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Aim: The aim of this paper was to review the role that donor human milk plays in caring for very low birth weight (VLBW) infants. Methods: This review focussed on academic papers and background information published in English and French up to 8 August 2021. Results: Donor human milk provides a useful bridge to successful breastfeeding in hospitalised neonates and does not have a negative impact on the use of mother's own milk and breastfeeding rates at discharge. It helps to prevent key complications of prematurity, particularly necrotising enterocolitis up to 36 weeks of postmenstrual age, which is more common in infants fed formulas based on cows' milk. When it is carefully fortified, it supports the postnatal growth of the majority of very preterm infants. Well‐organised, accessible human milk banks are required to cover the needs of hospitalised infants, and donor human milk must be prioritised for patients who derive the greatest health benefit from it. These include very preterm infants and those born at term, or near term, with surgical digestive malformations or congenital heart disease. Conclusion: Safe, high‐quality donor human milk, which is distributed by well‐organised human milk banks, is essential for the most vulnerable hospitalised neonates. [ABSTRACT FROM AUTHOR]

Aim: This scoping review aimed to identify and appraise the effectiveness and impact of breastfeeding promotion interventions conducted across Portuguese- speaking sovereign countries. Methods: Using the PRISMA-ScR guidelines, we searched 14 electronic databases for publications published through 31 July 2023. The search terms were designed to find studies promoting breastfeeding or exclusive breastfeeding in pre- defined Portuguese- speaking countries. Results: Of the 5263 papers initially retrieved, 30 interventional studies on breastfeeding met the inclusion criteria across three countries: Brazil (N = 26), Portugal (N = 2) and Guinea Bissau (N = 2). Participants ranged from pregnant women, mothers, mother-infant pairs, healthcare professionals, and school children. Overall, the interventions increased exclusive breastfeeding and better breastfeeding practices, such as a higher duration of breastfeeding. The interventions positively affected maternal breastfeeding self-efficacy, knowledge and perception. Only four studies used a theoretical framework. Conclusion: While the results were often statistically significant, no study had an outcome close to the recommended UNICEF and WHO goal of 70% breastfeeding at six months. The need to determine what works for the recommended six months postpartum period is critical for maximising children's health in Portuguese- speaking countries. [ABSTRACT FROM AUTHOR]

Aim: To explore the content, experiences and outcomes of interventions designed to increase early skin‐to‐skin contact (SSC) in high‐income settings. Methods: A mixed‐methods systematic review was undertaken across six bibliographic databases. References of all included studies were hand‐searched. All papers were quality appraised using a mixed‐method appraisal tool. A narrative synthesis was used to synthesise both quantitative and qualitative findings. Results: Database searches generated 1221 hits, and two studies were identified via hand‐searching. Ten studies were included; most (n = 7) were designed to improve SSC following a caesarean section, and half were of low/poor quality. Outcomes related to SSC prevalence and/or duration (n = 7), breastfeeding prevalence, (n = 4) and six explored mothers' and/or health professionals' experiences of the intervention. While the interventions had 'some' impact on the prevalence of SSC, the duration was often limited and not in line with WHO recommendations. Breastfeeding rates (exclusive/any) were found to improve but generally not to a significant extent. Mother and healthcare professionals were positive about the interventions, with barriers to implementation noted. Most interventions targeted healthcare professionals, rather than mothers. Conclusion: High‐quality interventions that increase SSC in line with WHO recommendations, and that target both health professionals and parents are needed. [ABSTRACT FROM AUTHOR]

Aim: As part of a multi‐country implementation trial, we tested a regionally specific model of kangaroo mother care (KMC). Effective KMC was defined as ≥8 h of newborn‐caregiver skin‐to‐skin contact daily plus exclusive breast feeding. The study was designed to achieve ≥80+% effective KMC coverage at the population level. Methods: The Amhara KMC model was designed using global evidence, formative research in the region and input from government officials, clinicians, newborn families and global scientists. We optimised the initial model using continuous quality improvement with process feedback, outcome measurement and collaborative re‐design. Outcomes from the evaluation period are reported. Results: At discharge, the final model resulted in a median of 16 h per day of skin‐to‐skin contact with 63% effective KMC coverage. Fifty‐three percent sustained effective KMC to 7 days post‐discharge. Conclusions: It is possible to achieve high coverage (63%), high‐quality KMC at public hospitals without prior KMC services using government‐owned, multisectoral collaborative design. Targeted co‐design, real‐time data and customisation of KMC interventions with input from impacted stakeholders was critical in achieving high coverage and sustained quality. [ABSTRACT FROM AUTHOR]

