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Barriers and Facilitators to Breastfeeding in Moderate and Late Preterm Infants: A Systematic Review

Lookup NU author(s): Professor Nicholas EmbletonORCiD


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© 2021, Mary Ann Liebert, Inc., publishers.Rationale: Most of the preterm infants are born between 32 and 36 weeks of gestation (moderate to late preterm infants [MLPIs]). This comes with significant short-and long-term risks. Breastfeeding reduces many of these risks, but breastfeeding rates in MLPIs are lower than those in full-term infants. We performed a systematic review of studies identifying factors associated with successful breastfeeding in MLPIs and interventions to improve breastfeeding. Methods: Systematic search performed using PubMed April 24, 2020. In total, 11 articles describing barriers to breastfeeding in MLPIs and 6 articles about interventions to improve breastfeeding were included. Interventions were categorized according to different outcomes: breastfeeding initiation, continuation for 5 days to 6 weeks, and continuation ≥3 months. Because of heterogeneity in study characteristics, no meta-analysis was performed. Results: Breastfeeding rates were lower in those with lower socioeconomic status and single-parent households. Providing parents with more information and direct health care support significantly improved breastfeeding initiation. Cup feeding instead of bottle feeding had inconsistent effects on breastfeeding initiation and continuation. Continuous skin-to-skin contact did not affect breastfeeding initiation or continuation. Discussion: Risk groups for lower breastfeeding rates of MLPIs include mothers with lower socioeconomic status and single mothers. Interventions that may improve breastfeeding include cup feeding and providing parents with more information and health care support. Key limitations of included studies are lack of adequate adjustment for confounders and lack of blinding. However, this is the first systematic review identifying both risk groups and interventions to improve breastfeeding in MLPIs.

Publication metadata

Author(s): Carpay NC, Kakaroukas A, Embleton ND, Van Elburg RM

Publication type: Review

Publication status: Published

Journal: Breastfeeding Medicine

Year: 2021

Volume: 16

Issue: 5

Pages: 370-384

Print publication date: 14/05/2021

Online publication date: 16/03/2021

Acceptance date: 02/04/2018

ISSN (print): 1556-8253

ISSN (electronic): 1556-8342

Publisher: Mary Ann Liebert Inc.


DOI: 10.1089/bfm.2020.0379

PubMed id: 33733865