on the experiences of parents with a preterm or unwell neonate during the Covid-19 pandemic. Findings showed significant psychological and emotional impacts due to restrictions imposed on the units, with parents also reporting concerns about bonding with their baby. Read more from this study below.
Breastmilk exposure is associated with cortical maturation in preterm infants
This study combined nutritional data with brain MRI to explore the extent to which breastmilk exposure in preterm infants during neonatal care resulted in a cortical morphology more closely resembling that of term infants. A total of 135 preterm and 77 term infants took part in this study, with results indicating that high breastmilk exposure was associated with reduced cortical gray matter volume, thickness and radial diffusivity, and increased fractional anisotropy after adjustment for age at MRI.
Gemma Sullivan, Kadi Vaher, Manuel Blesa, Paola Galdi, David Q. Stoye, Alan J. Quigley, Michael J. Thrippleton, Mark E. Bastin, James P. Boardman medRxiv 2022.01.04.22268723; doi: https://doi.org/10.1101/2022.01.04.22268723
Being the Father of a Preterm-Born Child: Contemporary Research and Recommendations for NICU Staff
This paper describes the role of fathers in the NICU, the best practices to support fathers, and explains the role of a psychologist in the NICU staff. Considerations and suggestions are provided on the difficulties encountered to support parents, with a focus on the role of fathers during the COVID-19 pandemic.
Family Integrated Care: A Framework for Practice
Family Integrated Care (FICare) is a model of neonatal care which promotes a culture of partnership between families and staff and enables parents to become confident, knowledgeable and independent primary caregivers. This BAPM framework describes a model of FICare and provides a structure for implementation in UK neonatal units and networks.
Symptoms of depression in parents after discharge from NICU associated with family-centred care
The aim of this longitudinal, multicentre cohort study conducted from 2018 to 2020 in 23 NICUs across 15 countries was to examine the potential association of family-centred care as perceived by parents during a NICU stay with parents’ depressive symptoms at discharge and at 4 months corrected for infant age (n= 635 mothers, n = 466, fathers, n= 739 infants). Results found that the mothers’ and the fathers’ perceptions of family-centred care were associated with their depressive symptoms at discharge and at 4 months corrected age, controlling for gestational age, multiple birth, parent education and relationship status. Parents’ participation in infant care, care-related decisions and emotional support provided to parents by staff explained the variation in the parents’ perceptions of family-centred care. The factors facilitating the implementation of family-centred care included unlimited access to the unit for the parents and for their significant others, as well as amenities for parents. Findings indicate that family-centred NICU care associates with parents’ depressive symptoms after a NICU stay.
ABM Clinical Protocol #35: Supporting Breastfeeding During Maternal or Child Hospitalisation
This protocol outlines recommended care for hospitalised lactating mothers and breastfeeding children and serves to set the standards to implement these model policies.
Melissa Bartick, Maria Teresa Hernández-Aguilar, Nancy Wight, Katrina B. Mitchell, Liliana Simon, Lauren Hanley, Samantha Meltzer-Brody, Robert M. Lawrence, and the Academy of Breastfeeding Medicine. Breastfeeding Medicine 2021 16:9, 664-674
Cue-based versus scheduled feeding for preterm infants transitioning from tube to oral feeding: the Cubs mixed-methods feasibility study
This mixed-methods intervention study analysed current approaches and understanding of cue-based feeding and the transition between preterm tube to oral feeding in neonatal units. Findings indicated that a cue-based feeding intervention was acceptable to parents and staff and would be feasible to implement. However, results also showed that this would require improvements to both staff training and data recording.
McFadden A, Fitzpatrick B, Shinwell S, Tosh K, Donnan P, Wallace LM, et al. Cue-based versus scheduled feeding for preterm infants transitioning from tube to oral feeding: the Cubs mixed-methods feasibility study. Health Technol Assess 2021;25(74)https://www.journalslibrary.nihr.ac.uk/hta/hta25740/#/abstract
Bliss research shows young parents face ‘double whammy’ of being underprepared and under-supported when their babies are in neonatal care
More than half of a group of 200 parents with a baby born premature or sick felt they were not as involved in care giving or decision making as they would have liked, a study by Bliss shares. One in five parents indicated that communication was often unclear, with some feeling they were excluded from care discussions because they were assumed to be incapable of contributing. Read more by visiting the Bliss website.
