Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland.
Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland.
Eur J Pediatr. 2022 Sep;181(9):3421-3428. doi: 10.1007/s00431-022-04559-9. Epub 2022 Jul 14.
The purpose of this study is to assess whether pacifier use is associated with breastfeeding success in term and preterm newborns and whether it influences hospitalization time in preterm newborns. Four databases were searched for randomized controlled trials (RCTs), and a systematic review and meta-analysis were conducted. The risk of bias and evidence quality, according to the GRADE methodology, were analyzed. Risk ratios with 95% confidence intervals (CI) for dichotomous outcomes and mean difference (MD) for continuous outcomes were used. The random effect model was used if heterogeneity was high (I over 40%). We screened 772 abstracts, assessed 44 full texts, and included 10 studies, of which 5 focused on term and 5 on preterm newborns. There were a few concerns about the risk of bias in 9 of the 10 studies. Breastfeeding rates were analyzed at 2, 3, 4, and 6 months, and the success rates were similar between the restricted and free pacifier use groups (evidence quality was moderate to high). In preterm neonates, the use of a pacifier shortened the duration of hospitalization by 7 days (MD 7.23, CI 3.98-10.48) and the time from gavage to total oral feeding by more than 3 days (MD 3.21 days, CI 1.19-5.24) (evidence quality was ranked as moderate). Conclusions: Based on our meta-analysis, pacifier use should not be restricted in term newborns, as it is not associated with lower breastfeeding success rates. Furthermore, introducing pacifiers to preterm newborns should be considered, as it seems to shorten the time to discharge as well as the transition time from gavage to total oral feeding. What is Known: • Observational studies show that infants who use a pacifier are weaned from breastfeeding earlier. • Previous randomized studies have not presented such results, and there have been no differences in the successful breastfeeding rates regardless of the use of pacifier. What is New: • Term and preterm newborns do not have worse breastfeeding outcomes if a pacifier is introduced to them, and additionally preterm newborns have shorter hospitalization times. • The decision to offer a pacifier should depend on the caregivers instead of hospital policy or staff recommendation, as there is no evidence to support the prohibition or restriction.
本研究旨在评估安抚奶嘴的使用是否与足月和早产儿的母乳喂养成功率相关，以及它是否会影响早产儿的住院时间。我们检索了四个数据库中的随机对照试验（RCT），并进行了系统评价和荟萃分析。根据 GRADE 方法分析了偏倚风险和证据质量。二分类结局采用风险比（RR）及其 95%置信区间（CI），连续结局采用均数差（MD）。如果异质性较高（I ² 超过 40%），则使用随机效应模型。我们筛选了 772 篇摘要，评估了 44 篇全文，纳入了 10 项研究，其中 5 项研究针对足月新生儿，5 项研究针对早产儿。10 项研究中有 9 项存在偏倚风险的担忧。母乳喂养率在 2、3、4 和 6 个月时进行分析，限制和自由使用安抚奶嘴的成功率相似（证据质量为中等到高）。在早产儿中，使用安抚奶嘴可使住院时间缩短 7 天（MD 7.23，95%CI 3.98-10.48），从管饲到完全口服喂养的时间超过 3 天（MD 3.21 天，95%CI 1.19-5.24）（证据质量为中等）。结论：基于我们的荟萃分析，不应对足月新生儿限制使用安抚奶嘴，因为它与母乳喂养成功率较低无关。此外，应考虑向早产儿引入安抚奶嘴，因为它似乎可以缩短出院时间以及从管饲到完全口服喂养的过渡时间。已知内容：•观察性研究表明，使用安抚奶嘴的婴儿更早断奶。•先前的随机研究并未呈现出这样的结果，并且无论是否使用安抚奶嘴，母乳喂养的成功率都没有差异。新内容：•如果给足月和早产儿引入安抚奶嘴，他们的母乳喂养结果不会更差，此外，早产儿的住院时间更短。•提供安抚奶嘴的决定应取决于护理人员，而不是医院政策或工作人员的建议，因为没有证据支持禁止或限制使用安抚奶嘴。
