Eight RCTs (n=1,125, range 14 to 308) were included. All studies described the methods of sequence generation and allocation concealment. Only one study reported blinding the care provider; the others were unclear. All studies addressed selective outcome reporting. There were no other sources of bias.
Exclusivity of breastfeeding: Nasogastric tube supplementation resulted in babies being 4.5 times more likely to breastfeed at discharge and 9.4 times more likely to fully breastfeed compared with bottle-fed babies; this persisted at up to three months post discharge. Cup feeding increased the odds of full breastfeeding compared with bottle feeding (OR 1.73, 1.04 to 2.88, p=0.03). Another study found that kangaroo care had a higher rate of exclusive breastfeeding at discharge and up to 18 months post discharge compared with standard nursery care (p=0.047). Other studies found no statistically significant differences between: early discharge with daily visits from a nurse specialist and routine discharge; support from a lactation consultant at home compared with support in hospital; and weighing milk at home using digital scales compared with a feeding routine.
Breastfeeding duration: Four studies reported on the duration of breastfeeding. Kangaroo care had a longer duration than routine care (5.08 versus 2.05 months, p=0.003). Peer counselling had 181% greater odds of providing any amount of breast milk at 12 weeks compared with no peer counselling. There were no statistically significant differences between groups for cup feeding compared with bottle feeding or milk weighing compared with a feeding routine.
Maternal satisfaction: Three studies measured maternal satisfaction with the breastfeeding interventions. All women who weighed their milk with digital scales reported that it had been very helpful and did not make them nervous. Most of the mothers who received early discharge supported by home visits from a nurse specialist were pleased with their care. Another study of early discharge with home visits from a lactation consultant reported that 93% of women were satisfied with their postpartum care.
Weight gain: Four studies reported on infant weight gain. These investigated cue-based feeding, feeding via a nasogastric tube, home visits from nurse specialists and weighing milk at home; no studies reported any statistically significant differences between the groups.