Preterm nutrition and neurodevelopmental outcomes
Inoculation of mother’s own milk could personalize pasteurized donor human milk used for feeding preterm infants
In an in-vitro study, pasteurized donor human milk was inoculated at 10% v/v using ten preterm milk samples and analysed in order to evaluate the effect in terms of bacterial growth, human milk microbiome and proteolytic phenomena. Findings showed that IM samples at T2 showed a Total Bacterial Count were not significantly different (p > 0.01) compared to preterm milk samples, demonstrating that inoculation of PDHM with mother’s own milk could restore bacterial growth and personalize human milk microbiome in PDHM. This effect could be beneficial because of the presence of maternal probiotic bacteria which make PDHM more similar to mother’s own milk.
Mallardi, D., Tabasso, C., Piemontese, P. et al. Inoculation of mother’s own milk could personalize pasteurized donor human milk used for feeding preterm infants. J Transl Med 19, 420 (2021). https://doi.org/10.1186/s12967-021-03096-7
Breastfeeding promotes early neonatal regulatory T-cell expansion and immune tolerance of non-inherited maternal antigens
Cardiac Performance in the First Year of Age Among Preterm Infants Fed Maternal Breast Milk
Preterm infants with higher consumption of mother’s own milk were found to have enhanced cardiac performance at age 1 year, suggesting that mother’s own milk consumption may play a dynamic modulator role on cardiac mechanics in preterm-born infants. This cross-sectional study of cardiac and nutritional data included 80 individuals born preterm and 100 individuals in the control group born full-term born between 2011 and 2013.
Neonatal health care providers can support lactation in the NICU and potentially reduce disparities in the provision of mother’s own milk by encouraging early and frequent milk expression and by promoting skin-to-skin contact and direct breastfeeding. Mother’s own milk is the optimal nutrition source for very low birth weight babies (≤1500 g), providing short- and long-term health benefits.
Is preterm donor milk better than preterm formula for very-low-birth-weight infants?
This single-centre prospective cohort study explored the effects of donor milk and preterm formula on growth, feeding tolerance and severe morbidity in 304 very-low-birth-weight infants. Results indicate that preterm donor milk does not affect growth in preterm infants, however it does significantly reduce feeding intolerance, helps to achieve full enteral feeding early, and lowers infection rates.
Fang, L., Zhang, M., Wu, L., Wang, R., Lin, B., Yao, J., & Chen, D. (2021). Is preterm donor milk better than preterm formula for very-low-birth-weight infants?. Food & Nutrition Research, 65. https://doi.org/10.29219/fnr.v65.5346
Variation in Oxygen Saturation by Pulse Oximetry During and After Breastfeeding Among Healthy Term Neonates During Early Postnatal Life at Tertiary Care Hospital
Variations in oxygen saturation levels of 60 healthy term infants were found to be significantly higher after breastfeeding, highlighting the crucial role effective breastfeeding plays in infant growth. Greater research is needed on infant breathing and sucking patterns to enable healthcare professionals to identify feeding difficulties and suggest effective breastfeeding methods.
Niaz S, Kumar V, Rahim A, et al. (2021) Variation in Oxygen Saturation by Pulse Oximetry During and After Breastfeeding Among Healthy Term Neonates During Early Postnatal Life at Tertiary Care Hospital. Cureus 13(7): e16564. doi:10.7759/cureus.16564
Locked out: the impact of Covid-19 on neonatal care
Findings from a survey of 70 NHS Trusts and over 500 parents of neonatal babies born between March 2020 and February 2021 indicate ongoing challenges faced by parents in spending time with their infants in the critical first days and weeks of life. This has a negative impact on bonding, attachment, and parental mental health, with parents 70% more likely to say they found it difficult to bond with their baby if Covid-19 had resulted in restricted access to the neonatal unit.
Intervention Strategies for the Poor Feeder in the Newborn Intensive Care Unit: External Pacing versus Imposed Regulation
This article compares and contrasts external pacing, a method of feeding developed in the 1980s as a cue-based technique to aid infants who were experiencing discomfort or distress – and imposed regulation – a diagnostic-based intervention strategy developed in the 1990s and implemented following a diagnosis of a disorganised suck on the Neonatal Oral-Motor Assessment Scale (NOMAS®).