Aim: Skin‐to‐skin contact immediately after birth is recognised as an evidence‐based best practice and an acknowledged contributor to improved short‐ and long‐term health outcomes including decreased infant mortality. However, the implementation and definition of skin‐to‐skin contact is inconsistent in both practice and research studies. This project utilised the World Health Organization guideline process to clarify best practice and improve the consistency of application. Methods: The rigorous guideline development process combines a systematic review with acumen and judgement of experts with a wide range of credentials and experience. Results: The developed guideline received a strong recommendation from the Expert Panel. The result concluded that there was a high level of confidence in the evidence and that the practice is not resource intensive. Research gaps were identified and areas for continued work were delineated. Conclusion: The World Health Organization guideline development process reached the conclusion immediate, continuous, uninterrupted skin‐to‐skin contact should be the standard of care for all mothers and all babies (from 1000 g with experienced staff if assistance is needed), after all modes of birth. Delaying non‐essential routine care in favour of uninterrupted skin‐to‐skin contact after birth has been shown to be safe and allows for the progression of newborns through their instinctive behaviours. [ABSTRACT FROM AUTHOR]

Aim: To assess the dose–response association between the duration of any breastfeeding and cognitive skills in children from 5 to 15 years of age. Methods: The data from the longitudinal cohort study Growing up in Australia: The Longitudinal Study of Australian Children (children born in 1999–2000 and 2003–2004) were accessed. Language skills were assessed via Peabody Picture Vocabulary Test at 5, 7 and 9 years of age (N = 8643), and non‐verbal intelligence was assessed via Matrix Reasoning subtest from Wechsler Intelligence Scale at 7, 9 and 11 years of age (N = 8560) and executive functions were examined via Cogstate Cognitive Testing battery in 15 years old (N = 6213). Breastfeeding was assessed via maternal questionnaires, partly prospective. Results: A longer duration of breastfeeding was significantly associated with greater language skills from 5 to 9 (0.05 [95% CI, 0.03–0.08], p < 0.0001) and greater non‐verbal intelligence from 7 to 11 years of age (0.02 [95% CI, 0.01–0.04], p < 0.001). No significant relation was found between the breastfeeding duration and executive functions in 15 years old. Conclusion: These results support a dose–response relationship between breastfeeding duration and language skills and non‐verbal intelligence during childhood and early adolescence. [ABSTRACT FROM AUTHOR]

Aim: We compared milk volumes, skin‐to‐skin contact and breastfeeding by the mothers of very preterm twins and singleton infants born at 28–32 weeks of gestation. Methods: This Norwegian longitudinal prospective comparative study was carried out in two neonatal intensive care units: one with single family rooms and one open bay unit. It comprised 49 singleton infants, 28 twins and their mothers. The mothers' milk volume and direct breastfeeding were recorded from birth until 4 months' of corrected age. They also answered the breastfeeding self‐efficacy scale and skin‐to‐skin contact was recorded. Results: The mothers of preterm twins produced doubled the volume of expressed milk at day 14, compared to the mothers of singletons (mean 816 ± 430 mL vs. 482 ± 372 mL, p < 0.05) and this difference was still sustained at 34 + 0 weeks/days (p < 0.02). Mothers of twins had their first breastfeeding attempt later than mothers of singletons (median of 133 h compared to 56 (p < 0.002). Preterm twins received less daily skin‐to‐skin contact (mean 157 ± 66 min each vs. 244 ± 109) (p < 0.001). There were no differences in receiving mother's own milk, exclusively direct breastfeeding or perceived breastfeeding self‐efficacy. Conclusion: Breastfeeding was initiated as successfully in preterm twins as singletons as the mothers' milk production doubled. [ABSTRACT FROM AUTHOR]

