Fallon Anne, Van der Putten Deirdre, Dring Cindy, Moylett Edina H, Fealy Gerard, Devane Declan
School of Nursing and Midwifery, National University of Ireland Galway, Áras Moyola, Galway, Ireland.
Cochrane Database Syst Rev. 2014 Jul 31(7):CD009067. doi: 10.1002/14651858.CD009067.pub2.
Baby-led breastfeeding is recommended as best practice in determining the frequency and duration of a breastfeed. An alternative approach is described as scheduled, where breastfeeding is timed and restricted in frequency and duration. It is necessary to review the evidence that supports current recommendations, so that mothers are provided with high-quality evidence to inform their feeding decisions.
To evaluate the effects of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2013), CINAHL (1981 to 13 November 2013), EThOS, Index to Theses and ProQuest database and World Health Organization's 1998 evidence to support the 'Ten Steps' to successful breastfeeding (6 November 2013).
Randomised and quasi-randomised trials with randomisation at both the individual and cluster level. Studies presented in abstract form were eligible for inclusion if sufficient data were available. Studies using a cross-over design were not eligible for inclusion.
We independently assessed for inclusion all the potential studies we identified as a result of the search strategy. We would have resolved any disagreement through discussion or, if required, consulted a third review author, but this was not necessary.
No studies were identified that were eligible for inclusion in this review.
AUTHORS' CONCLUSIONS: This review demonstrates that there is no evidence from randomised controlled trials evaluating the effect of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns, therefore no conclusions could be taken at this point. It is recommended that no changes are made to current practice guidelines without undertaking further robust research, to include many patterns of breastfeeding and not limited to baby-led and scheduled breastfeeding. Further research is needed to also evaluate the effects of baby-led compared with scheduled (or mixed) breastfeeding on successful breastfeeding, for healthy newborns. However, conducting such a study, particularly a randomised controlled trial is unlikely to receive ethical approval, as the issue of obtaining informed consent from new mothers or mothers-to-be for randomisation between baby-led and scheduled breastfeeding is a difficult one and it is likely that the Baby Friendly Hospital Initiative practices would prohibit such a study.
推荐采用按需哺乳作为确定母乳喂养频率和时长的最佳做法。另一种方法被描述为定时哺乳，即对母乳喂养的时间进行安排，并对频率和时长加以限制。有必要审视支持当前建议的证据，以便为母亲们提供高质量的证据，为她们的喂养决策提供参考。
评估对于健康新生儿，按需哺乳与定时（或混合）哺乳相比，在成功母乳喂养方面的效果。
我们检索了Cochrane妊娠与分娩组试验注册库（2013年11月13日）、护理学与健康领域数据库（1981年至2013年11月13日）、英国国家论文联合目录、学位论文索引和ProQuest数据库，以及世界卫生组织1998年支持成功母乳喂养“十项措施”的证据（2013年11月6日）。
个体和整群水平随机化的随机试验和半随机试验。如果有足够的数据，以摘要形式呈现的研究也符合纳入标准。采用交叉设计的研究不符合纳入标准。
我们独立评估了因检索策略而确定的所有潜在研究是否符合纳入标准。如有分歧，我们会通过讨论解决，如有必要，会咨询第三位综述作者，但实际并无此必要。
未发现符合本综述纳入标准的研究。
本综述表明，尚无随机对照试验的证据来评估对于健康新生儿，按需哺乳与定时（或混合）哺乳相比在成功母乳喂养方面的效果，因此目前无法得出结论。建议在未进行进一步有力研究之前，不要对现行实践指南做出改变，研究应涵盖多种母乳喂养模式，而不限于按需哺乳和定时哺乳。还需要进一步研究来评估对于健康新生儿，按需哺乳与定时（或混合）哺乳相比在成功母乳喂养方面的效果。然而，进行这样一项研究，尤其是随机对照试验不太可能获得伦理批准，因为对于新妈妈或准妈妈就按需哺乳和定时哺乳进行随机化获得知情同意是一个难题，而且爱婴医院倡议的做法可能会禁止此类研究。
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