The International Code of Marketing of Breast-milk Substitutes protects breastfeeding by restricting inappropriate promotion. This study assessed knowledge, attitudes and perceived compliance with the Code among maternal and child health professionals in Spain. A nationwide cross-sectional online survey was conducted from January to June 2025 among professionals caring for pregnant women, mothers, newborns, infants or children. Descriptive statistics and 95
Breastfeeding in the preterm infant population faces numerous practical challenges, and nipple shields play a crucial auxiliary role in achieving direct breastfeeding. Current related studies exhibit significant heterogeneity in design, outcome measures, and contexts, lacking a comprehensive overview of the existing evidence. This scoping review aims to systematically map the existing evidence regarding the application of nipple shields in direct breastfeeding for preterm infants, including its scope, characteristics, current controversies, and research gaps, to provide a reference for clinical practice. This study was prospectively registered on OSF. It adhered to the JBI (2020) methodological framework and was reported following the PRISMA-ScR statement. We searched four major English core databases (PubMed, Embase, Cochrane Library, Web of Science) and four major Chinese core databases (CNKI, Wanfang, VIP, CBM). The search timeframe for all databases spanned from their inception to December 2025. The PCC framework was used to determine inclusion criteria. A dual descriptive analysis was conducted on the included literature, and the extracted data were summarized and thematically analyzed to identify patterns and associations. Initial screening yielded 665 records, with 23 studies ultimately included. These encompassed various designs such as cohort studies, cross-sectional studies, quasi-experimental studies, and qualitative studies, with sample sizes ranging from 10 to 1488. The findings focused on three key aspects: (1) Infant Outcomes: Nipple shield use was observed to be associated with improved latching and increased milk transfer volume in preterm infants. (2) Breastfeeding Outcomes: The application of this tool may be associated with decreased rates of exclusive breastfeeding and shorter breastfeeding duration. (3) Challenges in Use: Maternal experiences were characterized by ambivalence—recognizing its short-term benefits (relieving nipple pain, increasing feeding confidence) while also expressing concerns about dependency and the added burden of use. There was a lack of consensus among healthcare professionals regarding the indications and timing for the use of nipple shields in preterm infants. This scoping review systematically synthesized the existing evidence in the field, revealing its diversity and complexity. Clinical use should involve clear timing, addressing maternal ambivalence, and, with professional lactation support, striking a balance between short-term benefits and long-term impacts. Furthermore, as current research is predominantly observational and descriptive, future high-quality prospective studies or randomized controlled trials are needed to further elucidate causal relationships and optimal usage strategies. Not applicable.
Although breastfeeding is strongly recommended for optimal maternal and infant health, global rates remain suboptimal. Fathers play an important role in supporting breastfeeding through their attitudes and participation. However, evidence on how fathers’ attitudes, participation, and influence affect breastfeeding practices and maternal decision-making regarding breastfeeding continuation and cessation is limited. Understanding these relationships can inform family centered interventions and strategies to improve breastfeeding outcomes, highlighting the practical significance of this study beyond contributing to the literature. This study aimed to examine fathers’ attitudes toward breastfeeding, their level of participation in the breastfeeding process, and their influence on breastfeeding. This descriptive cross-sectional study was conducted in Turkey and included 269 fathers who met the following inclusion criteria: agreeing to participate in the research, living in Turkey, being able to read and understand Turkish, and having a baby aged 0–24 months. Data were collected using the Sociodemographic Data Collection Form, the Fathers’ Breastfeeding Attitude and Participation Scale, and the Partner Breastfeeding Influence Scale. Descriptive statistics summarized participants’ characteristics and scale scores. Pearson correlation examined relationships between the scales. Simple linear regression examined the association between fathers’ attitudes and both participation and influence, while multiple linear regression assessed the associations between sociodemographic factors and fathers’ influence on breastfeeding. Significance was set at p < 0.05. Fathers’ breastfeeding attitudes were predominantly negative, and participation was generally low, whereas influence scores indicated a relatively higher level of influence on breastfeeding. Attitudes were moderately positively correlated with participation (r = 0.539) and weakly with influence (r = 0.177). Regression analysis showed that attitudes were significantly associated with both participation (β = 0.539, p < 0.001) and influence (β = 0.177, p = 0.004), with a stronger association for participation. Higher education was associated with greater influence, whereas participation in breastfeeding education was unexpectedly linked to lower influence scores. Fathers’ attitudes were associated with their participation in breastfeeding, while training attendance showed a lower than expected association with influence scores. Fathers’ attitudes toward breastfeeding were significantly associated with both breastfeeding participation and influence on breastfeeding. Overall, fathers’ participation was low, while influence on breastfeeding was relatively higher. Not applicable.
