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Neonatal Care Research

Home > Baby Friendly News and Research > Research > Research on Neonatal Care

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.

Effect of breast milk intake volume on early behavioral neurodevelopment of extremely preterm infants

This study aimed to explore the effects of breast milk feeding volume on the early behavioral neurodevelopment of extremely preterm infants (gestational age < 28 weeks). Findings indicate that medium to high levels of breast milk feeding contribute positively to motor and behavioral neurological development in extremely preterm infants and decrease the likelihood of ventricular hemorrhage. However, it does not have a significant effect on the development of behavioral abilities. Due to the limited sample size, the next step will be to expand the sample size and further investigate the extent of the impact on various aspects of the nervous system.

Gao, Y., Lu, X., Pan, M. et al. Effect of breast milk intake volume on early behavioral neurodevelopment of extremely preterm infants. Int Breastfeed J 19, 3 (2024). https://doi.org/10.1186/s13006-024-00612-5

The anatomy of compassion part 2: nurturing compassionate cultures of maternity and neonatal care. Infant 2023; 19(6): 213-18.

The NHS England Three Year Delivery Plan for Maternity and Neonatal Services1 prioritises compassionate care for families and compassionate cultures for staff. In a previous article, we proposed a shared language and understanding of the complexities of practising compassion in this context and why it can feel hard to do. In the following article, we outline what is required to take practical steps – at each level of the system – to foster compassionate care in maternity and neonatal services.

Evans D, Butterworth R, Atkins E, Barr K, Chilvers R, Cole S, Cordwell J, D’Urso A, Higgins S, Marsh A.The anatomy of compassion part 2: nurturing compassionate cultures of maternity and neonatal care. Infant 2023; 19(6): 213-18.

Prevalence and Risk Factors for Post-Discharge Feeding Problems in Children Born Extremely Preterm

Preterm infants have a high risk of post-discharge feeding problems, but there is a lack of population-based studies in infants born extremely preterm and little is known about underlying mechanisms. The objectives were to assess the incidence of post-discharge feeding problems and underweight in a population-based cohort of infants born extremely preterm in Sweden (EXPRESS) and identify perinatal risk factors.

Alm,S., Sjöström, E. S., & Domellöf, M. (2023). Prevalence and Risk Factors for Post-Discharge Feeding Problems in Children Born Extremely Preterm. Journal of Paediatric Gastroenterology and Nutrition, 76(4), 498.

A descriptive evaluation of early feeding development of infants in a local neonatal unit

A local neonatal unit undertook a descriptive evaluation of feeding development of infants receiving care so as to identify and maximise effective neonatal team care and support. A retrospective data review examined infant feeding development from one local neonatal unit. Data were stratified according to gestational birth age and included infant health, post – menstrual age on introduction of oral feeding, oral feeding progression, method of feeding and re-admission to hospital in the first 12 months of life.

The anatomy of compassion part 2: nurturing compassionate cultures of maternity and neonatal care

The NHS England Three Year Delivery Plan for Maternity and Neonatal Services prioritises compassionate care for families and compassionate cultures for staff. In a previous article, we proposed a shared language and understanding of the complexities of practising compassion in this context and why it can feel hard to do. In the following article, we outline what is required to take practical steps – at each level of the system – to foster compassionate care in maternity and neonatal services.

The anatomy of compassion part 2: nurturing compassionate cultures of maternity and neonatal care | Article | Infant journal

BAPM Responds to Single Delivery Plan

On 30th March 2023 NHS England published the Three year delivery plan for maternity and neonatal services. The plan sets out how the NHS will make maternity and neonatal care safer, more personalised, and more equitable for women, babies, and families. BAPM has produced a formal response to the plan.

