Neonatal Care Research
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.
Inpatient Skin-to-skin Care Predicts 12-Month Neurodevelopmental Outcomes in Very Preterm Infants
This study aimed to examine the relationship between inpatient skin-to-skin care rates and neurodevelopmental scores measured at 12 months in very preterm (VPT) infants. Findings indicated that VPT infants who experienced more skin-to-skin care during hospitalization demonstrated higher scores on 12-month neurodevelopmental assessments. Results provide evidence that skin-to-skin care confers extended benefits to VPT infants through the first year of life. Skin-to-skin care offers promise as a family-centered intervention designed to promote positive developmental outcomes in at-risk infants.
Practices supporting cue-based breastfeeding of preterm infants in neonatal intensive care units across Europe
Emerging knowledge about supportive neurodevelopmental neonatal care shows the need for an individual approach to establish breastfeeding. However, evidence on how cue-based breastfeeding is supported in neonatal intensive care units (NICUs) is scarce. Therefore, the aim was to describe supporting practices for cue-based breastfeeding. Findings indicate that European NICUs employ supportive practices, SSC, early initiation of breastfeeding, and provide information to parents. Staff plays a significant role in fostering cue-based feeding in preterm infant-mother dyads. There still exist restrictions for SSC and breastfeeding. To understand the impact of different strategies and practices, there is need for evaluations by parents and testing of the implementation of cue-based feeding practices in neonatal care.
Ensuring neonatal human milk provision: A framework for estimating potential demand for donor human milk
This study presents a framework for estimating DHM potential demand for infants born preterm, which allows for various sources of secondary population data, different feeding protocols and policy options for DHM provision. A Monte Carlo Simulation (MCS) is developed which follows the framework, simulating annual births (based on historical data) and incorporating uncertainty related to infant and maternal populations. A case study on human milk banking serves as the basis for the application of the framework and the modelling approach. Our model estimates the overall demand for DHM in England and Wales, the local level demand for NHS Trusts in England and provides an indication of the associated uncertainties. Our study provides a useful tool to enrich the strategic and operational level decision-making environment, benefitting both policymakers and milk bankers by providing a better understanding of the impact of policy decisions on the future development of the milk bank infrastructure.
Mental health, bonding, family wellbeing, and family functioning in parents of infants receiving neonatal intensive care
This study aimed to describe self-reported mental health, bonding with the infant, family wellbeing, and family functioning among mothers and non-birthing parents with children receiving neonatal intensive care and to explore factors associated with bonding with the child, family wellbeing, and family functioning. Conclusions indicate that symptoms of anxiety were common but might be a natural and transient reaction. Identifying depression is important to be able to provide targeted family support.
Disparities in being able to donate human milk impacts upon maternal wellbeing: Lessons for scaling up milk bank service provision
This study aimed to examine the impact of being able to donate milk, as well as the impact of not being able to do so, using a survey containing open and closed questions in a large UK sample. Overall, 1149 women completed the survey, 417 (36.3%) who donated their milk and 732 (63.7%) who did not. Most women who donated found it had a positive impact upon their wellbeing, feeling proud, useful and that they had achieved something important. Conversely, those unable to donate often felt rejected, frustrated, and excluded, especially if they received no response or felt that restrictions were unfair. Findings further extend the impacts of milk banking services beyond infant health and development and support expanded service delivery.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 .
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.
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.
Cessation of breastfeeding in mothers of preterm infants-A mixed method study
Maternal passivity or activity influenced the cessation of breastfeeding in mothers of preterm infants who breastfed at the time of discharge from the neonatal unit. Passive behaviour related to breastfeeding may result in early cessation of breastfeeding, and low breastfeeding satisfaction while active behaviour may increase breastfeeding length and satisfaction. This study examined the cessation of breastfeeding among mothers of preterm infants. Thus, the aim was to describe the cessation of breastfeeding in mothers of preterm infants up to 12 months after birth.
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.
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.
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.
Older research
- 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
- 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.
- 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
- 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
- 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
- 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
- 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
- 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