Establishing breastfeeding in mothers of preterm infants is particularly challenging because direct breastfeeding is often not feasible during the first days after birth, making milk expression essential for initiating and maintaining lactation. Early expressed milk volume may predict subsequent lactation success, whereas the macronutrient composition of preterm human milk may vary according to maternal and neonatal factors. This study aimed to assess expressed milk volume and macronutrient composition during the first 15 postpartum days in mothers of preterm infants and to identify early predictors of adequate milk production. We conducted a prospective, longitudinal observational study with repeated measures over a 1-year period in a level III neonatal intensive care unit. Twenty-seven mothers of 34 preterm infants (≤ 32 weeks’ gestational age and/or birth weight ≤ 1,500 g) were included. Total expressed milk volume over 24 h was recorded on postpartum days 3, 4, 7, and 15. Fresh milk samples collected on days 3, 7, and 15 were analysed for protein, carbohydrate, and lipid content using Fourier-transform infrared spectroscopy. Total expressed milk volume increased significantly over time, from a median of 23 mL on postpartum day 3 to 505 mL on day 15 (p < 0.001). Lactogenesis II occurred at a median of 4 days postpartum. Milk volume on postpartum day 4 was significantly associated with milk production at 2 weeks: all mothers expressing ≥ 140 mL/day on day 4 achieved ≥ 500 mL/day on day 15 (p < 0.001). Initiation of milk expression within the first postpartum hour was associated with significantly higher milk volumes on days 4 and 7. Protein concentration decreased significantly over time, whereas carbohydrate and lipid concentrations increased. Protein content was higher in mothers aged ≥ 35 years on days 3 and 7 and was negatively correlated with gestational age and birth weight on day 15. Early monitoring of expressed milk volume, particularly on postpartum day 4, may help identify mothers of preterm infants at risk of inadequate milk production. Very early initiation of milk expression appears to support improved milk output, whereas changes in milk macronutrient composition highlight the potential value of individualised nutritional strategies for preterm infants in neonatal intensive care settings.
The sustainability of milk banking services depends on recruiting donors who are willing and able to donate. Healthcare professionals (HCPs) often interact with women during pregnancy, birth, and postpartum care, making them well-positioned to promote awareness of milk donation amongst potential donors and support women with aspects of the donation process. However, limited research has examined HCPs’ perspectives on their role in supporting milk donation. The experiences and perspectives of HCPs who work with women potentially eligible to donate to an Australian milk bank were explored using qualitative description. Fourteen HCPs across three Australian states participated in semi-structured interviews conducted between May and September 2024. Interviews were audio-recorded, transcribed, and analysed using thematic analysis. Five themes described how HCPs understand and enact their role in relation to milk donation: (1) Scope of HCP role in milk donation, which ranged from not viewing support for milk donation as part of their role, to indirectly supporting donation through promoting breastfeeding, to actively facilitating referrals to a milk bank; (2) Identifying potential milk donors, influenced by perceived oversupply, welfare of mother and baby, predisposition to help others, donor eligibility considerations, and bereavement circumstances; (3) Conversations about milk donation, influenced by HCPs’ confidence, knowledge, and experience (4) Facilitating milk donation, including referring potential donors to milk banks, navigating milk bank processes, and the impact of connections with milk bank staff; and (5) Informal milk sharing, which some HCPs encountered or supported when women were ineligible for formal donation or because it was more likely to benefit their client group. Across themes, HCPs described gaps in knowledge, training, clear guidance, and accessible resources that hindered the consistent provision of support for donation. HCPs recognise the importance of donor recruitment and their potential role in supporting milk donation. However, many felt inadequately prepared to have conversations about milk donation with women or facilitate donation due to limited knowledge, confidence, and organisational support. To enable HCPs to identify potential milk donors and provide informed and consistent guidance to those considering donation, access to targeted training and accessible resources are needed. Not applicable.