Main outcomes:

  • Increased funding required to implement recommendations
  • Calls for a national neonatal safety champion as there is for maternity and obstetrics
  • Positive that the FiCare approach is included
  • Calls for funded and protected time for FiCare and BFI leads
  • More funding for cot capacity, parental accommodation, bereavement facilities, neonatal workforce, data benchmarking and analytics (including single data entry points and joined up EPR systems)

https://www.bapm.org/articles/bapm-responds-to-single-delivery-plan

Impact of intrapartum oxytocin administration on neonatal sucking behavior and breastfeeding

This study aimed to examine the effect of intrapartum oxytocin administration on neonatal sucking behavior and breastfeeding. A total of 64 pairs (29 in the group treated with intrapartum oxytocin and 35 in the control group) of normal infants within 24–48 h of birth and their mothers were recruited. Sucking ability was evaluated by measuring Non-Nutritive Sucking (NNS) for 5 min. Data on the rate of exclusive breastfeeding at 1 month postpartum were collected. Findings demonstrate that infants born to mothers who receive intrapartum oxytocin may have impaired sucking ability for at least the first 48 h after birth, and breastfeeding support should be provided.

Omaru M, Kajiwara S, Wakamatsu E et al (2024) Impact of intrapartum oxytocin administration on neonatal sucking behaviour and breastfeeding. Scientific Reports. 14; 5859. Available at: https://www.nature.com/articles/s41598-024-56635-9

Positive breastfeeding experiences and facilitators in mothers of preterm and low birthweight infants: a meta-ethnographic review

Most qualitative research on breastfeeding the preterm or low-birthweight (LBW) infant has focused on negative insights; there are no comprehensive insights into how, when and why mothers experience positive breastfeeding experiences. We aimed to address this knowledge gap by exploring what characterizes and facilitates a positive breastfeeding experience in mothers of preterm and/or LBW infants. Findings offer new insights into what characterizes a positive breastfeeding experience and how staff can facilitate and enable mothers to achieve attuned breastfeeding. Improvements in units’ design, such as for rooming-in and having prolonged skin-to-skin contact, and care provided by knowledgeable, supportive and encouraging staff and peers, are crucial. The mother’s physical and emotional states and the infant’s behavioural responses and physiological signals should guide the process towards positive breastfeeding practices.

Flacking, R., Tandberg, B.,Niela-Vilen, H., Jonsdottir, R., Jonas, W., Ewald, U. and Thomson, G. (2021) ‘Positive breastfeeding experiences and facilitators in mothers of preterm and low birth weight infants: a meta-ethnograp’, International Breastfeeding Journal. 16(88). Available at: https://internationalbreastfeedingjournal.biomedcentral.com/ 

British Association of Perinatal Medicine – BAPM (2023) The Use of Donor Human Milk in Neonates, A BAPM framework for practice.

This revised BAPM Framework outlines best practice use of donor human milk (DHM) for neonates in the UK. It aligns with the Neonatology Getting It Right First Time (GIRFT) Report recommendation that DHM should be available for high risk preterm infants in the absence of sufficient MOM, and advocates for equity of access across all neonatal units and networks.

Available at: https://www.bapm.org/resources/the-use-of-donor-human-milk-in-neonates

Oxytocin Levels Increase and Anxiety Decreases in Mothers Who Sing and Talk to Their Premature Infants during a Painful Procedure

This study aims to assess the effect of maternal singing and speaking on mothers. During a painful procedure over two days, twenty preterm infants were randomly exposed to their mother’s live voice (speaking or singing). Maternal OXT levels were measured twice: before and after singing, as well as before and after speaking. The anxiety and resilience responses of mothers were studied before and after the two-day interventions, regardless of the speaking/singing condition. OXT could be identified as a key mechanism for anxiety regulation in parents, even in sensitive care situations, such as when their infant is in pain. Active involvement of parents in the care of their preterm infants can have a positive effect on their anxiety as well as potential benefits to their sensitivity and care abilities through OXT.

Filippa M, Monaci MG, Spagnuolo C, Di Benedetto M, Serravalle P, Grandjean D. Oxytocin Levels Increase and Anxiety Decreases in Mothers Who Sing and Talk to Their Premature Infants during a Painful Procedure. Children (Basel). 2023 Feb 9;10(2):334. doi: 10.3390/children10020334. PMID: 36832462; PMCID: PMC9955880.

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.