Early breastmilk exposure modifies brain connectivity in preterm infants
Preterm infants are at increased risk of alterations in brain structure and connectivity and subsequent neurocognitive impairment. This study explores the extent to which breastmilk exposure is associated with improved markers of brain development and connectivity in preterm infants at term equivalent age. Findings from an analysis of data on 47 preterm infants’ neonatal breastmilk exposure and brain MRI suggests that breastmilk feeding in the weeks after preterm birth is associated with improved structural connectivity of developing networks and greater fractional anisotropy in major white matter fasciculi.
Blesa M, Sullivan G, Anblagan D, Telford EJ, Quigley AJ, Sparrow SA, Serag A, Semple SI, Bastin ME, Boardman JP. Early breast milk exposure modifies brain connectivity in preterm infants. Neuroimage. 2019 Jan 1;184:431-439. doi: 10.1016/j.neuroimage.2018.09.045. Epub 2018 Sep 18. PMID: 30240903.
Nurturescience versus neuroscience: A case for rethinking perinatal mother–infant behaviors and relationship
With the understanding that there has not been a significant improvement in the outcomes for babies who were separated from their mothers due to prematurity or birth defects in the past two decades, and that current neuroscience-based theories and treatment paradigms have not yet generated explanatory mechanisms that work, or provided testable hypotheses, a new field of scientific investigation titled “nurturescience” is proposed in this article, described as being drawn from biology, anthropology, sociology, physiological, and clinical research, and based on the basic needs of all newborns, mothers and families. Key themes in this new field include that the mother–infant dyad should not be separated, skin-to-skin contact, and infant and family centered developmental care .
Bergman, Nils & Ludwig, Robert & Westrup, Björn & Welch, Martha. (2019). Nurturescience versus neuroscience: A case for rethinking perinatal mother–infant behaviors and relationship. Birth Defects Research. 111. 10.1002/bdr2.1529
Neuroscience meets nurture: challenges of prematurity and the critical role of family-centred and developmental care as a key part of the neuroprotection care bundle
This review examines the developmental milestones of fetal brain development and how preterm birth can disrupt this trajectory. Authors review the common morbidities associated with premature birth, and outline a range of sustainable and effective non-medical, family-centred and developmental care strategies which have the potential to improve neurodevelopmental outcomes and which and need to be considered part of the future neuroprotection care bundle.
Positive Effects of Kangaroo Mother Care on Long-Term Breastfeeding Rates, Growth, and Neurodevelopment in Preterm Infants
This study investigates the impact of kangaroo mother care (KMC) on breastfeeding and health outcomes in Chinese preterm infants. A longitudinal randomised controlled study was conducted with 79 preterm infant-mother dyads. The KMC group (n = 36) was provided 2.5 hours/day KMC during the neonatal intensive care unit (NICU) hospitalization, while the control group (n = 43) received standard care. Infant’s feeding regimens and physical growth were documented daily at NICU. Physical growth and Neonatal Behavioral Neurological Assessment were measured at 40 weeks, 3 months, and 6 months of corrected age (CA). Breastfeeding outcomes were documented at 6 months of CA. Findings showed that the KMC infants received higher mothers’ milk proportion during hospitalisation, less feeding intolerance at discharge, and higher exclusive breastfeeding proportion at 6 months CA. They also had increased body weight and measurements at discharge, along with higher neurobehavioral scores. Authors concluded that longitudinal KMC effects are significant in promoting preterm infants’ breastfeeding outcomes, growth, and neurodevelopment. Early initiation of KMC practice is highly recommended to the parent-infant population in Chinese NICUs to promote breastfeeding and developmental outcomes.
Wang Y, Zhao T, Zhang Y, Li S, Cong X. Positive Effects of Kangaroo Mother Care on Long-Term Breastfeeding Rates, Growth, and Neurodevelopment in Preterm Infants. Breastfeed Med. 2021 Feb 2. doi: 10.1089/bfm.2020.0358. Epub ahead of print. PMID: 33533688.