Human Milk Banks (HMB) are specialized services that promote, protect, and support breastfeeding, as well as process, control, and distribute donated human milk, especially for premature or hospitalized infants. Brazil has the largest and most consolidated HMB network worldwide, structured under standardized protocols and regulations to ensure human milk quality and safety. Despite this framework, systematic management of quality and safety remains challenging. This study aimed to develop and evaluate the usability and appearance of SisBLH, a prototype software designed to support the quality management in Brazilian HMB. A methodological study focused on technological development was conducted between 2022 and 2024 at the Ana Abrão Breastfeeding Center and HMB, in São Paulo, Brazil. The prototype software was developed in five stages: communication, planning, modeling, construction, and implementation, based on Pressman’s software development model and grounded in Donabedian’s quality and Brazilian Health Regulatory Agency (Resolution 918). Thirty evaluators participated in the study: 11 human milk donors, 11 health professionals, and eight information and communication technology (ICT) specialists. Usability was evaluated by donors using an instrument based on International Organization for Standardization standards, by professionals using the System Usability Scale, and by ICT specialists using Nielsen’s Heuristics. Visual appearance was assessed by professionals using the Instrument for Validation of Educational Health Technology Appearance. Data were analyzed using the Content Validity Index and the modified Kappa coefficient. The SisBLH prototype was developed in web and mobile versions, including modules for donor registration and monitoring of quality indicators. Usability scores indicated high adequacy, with a score 79.8
Little is known about infant feeding practices of Indian immigrant mothers in Australia; this study examined current practices and associated sociodemographic factors. A cross-sectional online survey collected infant feeding practices and sociodemographic data from 365 mothers born in India, with a full-term child born in Australia aged 1.5-5 years. Exclusive breastfeeding duration was calculated based on the child’s earliest introduction to any non-breastmilk liquids or solids. Multivariable linear and logistic regression assessed the association between sociodemographic characteristics and infant feeding practices. Mean breastfeeding duration and age when exposed to formula was 15.0 and 2.9 months, respectively. Exclusive breastfeeding until 6 months was reported by 30.1
Abstract Background Many mothers intend to breastfeed but stop earlier than planned, despite strong public health recommendations from the World Health Organisation promoting exclusive breastfeeding for the first six months of life. Although early cessation is widespread, it remains poorly understood, particularly regarding how mothers experience stopping earlier than intended and how these experiences shape their sense of self, identity, and motherhood. Existing research has primarily focused on prevalence and predictors, with less attention to mothers’ lived experiences. This scoping review aimed to map existing knowledge of mothers’ experiences of unwanted early cessation of breastfeeding. Main body The review followed the Joanna Briggs Institute methodology for scoping reviews. A comprehensive search was conducted in CINAHL, PubMed, PsycINFO, and Embase in June 2024, updated in July 2025 and updated again in June 2026. Reference lists and citations of relevant studies were also screened to ensure comprehensive coverage. Fifteen studies met the inclusion criteria. The findings were synthesised into three overarching themes: (1) The Ideal of the ‘Good Mother’ Under Pressure, (2) Existential Consequences Arising from Breastfeeding Difficulties, and (3) Insufficient Support Undermining Breastfeeding. Across the included studies, mothers described a pronounced gap between expectations and lived experiences, often accompanied by guilt, shame, and a pervasive sense of failure. Early cessation was not merely a practical outcome but a deeply emotional, identity-shaping event. These experiences were frequently intensified by perceived inadequacies in professional support, including a lack of individualised, consistent, and empathetic care, as well as conflicting advice from healthcare professionals. Conclusion Unwanted early cessation of breastfeeding is a complex, emotionally significant experience that extends beyond feeding practices. This review offers a comprehensive overview of how mothers experience early cessation and highlights the need for breastfeeding support that is not only clinically and technically competent but also emotionally attuned and responsive to mothers’ needs. Recognising the existential and identity-related dimensions of early cessation may contribute to more responsive postnatal care and better support for mothers navigating this transition.
