Sikorski Jim, Renfrew Mary J, Pindoria Sima, Wade Angela
Department of General Practice and Primary Care, GKT School of Medicine, London, UK.
Paediatr Perinat Epidemiol. 2003 Oct;17(4):407-17. doi: 10.1046/j.1365-3016.2003.00512.x.
Although the benefits of breastfeeding are widely accepted, the effectiveness of different strategies to promote the continuation of breastfeeding once initiated are less clear. The objective of this systematic review was to describe studies comparing standard care with the provision of extra breastfeeding support and to measure its effectiveness. Outcome measures used were rates of cessation of any breastfeeding or exclusive breastfeeding at chosen points in time. Measures of child morbidity and maternal satisfaction were also used when these were reported. Twenty eligible randomised or quasi-randomised controlled trials were identified, involving 23 712 mother-infant pairs. Extra support had a beneficial effect on the duration of any breastfeeding (RR [95% confidence intervals] for stopping any breastfeeding before the last study assessment up to 6 months 0.88 [0.81, 0.95]; 15 trials, 21 910 women). The effect was greater for exclusive breastfeeding (RR for stopping exclusive breastfeeding before the last study assessment 0.78 [0.69, 0.89]; 11 trials, 20 788 women). Although the point estimates of relative risk were very similar, benefit derived from professional support achieved statistical significance for any breastfeeding (RR 0.89 [0.81, 0.97]; 10 trials, 19 696 women) but not for exclusive breastfeeding (RR 0.90 [0.81, 1.01]; six trials, 18 258 women). Lay support was effective in reducing the cessation of exclusive breastfeeding (RR 0.66 [0.49, 0.89]; five trials, 2530 women) while the strength of its effect on any breastfeeding was less clear (RR 0.84 [0.69, 1.02]; five trials, 2224 women). Professional support in the largest trial to assess health outcomes produced a significant reduction in the risk of gastrointestinal infections and atopic eczema. In two trials with children suffering from diarrhoeal illness, extra support was highly effective in increasing short-term exclusive breastfeeding rates and reducing recurrence of diarrhoea. This review supports the conclusion that supplementary breastfeeding support should be provided as part of routine health service provision. There is clear evidence for the effectiveness of professional support on the duration of any breastfeeding although the strength of its effect on the rate of exclusive breastfeeding is uncertain. Lay support is effective in promoting exclusive breastfeeding although the strength of its effect on the duration of any breastfeeding is uncertain. Evidence supports the promotion of exclusive breastfeeding as central to the management of diarrhoeal illness in partially breast-fed infants.
尽管母乳喂养的益处已被广泛认可，但不同策略对促进母乳喂养开始后持续进行的有效性尚不太明确。本系统评价的目的是描述比较标准护理与提供额外母乳喂养支持的研究，并衡量其有效性。所使用的结局指标是在选定时间点停止任何母乳喂养或纯母乳喂养的比率。当有相关报告时，还使用了儿童发病率和母亲满意度的指标。共确定了20项符合条件的随机或半随机对照试验，涉及23712对母婴。额外支持对任何母乳喂养的持续时间有有益影响（在最后一次研究评估前停止任何母乳喂养的风险比[95%置信区间]，长达6个月为0.88[0.81,0.95]；15项试验，21910名女性）。对纯母乳喂养的影响更大（在最后一次研究评估前停止纯母乳喂养的风险比为0.78[0.69,0.89]；11项试验，20788名女性）。尽管相对风险的点估计非常相似，但专业支持对任何母乳喂养产生的益处具有统计学意义（风险比0.89[0.81,0.97]；10项试验，19696名女性），但对纯母乳喂养则不然（风险比0.90[0.81,1.01]；6项试验，18258名女性）。非专业支持在减少纯母乳喂养停止方面有效（风险比0.66[0.49,0.89]；5项试验，2530名女性），而其对任何母乳喂养的影响强度不太明确（风险比0.84[0.69,1.02]；5项试验，2224名女性）。在评估健康结局的最大规模试验中，专业支持显著降低了胃肠道感染和特应性皮炎的风险。在两项针对患有腹泻病儿童的试验中，额外支持在提高短期纯母乳喂养率和减少腹泻复发方面非常有效。本综述支持以下结论：应提供补充母乳喂养支持作为常规卫生服务的一部分。有明确证据表明专业支持对任何母乳喂养的持续时间有效，尽管其对纯母乳喂养率的影响强度尚不确定。非专业支持在促进纯母乳喂养方面有效，尽管其对任何母乳喂养持续时间的影响强度尚不确定。有证据支持将促进纯母乳喂养作为部分母乳喂养婴儿腹泻病管理的核心。