Jordan, K. et al. 2022. Bovine-based breast milk fortifier and neonatal outcomes in premature infants <32 weeks’ gestational age. https://doi.org/10.21203/rs.3.rs-1618734/v1

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.

Becker GE, Ching C, Nguyen TT, et alBabies before business: protecting the integrity of health professionals from institutional conflict of interestBMJ Global Health 2022;7:e009640.

Family-centred care and breastfeeding self-efficacy determined how ready mothers were for their infants to be discharged from a neonatal intensive care unit

This was a secondary analysis of a study on the well-being of mothers whose infants were hospitalised in the level 3 NICU at the Jewish General Hospital in Canada. A total of 132 mother-infant dyads were assessed, with 70 from an open ward NICU and 62 from the purpose-built NICU with pods or single-family rooms that replaced it in 2016. The quality of early family-centred care and breastfeeding self-efficacy were significantly associated with how ready mothers were for their preterm infant to be discharged from the NICU.

Lebel V, Argiropoulos N, Robins S, Charbonneau L, Feeley N. Family-centred care and breastfeeding self-efficacy determined how ready mothers were for their infants to be discharged from a neonatal intensive care unit. Acta Paediatr. 2022 Dec;111(12):2299-2306. doi: 10.1111/apa.16538. Epub 2022 Sep 11. PMID: 36057447.

Effect of a light-darkness cycle on the body weight gain of preterm infants admitted to the neonatal intensive care unit

The Continuous bright light conditions to which premature infants are subjected while hospitalized in Neonatal Intensive Care Units (NICU) can have deleterious effects in terms of growth and development. This study evaluates the benefits of a light/darkness cycle (LDC) in weight and early hospital discharge from the NICU. Subjects were recruited from three participating institutions in Mexico. Main outcome was weight gain and the effect of reducing the intensity of nocturnal light in development of premature infants. Infants to the LDC gained weight earlier, compared with those randomized to CBL, and had a significant reduction in length of hospital stay. These results highlight those premature infants subjected to a LDC exhibit improvements in physiological development, favoring earlier weight gain and consequently a decrease in hospital stays.

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

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.

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.

World Health Organization. (‎2022)‎. WHO recommendations for care of the preterm or low-birth-weight infant. World Health Organization. https://apps.who.int/iris/handle/10665/363697. License: CC BY-NC-SA 3.0 IGO

Neonatal outcomes from a quasi-experimental clinical trial of Family Integrated Care versus Family-Centered Care for preterm infants in U.S. NICUs

This quasi-experimental study enrolled preterm infant (≤ 33 weeks)/parent dyads from 3 NICUs into sequential cohorts: FCC or mFICare. The primary outcome was 21-day change in weight z-scores, and secondary outcomes were nosocomial infection, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and human milk feeding (HMF) at discharge. Intention-to-treat analyses was then used to examine the effect of the FCC and mFICare models overall and per protocol analyses to examine the effects of the mFICare intervention components. Findings indicated that mFICare may have direct benefits on infant outcomes such as weight gain and nosocomial infection. Future studies using implementation science designs are needed to optimize intervention delivery and determine acute and long-term infant and family outcomes.

Franck LS, Gay CL, Hoffmann TJ, Kriz RM, Bisgaard R, Cormier DM, Joe P, Lothe B, Sun Y. Neonatal outcomes from a quasi-experimental clinical trial of Family Integrated Care versus Family-Centered Care for preterm infants in U.S. NICUs. BMC Pediatr. 2022 Nov 22;22(1):674. doi: 10.1186/s12887-022-03732-1. PMID: 36418988.

Implementing infant and family-centred developmental care: Exploring the impact of an innovative educational initiative

The study used a descriptive qualitative design. Five neonatal practitioners participated in semistructured interviews. Interviews were audio-recorded and transcribed for thematic analysis. The qualitative analysis gave rise to four themes and nine subthemes. The four primary themes were motivation and preparedness for FINE 2; learning experiences during FINE 2; post-training reflections and experiences; and anticipating the future. Neonatal practitioners reported positive outcomes from their participation in relation to the development of their knowledge and skills, their performance of their clinical role and the influence on their relationships with other neonatal staff. Being adequately prepared for the programme in terms of managing the time demands, enabling peer support, the role of additional reading and ensuring realistic line management support were identified as important mechanisms for successful engagement and are being used to support further enhancements of the FINE 2 programme.