Human milk provides critical benefits for preterm and medically vulnerable infants. To improve access to donor human milk (DHM), the Belgian Federal Public Service of Health supported the establishment of two external DHM banks in 2023: DONEO (UZ Leuven) and the Banque de Lait Belge (CHU Liège). These banks are responsible for donor recruitment, milk processing and distribution to NICUs throughout Belgium and operate within a unified national quality framework that harmonises donor screening, processing, traceability and distribution. Hospital-based internal milk banks continued to provide donor milk locally within the same framework. This study evaluates the feasibility and early implementation outcomes of the national DHM system. This descriptive implementation and feasibility study analysed programme data from the two external DHM banks, internal milk bank activity reports and national quality guidance between 2024 and 2025. Outcomes included implementation of national quality standards, donor recruitment, milk processing activity, traceability systems, infrastructure development and early national distribution capacity. Establishment of the national DHM network proved operationally feasible. During the foundational phase in 2024, both external banks developed infrastructure, donor recruitment pathways, traceability systems and harmonised quality procedures. Liège registered 87 donors and collected 549 L of DHM, while Leuven completed infrastructure development and collected 175 L from 22 donors. Internal milk banks processed an additional 580 L. In 2025, both external banks operated at national scale. A total of 256 donors were screened, contributing 1,598 L of raw milk, of which 1,040 L was approved for clinical use. Both banks implemented validated temperature-controlled transport, standardised bacteriological testing and comprehensive traceability systems. However, administrative delays in contracting between NICUs and donor milk banks limited early uptake. Consequently, 935 L of DHM was distributed nationally, while internal milk banks supplied an additional 563 L locally, representing approximately half of the estimated annual national requirement. Establishing a coordinated national DHM system in Belgium was feasible despite a complex healthcare governance structure. Early implementation outcomes demonstrate successful deployment of harmonised quality standards, donor recruitment pathways, traceability systems and national distribution capacity. Further follow-up is required to assess the system’s long-term impact on equity of access, service utilisation and clinical outcomes.
Pregnant women with gestational diabetes mellitus (GDM) frequently experience delayed onset of lactogenesis, insufficient breastfeeding self-efficacy, and low rates of early exclusive breastfeeding, highlighting the need for effective interventions. To investigate the effects of antenatal milk expression (AME) on prenatal breastfeeding self-efficacy, lactogenesis onset, and early exclusive breastfeeding in pregnant women with GDM. In this single-center randomized controlled trial conducted at Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital) in China, 240 women with GDM in late pregnancy were enrolled and randomly assigned in a 1:1 ratio to an intervention group or a control group. The control group received routine prenatal care, whereas the intervention group received routine care plus AME. Prenatal breastfeeding self-efficacy, time to lactogenesis onset, incidence of delayed onset of lactogenesis II, exclusive breastfeeding rates at 24 h postpartum and before hospital discharge, as well as social support and breastfeeding behavior prediction indicators, were compared between the two groups. A total of 233 participants completed the study. Compared with the control group, the intervention group showed significantly higher total and domain scores for prenatal breastfeeding self-efficacy; a significantly shorter time to lactogenesis onset [(41.15 ± 21.94) h vs. (55.74 ± 23.29) h]; a significantly lower incidence of delayed onset of lactogenesis II (8.6
Pasteurized donor human milk (PHDM) is recommended for preterm infants when the mother’s own milk is unavailable, as it reduces complications such as necrotizing enterocolitis and supports the early initiation of human milk feeding. Current guidelines in Japan require thawed PDHM to be discarded after 24 h, although emerging evidence suggests that PDHM may remain safe for up to 48 h. This study evaluated the microbiological safety of PDHM at 48 h post-thawing and estimated the amount of waste that could be potentially reduced if the allowable use period were extended. Forty PHDM samples provided by the Japan Human Milk Bank were thawed and stored at 4 °C. Aliquots were collected at 24 and 48 h post-thawing for quantitative bacterial culture. To estimate potential waste reduction, the medical records of 23 neonates who received PDHM were retrospectively reviewed. For each neonate, the actual PDHM intake, thawed volume, and discarded volume were recorded up to day 15 of life, and the expected reduction in waste under a 48-h use policy was calculated. No bacterial growth was detected in any sample at 24–48 h post-thawing. Among 23 preterm infants who received PDHM, extending the allowable post-thaw usage period to 48h was estimated to save 2,051 mL of PDHM and potentially reduce discarded volume by 84.7