The Economic Impact of Donor Milk in the Neonatal Intensive Care Unit
Researchers conducted a retrospective analysis of 319 infants with very low birth weight born before (January 2011-December 2012, mother’s own milk + formula, n = 150) and after (April 2013-March 2015, mother’s own milk + donor milk, n = 169) to assess the cost-effectiveness of mother’s own milk supplemented with donor milk vs mother’s own milk supplemented with formula for infants of very low birth weight in the neonatal intensive care unit (NICU). Results found that infants receiving mother’s own milk + donor milk had a lower incidence of necrotizing enterocolitis (NEC) than infants receiving mother’s own milk + formula (1.8% vs 6.0%, P = .048). Mother’s own milk + donor milk was associated with $15 555 lower costs per infant (P = .045) and saved $1812 per percentage point decrease in NEC incidence.
The stepwise assembly of the neonatal virome is modulated by breastfeeding
Whilst healthy human neonates typically do not have viruses at birth, they can quickly become colonised which can lead to gastrointestinal disorders. This takes place in distinct steps: early after birth, bacteria colonises the infant gut and by one month can lead to virus-like particles. By four months of life, these viruses can become more prominent. The findings of this study concur with other reports that breastmilk can provide protection against viral infections.
Preterm Infants Fed Cow’s Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother’s Own Milk
This study re-analysed a 12-centre randomised trial that compared exclusive human milk feeding, including mother’s own milk, donor milk and human milk-derived fortifier versus a cow’s milk exposed group fed mother’s own milk, preterm formula and cow’s milk derived fortifier (CMDF). To allow for an isolated comparison of fortifier type and to evaluate rates of necrotizing entercolitis (NEC), severe morbidity index of NEC surgery or death and other outcomes, a subgroup analysis (n = 114) selecting only infants receiving 100% mother’s own milk plus fortification/fed no donor milk or preterm formula was conducted. The study concluded that available evidence points to an increase in adverse outcomes with CMDF, including NEC and severe morbidity comprising NEC surgery or death.
National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis
This study from the London School of Hygiene & Tropical Medicine, the World Health Organization (WHO) and UNICEF estimates that globally 20.5 million babies were born with a low birthweight in 2015 – around 1 in 7 babies. The findings show that the problem is substantial in both high and low income countries, and highlight the need for more action to help tackle the underlying causes of low birthweight as well as improve care for low birthweight babies and their families. In the UK, the Unicef UK Baby Friendly Initiative neonatal standards support units to empower parents to be active partners in their baby’s care, support the development of close and loving parent-infant relationships, and enable babies to receive breastmilk, which gives them vital protection against infection and supports their short and long-term health outcomes.
Blencowe, H, Krasevec, J, de Onis, M, et al (2019). National, regional, and worldwide estimates of low birthweight in 2015, with trends from 2000: a systematic analysis. The Lancet Global Health, doi.org/10.1016/S2214-109X(18)30565-5
The effects of kangaroo mother care on the time to breastfeeding initiation among preterm and low birthweight infants: a meta-analysis of published studies
This review of studies found that preterm and low birthweight infants receiving a kangaroo mother care intervention initiated breastfeeding 2 days 14 h 24 min earlier than infants who received the “conventional” care of the radiant warmer/incubator method.
Mekonnen, A, Yehualashet, S and Bayleyegn, D, (2019). The effects of kangaroo mother care on the time to breastfeeding initiation among preterm and low birthweight infants: a meta-analysis of published studies. International Breastfeeding Journal, doi.org/10.1186/s13006-019-0206-0
Reducing parental trauma and stress in neonatal intensive care: systematic review and meta-analysis of hospital interventions
This review of studies suggests that interventions designed to support parents on a neonatal unit can be successful in reducing parental distress – in particular, complementary/alternative medicine and family-centered instruction interventions each decreased distress symptoms, with fathers and mothers improving to similar extents. The authors recommend further research into the issue, and argue for the importance of developing psychosocial interventions that serve NICU parents at large, including fathers and parents of full-term infants.
Sabnis, A, Fojo, S, Nayak, S, et al, (2019). Reducing parental trauma and stress in neonatal intensive care: systematic review and meta-analysis of hospital interventions. Journal of Perinatology, doi.org/10.1038/s41372-018-0310-9
- The type of feeding at discharge of very preterm infants: Neonatal intensive care units policies and practices make a difference
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