Gibbs D, Warren IM. Implementing infant and family-centred developmental care: Exploring the impact of an innovative educational initiative. Acta Paediatr. 2022 Nov 22. doi: 10.1111/apa.16603. Epub ahead of print. PMID: 36415078.

Psychosocial Difficulties Experienced By Parents Of Babies Treated In A Neonatal Intensive Care Unit During The Coronavirus Pandemic

This study aimed to  investigate the psychosocial difficulties experienced by parents of babies treated in a neonatal intensive care unit during the coronavirus pandemic and to determine parent-infant attachment. The sample consisted of 20 parents of babies treated in the neonatal intensive care unit (NICU) of a City Hospital in Turkey between July and August 2021. Participation was voluntary. Data were collected using a sociodemographic characteristics questionnaire and a semi-structured qualitative interview form. Each participant was interviewed face to face. Each interview was recorded and transcribed. The data were analyzed using content analysis. Results found that parents of babies treated in the NICU during the COVID-19 pandemic experience anxiety, sadness, unhappiness, and loneliness. The preventive measures against the pandemic affect parents psychosocially. Healthcare professionals should plan and implement care practices and establish effective communication with parents to identify their physiological, psychological, and social needs and help them produce breastmilk and bond with their babies.

Taşgıt A, Dil S. Psychosocial Difficulties Experienced By Parents Of Babies Treated In A Neonatal Intensive Care Unit During The Coronavirus Pandemic. Arch Psychiatr Nurs. 2022 Dec;41:295-299. doi: 10.1016/j.apnu.2022.08.008. Epub 2022 Sep 6. PMID: 36428063.

The relationship between prematurity and maternal mental health during the first postpartum year

Enteral Nutrition in Preterm Infants (2022): A Position Paper from the ESPGHAN Committee on Nutrition and invited experts

This summary paper reviews the current literature and develop consensus conclusions and recommendations on nutrient intakes and nutritional practice in preterm infants with birthweight <1800g and provides updated ESPGHAN CoN consensus-based conclusions and recommendations on nutrient intakes and nutritional management for preterm infants. It is supported by additional supplementary digital content that provide a fuller explanation of the literature and relevant physiology.

Embleton, N. et al. Enteral Nutrition in Preterm Infants (2022): A Position Paper from the ESPGHAN Committee on Nutrition and invited experts. Journal of Pediatric Gastroenterology and Nutrition: October 21, 2022 – Volume – Issue – 10.1097/MPG.0000000000003642 doi: 10.1097/MPG.0000000000003642

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.

British Association of Perinatal Medicine, November 2022. 

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

The Swedish approach to nurturing extremely preterm infants and their families: A nursing perspective

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.

M.T. Perrin, B. Gutierrez dos Santos, K. Mansen et al., Global neonatal care and access to human milk, Jornal de Pediatria (2022), https://doi.org/10.1016/j.jped.2022.07.001

The role of skin-to-skin contact in exclusive breastfeeding: a cohort study

This Brazilian multicentre cohort study explores the role of skin-to-skin and its minimum duration in determining exclusive breastfeeding at hospital discharge in 388 infants weighing up to 1,800g at birth. For infant’s weighting between 1,125-1,655g, skin-to-skin contact was strongly associated with exclusive breastfeeding. Infants with an average > 149.6 min/day of skin-to-skin contact had higher chances in this outcome. Skin-to-skin proved to be of great relevance in maintaining exclusive breastfeeding at hospital discharge for preterm infants.
Goudard MJF, Lamy ZC, Marba STM, Lima GMS, Santos AMD, Vale MSD, Ribeiro TGDS, Costa R, Azevedo VMGO, Lamy-Filho F. The role of skin-to-skin contact in exclusive breastfeeding: a cohort study. Rev Saude Publica. 2022 Jul 25;56:71. doi: 10.11606/s1518-8787.2022056004063. PMID: 35894408; PMCID: PMC9337846.
Why is Kangaroo Mother Care not yet scaled in the UK? A systematic review and realist synthesis of a frugal innovation for newborn care

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.