Human milk feeding proportions among preterm infants remain unsatisfactory, and donor human milk is recommended as the best alternative when mother’s own milk is insufficient. Although established human milk banks provide essential donor human milk services, some settings may face challenges related to donor continuity and the timely alignment of donor milk supply with recipient demand. We therefore developed an in-hospital peer-supported human milk bank management model featuring a structured recipient-to-voluntary-donor pathway within the same neonatal unit. This peer-supported model was implemented at Shenzhen Maternity and Child Healthcare Hospital in January 2024. In this retrospective analysis, extremely preterm infants admitted from January to December 2023 served as the control group and received the usual feeding practice, with mother’s own milk supplemented by preterm formula when insufficient. Infants admitted from January to December 2024 comprised the human milk bank group and received donor human milk from the in-hospital peer-supported bank when maternal milk was insufficient. Clinical outcomes including human milk feeding proportions, necrotizing enterocolitis, and bronchopulmonary dysplasia were compared between the two groups to examine the associations between implementation of the model and human milk feeding proportions and clinical outcomes. Human milk feeding proportions were significantly higher in the human milk bank group than in the control group during the first 7 days of life (100
Breastfeeding beyond infancy provides health benefits for both children and breastfeeding parents but supporting it is not an established practice in health promotion in Western countries. The present study is the first to present a framework describing the measures required in health care settings to develop counseling and support for long-term breastfeeding. The study was carried out in Finland and provides perspectives into the development of breastfeeding counseling practice in Western healthcare settings. This qualitative descriptive study employed online focus group interviews (n = 4) and inductive content analysis. The participants (N = 22) were public health nurses (n = 12) with experience in supporting long-term breastfeeding in maternity and child health clinics, and trained breastfeeding peer supporters (n = 10), who play a key role in promoting breastfeeding beyond infancy. To support consensus-building during the development of the framework, a feedback round of the analysis was conducted among the participants. The framework consisted of two main categories: Individual counseling, and Structural-level support. Individual counseling involved active promotion of long-term breastfeeding, counseling during infancy to enable continuation of breastfeeding, counseling for long-term breastfeeding and a family-centered approach. Structural-level support included a system structured to support long-term breastfeeding and ensured competence related to long-term breastfeeding support. The framework outlines the key counseling content and practical strategies to effectively support families with breastfeeding beyond infancy. The results emphasize the need for multi-level actions, from individual professionals to organizational structures, to create supportive environments for long-term breastfeeding within health care services. The framework offers practical value for enhancing training initiatives for health professionals and for developing maternal and child health services at the organizational level. Breastfeeding beyond infancy benefits the health of children and breastfeeding parents. The framework shows the multidimensionality of health care support for long-term breastfeeding. Long-term breastfeeding counseling requires consideration of families’ individual needs. There is a need for system-level improvements to support and promote long-term breastfeeding in Finland. The framework can be utilised in nursing education and in the training of health professionals in Western countries.
Exclusive breastfeeding is essential for health throughout life. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months, as well as continued breastfeeding for up to two years or more in addition to an appropriate diet. In French Guiana, a French overseas territory characterized by cultural diversity, socioeconomic inequalities, and structural healthcare challenges, there was a lack of recent, representative data on breastfeeding practices. The ANJE Nutri study aimed to estimate the prevalence of breastfeeding practices and to identify factors associated with exclusive breastfeeding at four months (EBF-4), the national benchmark defined by the French National Nutrition and Health Program (PNNS). This multicenter survey was conducted by telephone with mothers included in the Nutri Pou Ti’moun study approximatively 12 months after delivering in one of French Guiana’s three maternity wards. Multilingual interviewers collected data using a structured questionnaire designed to measure Infant and Young Child Feeding (IYCF) indicators. Modified Poisson regression was used to identify factors associated with EBF-4. Between March and October 2024, 382 mother-child pairs were included in the study. The majority of infants (91.6
To examine the associations between postpartum smoking and breastfeeding initiation and duration by race/ethnicity among U.S. women. Cross-sectional survey weighted data from the 2016–2022 Pregnancy Risk Assessment Monitoring System (PRAMS) were analyzed. Breastfeeding initiation and duration were defined by self-report of ever breastfeeding and breastfeeding duration (weeks), postpartum smoking was any cigarette use in the prior three months. Multivariable logistic regression estimated the adjusted odds of breastfeeding initiation by smoking status. Cox proportional hazards regression quantified the median time to and adjusted hazard of breastfeeding cessation by smoking status. Significant interaction between smoking and race/ethnicity led to stratified analyses. Among 203,802 women, 87.9
