Thirty-one randomised controlled trials and 17 other studies were included. Eight studies were conducted in the UK. Seven studies were of good quality and 28 were moderate.
There was strong evidence that short periods of skin-to-skin contact, for stable infants, increased the duration of breastfeeding by one month after discharge (RR 4.76, 95% CI 1.19 to 19.10) and by over six weeks (RR 1.95, 95% CI 1.03 to 3.70). Peer support at home for mothers of term, low birthweight infants increased breastfeeding up to 24 weeks (RR 2.18, 95% CI 1.45 to 3.29) and exclusive breastfeeding from birth to six months (RR 65.94, 95% CI 4.12 to 1055.70). Peer support in hospital and at home for mothers of infants in Special Care Baby Units increased provision of any breast milk at 12 weeks (OR 2.81, 95% CI 1.11 to 7.14).
Limited evidence was found for other interventions: multidisciplinary staff training might increase knowledge and could increase initiation rates and duration of breastfeeding; and a lack of staff training was an important barrier to the implementation of effective interventions.
No studies met the selection criteria for the health economics review. The economic modelling found that additional skilled professional support in hospital was cost-effective compared with normal staff contact. Donor milk became cost-effective with improved mechanisms for its provision.