Stefani G, Skopec M, Battersby C, et al. BMJ Innov 2022;8:9–20

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

Milk fortifiers help meet the nutritional needs of preterm infants receiving their mother’s own milk (MOM) or donor human milk. We conducted a randomized clinical trial (NCT03214822) in 30 very low birth weight premature neonates comparing bovine-derived human milk fortifier (BHMF) versus human-derived fortifier (H2MF). We found that fortifier type does not affect the overall microbiome, although H2MF infants were less often colonized by an unclassified member of Clostridiales Family XI. Secondary analyses show that MOM intake is strongly associated with weight gain and microbiota composition, including Bifidobacterium, Veillonella, and Propionibacterium enrichment. Finally, we show that while oxidative stress (urinary F2-isoprostanes) is not affected by fortifier type or MOM intake, fecal calprotectin is higher in H2MF infants and lower in those consuming more MOM. Overall, the source of human milk (mother versus donor) appears more important than the type of milk fortifier (human versus bovine) in shaping preterm infant gut microbiota.
Associations of Maternal Milk Feeding With Neurodevelopmental Outcomes at 7 Years of Age in Former Preterm Infants

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 aimed to characterise the quality of interactions of parent-infant dyads involving preterm infants who may display sensory processing differences and to examine the associations between parent-infant interaction quality, preterm status and infant sensory processing.  Findings suggest that preterm birth is related to sensory processing difficulties, and that prematurity and sensory processing are differentially associated with aspects of interaction quality. These findings support the further examination of the interplay between preterm birth, sensory processing, and parent-infant interaction quality.

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.

Durrani N, U, R, Imam A, A, Soni N: Hypernatremia in Newborns: A Practical Approach to Management. Biomed Hub 2022;7:55-69. doi: 10.1159/000524637

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

Assessment and Correction of Stress in Preterm Infants and Their Mothers

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.

Sarapuk I, Pavlyshyn H. Assessment and Correction of Stress in Preterm Infants and Their Mothers. Turk Arch Pediatr. 2022 Mar;57(2):146-150. doi: 10.5152/TurkArchPediatr.2022.21158. PMID: 35383008.

Kangaroo mother care had a protective effect on the volume of brain structures in young adults born preterm

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.

Findings from a study exploring different approaches to neonatal hospitalisation and related outcomes on paternal mental health suggest that a family integrated care model is associated with decreased paternal stress at discharge and enables fathers to be present and participate more. Supporting fathers to actively participate in all aspects of care should be encouraged regardless of architectural design of the neonatal unit.

van Veenendaal NR, van der Schoor SRD, Broekman BFP, de Groof F, van Laerhoven H, van den Heuvel MEN, Rijnhart JJM, van Goudoever JHB, van Kempen AAMW. Association of a Family Integrated Care Model With Paternal Mental Health Outcomes During Neonatal Hospitalization. JAMA Netw Open. 2022 Jan 4;5(1):e2144720. doi: 10.1001/jamanetworkopen.2021.44720. PMID: 35072721.

Exploring outcomes for women and neonates having skin-to-skin contact during caesarean birth: A quasi-experimental design and qualitative study

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.

Marino, L.V., Collaço, N., Johnson, M.J. and Darlington, A.-S. (2022), Preterm birth during the COVID-19 pandemic: Parental experience. Acta Paediatr. https://doi.org/10.1111/apa.16229

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.

Baldoni, F. et al. Front. Pediatr., 06 September 2021. Sec. Pediatric Critical Care. https://doi.org/10.3389/fped.2021.724992

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.

Family Integrated Care: A Framework for Practice. British Association of Perinatal Medicine. November 2020. 

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.

Axelin, A. et al. 2022. Symptoms of depression in parents after discharge from NICU associated with family-centred care. 2021. Adv Nurs. 78:1676-1687. 

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.

Bliss research shows young parents face ‘double whammy’ of being underprepared and under-supported when their babies are in neonatal care. Neonatal Care through a Young Parent Lens. October 2021. 