Aim: A number of studies have indicated the potential benefits that breastfeeding has on reducing childhood obesity, but few studies have evaluated the effect on adolescent obesity. We examined the association between breastfeeding and overweight or obesity at 15 years of age using data from a large nationwide longitudinal study launched by the Japanese Government in 2001. Methods: We analysed data for 26 164 participants with known infant feeding practices at 6 months of age, namely the duration of breastfeeding or formula feeding. Overweight or obesity at 15 years of age were calculated based on the subject's self‐reported height and weight. Multinomial logistic regression analysis adjusted the data for child factors, namely sex, siblings, birth weight and physical activity clubs and the maternal factors of age, educational attainment and smoking status. Results: Formula feeding was associated with an increased risk of overweight or obesity at 15 years of age. The adjusted odds ratios (95% confidence intervals) were 0.99 (0.89–1.09) for partial breastfeeding and 1.23 (1.02–1.48) for formula feeding, when exclusive breastfeeding was the reference category. Conclusion: Breastfeeding during infancy had potential benefits for overweight or obesity among 15‐year‐old adolescents. Our results provide further evidence of the importance of breastfeeding. [ABSTRACT FROM AUTHOR]

Aim: To update a systematic review and meta‐analysis of the association of breastfeeding with overweight or obesity that had been commissioned by the World Health Organization. We also assessed the likelihood of residual confounding. Methods: Two independent reviewers searched MEDLINE, LILACS and Web of Science for manuscripts published between August 2014 and May 2021. Studies that only evaluated infants were excluded. Random‐effects models were used to pool the estimates. Results: The review comprised 159 studies with 169 estimates on the association of breastfeeding with overweight or obesity, and most of the studies were carried out among individuals aged 1–9 years (n = 130). Breastfeeding protected against overweight or obesity (pooled odds ratio:0.73, 95% confidence interval:0.71; 0.76). And, even among the 19 studies that were less susceptible to publication bias, residual confounding and misclassification, a benefit was observed (pooled odds ratio:0.85, 95% confidence interval:0.77; 0.93). Among those studies that were clearly susceptible to positive confounding by socioeconomic status, a benefit of breastfeeding was observed even after adjusting for socioeconomic status (pooled odds ratio:0.76, 95% confidence interval: 0.69; 0.83). Conclusion: Breastfeeding reduced the odds of overweight or obesity, and this association was unlikely to be due to publication bias and residual confounding. [ABSTRACT FROM AUTHOR]

Aim: We examined if a range of factors were associated with how ready mothers were for their infants to be discharged from a neonatal intensive care unit (NICU). Methods: 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. We studied 132 mother–infant dyads: 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 mothers completed a questionnaire on NICU stress and their perceptions of family‐centred care on enrolment and another on breastfeeding self‐efficacy and readiness to go home a week before discharge. The infants' characteristics were retrieved from the medical files. Results: The infants were born at a mean age of 29.8 ± 3.1 weeks. Greater family‐centred care during early hospitalisation (p = 0.01) and greater breastfeeding self‐efficacy in the period before discharge (p = 0.04) were significantly associated with higher readiness for discharge. The unit design was not significantly associated with readiness for discharge. Conclusion: 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. [ABSTRACT FROM AUTHOR]

The Baby‐friendly Hospital Initiative for Neonatal Wards (Neo‐BFHI) is an expansion of the WHO/UNICEF Ten Steps to Successful Breastfeeding to address the needs of infants and families in all levels of neonatal care. The Neo‐BFHI includes Three Guiding Principles as basic tenets, Ten Steps to protect, promote and support breastfeeding closely following the original Baby‐friendly Hospital Initiative, and adherence to the International Code of Marketing of Breast‐milk Substitutes. In 2020, the WHO/UNICEF published recommendations for breastfeeding small, sick and preterm newborns that aligns with the Neo‐BFHI. Conclusion: This mini review provides a brief description of the content in the Neo‐BFHI. [ABSTRACT FROM AUTHOR]