Preterm nutrition and neurodevelopmental outcomes

Whilst survival of preterm infants has been steadily improving due to advances in perinatal and neonatal medicine, it does not reach the ideal target level of the normal fetus of the same gestational age. Postnatal weight gain is also often not achieved because extrauterine growth has higher energy requirements than intrauterine growth, due to the intensive care environment, illness and inadequate nutrition. This review focuses on the role of nutrition in preterm neurodevelopment, including the primordial importance of human milk and oligosaccharides and how these help to prevent neonatal complications and contribute to increased preterm survival.

Skinner AM, Narchi H. Preterm nutrition and neurodevelopmental outcomes. World J Methodol. 2021 Nov 20;11(6):278-293. doi: 10.5662/wjm.v11.i6.278. PMID: 34888181; PMCID: PMC8613713.

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

This comparative analysis of immune repertoire and function at birth and 3 weeks of age assessed 38 term breastfed and formula fed neonates born by caesarean section. Upon examination of the immune phenotype in neonatal and maternal blood samples and mixed lymphocyte reactions, findings indicated that exposure of the neonate to maternal cells through breastfeeding helps drive the maturation of Tregs and aids in ‘tolerising’ the neonate towards non-inherited maternal antigens

Wood, H. et al. 2021. Breastfeeding promotes early neonatal regulatory T-cell expansion and immune tolerance of non-inherited maternal antigens. https://doi.org/10.1111/all.14736

Effects of COVID-19 pandemic on breastfeeding rates in a neonatal intensive care unit

This study examines the effects of the pandemic on breastfeeding rates for babies who were hospitalised in the NICU for reasons other than Covid-19. Among 154 mother-baby dyads, delivery rates of breastmilk to the NICU were maintained at 100% with no change indicated in rates of expressed breastmilk between discharge and the 30th day of life. Rates were lowest during periods of uncertainty regarding NICU protocol, and increased significantly following the establishment of procedures and policies.

Gunes AO, Dincer E, Karadag N, Topcuoglu S, Karatekin G. Effects of COVID-19 pandemic on breastfeeding rates in a neonatal intensive care unit. J Perinat Med. 2021 Jan 6;49(4):500-505. doi: 10.1515/jpm-2020-0462. PMID: 33554582.

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.

El-Khuffash A, Lewandowski AJ, Jain A, Hamvas A, Singh GK, Levy PT. Cardiac Performance in the First Year of Age Among Preterm Infants Fed Maternal Breast Milk. JAMA Netw Open. 2021 Aug 2;4(8):e2121206. doi: 10.1001/jamanetworkopen.2021.21206. PMID: 34448867; PMCID: PMC8397926.

Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant

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.

Parker, M. et al. 2020. Promoting Human Milk and Breastfeeding for the Very Low Birth Weight Infant.

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 Research65. 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.

Bliss. 2021. Locked out: the impact of Covid-19 on neonatal care

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.

Soni RTscherning Wel-Wel CRobertson NJ. 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.

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.

Johnson, T., Bernez, A. et al. (2020). The Economic Impact of Donor Milk in the Neonatal Intensive Care Unit. The Journal of Pediatrics. https://doi.org/10.1016/j.jpeds.2020.04.044

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.

Liang, G., Zhao, C., Zhang, H. et al. The stepwise assembly of the neonatal virome is modulated by breastfeeding. Nature (2020). https://doi.org/10.1038/s41586-020-2192-1

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.

Lucas, A., Boscardin, J., Abrams, S. (2020) Preterm Infants Fed Cow’s Milk-Derived Fortifier Had Adverse Outcomes Despite a Base Diet of Only Mother’s Own Milk. https://doi.org/10.1089/bfm.2019.0133

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.

Read more about the study.

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

Older research 

  • The type of feeding at discharge of very preterm infants: Neonatal intensive care units policies and practices make a difference

Rodrigues, C, Severo, M, et al (2018). The type of feeding at discharge of very preterm infants: neonatal intensive care units policies and practices make a difference. Breastfeeding Medicine, doi.org/10.1089/bfm.2017.0135

  • Parental experience of interaction with healthcare professionals during their infant’s stay in the neonatal intensive care unit

Gallagher, K, Shaw, C, et al, (2017). Parental experience of interaction with healthcare professionals during their infant’s stay in the neonatal intensive care unit. Archives of Disease in Childhood – Fetal and Neonatal Edition, 2018;103:F343-F348.

  • Breastfeeding and risk for ceasing in mothers of preterm infants—Long‐term follow‐up

Ericson, J, & Eriksson, M, et al, (2018). Breastfeeding and risk for ceasing in mothers of preterm infants—Long‐term follow‐up. Maternal & Child Nutrition, DOI: 10.1111/mcn.12618

  • The impact of preterm infants’ continuous exposure to breast milk odour on stress parameters: A pilot study

Maayan-Metzger, A, & Kedem-Friedrich, P, et al, (2018). The impact of preterm infants’ continuous exposure to breast milk odour on stress parameters: A pilot study. Breastfeeding Medicine, doi.org/10.1089/bfm.2017.0188

  • Parents as partners in care: Lessons from the Baby Friendly Initiative in Exeter

Read, K, and Rattenbury, L (2018). Parents as partners in care: Lessons from the Baby Friendly Initiative in Exeter, Journal of Neonatal Nursing, https://doi.org/10.1016/j.jnn.2017.11.006

  • Personalization of the Microbiota of Donor Human Milk with Mother’s Own Milk

Cacho, N, et al (2017), Personalization of the Microbiota of Donor Human Milk with Mother’s Own Milk. Frontiers in Microbiology, doi:  10.3389/fmicb.2017.01470

  • The Dual Nature of Early-Life Experience on Somatosensory Processing in the Human Infant Brain

Maitre, N, et al (2017), The Dual Nature of Early-Life Experience on Somatosensory Processing in the Human Infant Brain. Current Biology, DOI: http://dx.doi.org/10.1016/j.cub.2017.02.036

  • A Comparison of Breast Milk and Sucrose in Reducing Neonatal Pain During Eye Exam for Retinopathy of Prematurity (ROP)

Taplak, A S, and Erdem, E (2017), A Comparison of Breast Milk and Sucrose in Reducing Neonatal Pain During Eye Exam for Retinopathy of Prematurity. Breastfeeding Medicine doi/full/10.1089/bfm.2016.0122

Hair, A, Peluso, A, et al, (2016). Beyond necrotizing enterocolitis prevention: Improving outcomes with an exclusive human milk–based diet. Breastfeeding Medicine, doi.org/10.1089/bfm.2015.0134

  • Kangaroo mother care for preterm infants

Charpak, N (2016), Twenty-year Follow-up of Kangaroo Mother Care Versus Traditional Care. Pediatrics 139(1):e20162063

  • Beyond necrotizing enterocolitis prevention: Improving outcomes with an exclusive human milk–based diet

Hair, A, Peluso, A, et al, (2016). Beyond necrotizing enterocolitis prevention: Improving outcomes with an exclusive human milk–based diet. Breastfeeding Medicine, doi.org/10.1089/bfm.2015.0134

  • Breastmilk Feeding, Brain Development, and Neurocognitive Outcomes: A 7-Year Longitudinal Study in Infants Born at Less Than 30 Weeks’ Gestation

Belfort, M B, et al (2016) Breast Milk Feeding, Brain Development, and Neurocognitive Outcomes: A 7-Year Longitudinal Study in Infants Born at Less Than 30 Weeks’ Gestation. The Journal of Pediatrics, Vol 177, pp 133–139 dx.doi.org/10.1016/j.jpeds.2016.06.045

  • “Giving us hope”: Parent and neonatal staff views and expectations of a planned family- centred discharge process

Ingram, J, et al (2016) “Giving us hope”: Parent and neonatal staff views and expectations of a planned family- centred discharge process (Train to Home). Health Expectations, doi:10.1111/hex.12514

 

Related research and further reading

Research on Necrotising Enterocolitis

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Blog: Transforming care for our most vulnerable babies

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