Background: Perceived insufficient milk supply (PIMS) is a common early postpartum concern; this study tested whether a brief predischarge program (Uriclarity) reduces PIMS in the early postpartum period. Methods: Parallel-group, superiority, single-blind randomized trial (1:1; computer-generated simple randomization; allocation concealment with sequentially numbered opaque sealed envelopes). Outcome assessors and the data analyst were blinded. Conducted in three public hospitals in Piura, Peru. Participants were postpartum women ≥18 years, 24–48 h after term birth, exclusively breastfeeding. Interventions: Uriclarity—2-hour in-person educational workshop during discharge plus standardized WhatsApp messages/videos through the first two days after the workshop—versus routine pre-discharge breastfeeding counseling. Primary outcome was PIMS (MILQ, 0–8; higher = better perceived sufficiency) on days 1, 3, 7, and 14. Between-group comparisons used the Wilcoxon rank-sum test; the prespecified primary analysis was a cumulative-link proportional-odds mixed model (random intercept), adjusted for maternal age, parity, and education; intention-to-treat. Results: Of 114 screened, 100 were randomized (54 intervention; 46 control) and all were analyzed. At each follow-up, medians favored the intervention (all p < 0.001); typical Hodges–Lehmann difference +2.00 points (95% CI 1.00–2.00 to 1.00–3.00). By day 14, 83.3% (40/48) vs 30.2% (13/43) achieved MILQ ≥ 7 (RD +53.1 pp; NNT = 2). The adjusted mixed model showed markedly higher odds of being in a better MILQ category with Uriclarity (OR 10.64, 95% CI 4.26–26.58; p < 0.001). No intervention-related harms occurred. As a secondary finding, the AUS showed modest ROC discrimination (AUC 0.60–0.69) with high sensitivity at AUS ≤ 2. Conclusions: A brief, low-cost program embedded in the discharge workflow produced large, consistent reductions in PIMS over two postpartum weeks. Larger multicenter trials with longer follow-up and hard breastfeeding outcomes are warranted. Trial registration: ClinicalTrials.gov NCT06857461 (prospective; registered February 26, 2025).
Breast milk reduces complications among very low birth weight infants (VLBWIs) admitted to neonatal intensive care units (NICUs). When mothers’ own milk (MOM) is temporarily unavailable, donor human milk (DHM) is used as an alternative. In Japan, the first human milk bank was established in 2017, and the use of DHM remains relatively new. However, little is known about how mothers experience emotional changes and social interactions related to DHM use while continuing to express their own milk. Semi-structured interviews were conducted with 10 mothers of VLBWIs who had used DHM immediately after birth, and data were analysed using the Modified Grounded Theory Approach. Mothers experienced emotional conflict between their desire to provide their own milk and the need to prioritize their infant’s health and survival; however, support from family members and healthcare professionals facilitated emotional reconciliation through continued milk expression and observing their infants’ growth. Mothers experienced emotional conflict regarding DHM use; however, support from spouses, family members, and healthcare professionals helped mothers gradually come to terms with these feelings through continued milk expression and observing their infants’ growth.
Complete breastfeeding cessation is an important maternal–child health transition and is distinct from complementary feeding, which the World Health Organization defines as providing foods in addition to milk when milk alone is no longer adequate (generally from 6 to 23 months). Evidence on how mothers decide to stop breastfeeding and which practices they use remains limited in LMICs. This study described breastfeeding cessation timing, decision-making, practices, and support-seeking among mothers in Tehran, Iran, using a Social Ecological Model to organize influences at individual, interpersonal, healthcare/organizational, and broader contextual levels. We conducted a cross-sectional online survey from March to August 2021 among mothers of healthy singleton children aged 6 months to <4 years, recruited from 28 public health centers in Tehran. The final analytic sample included 420 mothers. Data were collected using a 42-item questionnaire with structured items and optional open-text questions; open-text responses were provided by 98–380 mothers, depending on the item. Quantitative data were summarized descriptively, and associations were examined using bivariate tests. Open-text responses were analyzed using thematic content analysis to contextualize the survey findings. Findings were organized using the Social Ecological Model across individual, interpersonal, healthcare/organizational, and broader contextual levels. Most mothers were aged 25–34 years (69.3
BACKGROUND:Globally, only 40% of newborns admitted to neonatal intensive care units (NICUs) are exclusively breastfed, a figure that decreases to approximately 20% in low- and middle-income countries. This study aimed to evaluate the effect of a multimodal intervention on exclusive breastfeeding at NICU discharge and to assess changes in parental stress, breastfeeding self-efficacy, breastfeeding knowledge, and risk of postpartum depression among mothers during their newborns' hospitalization. METHODS:We conducted a quasi-experimental before-and-after intervention study among mothers of newborns admitted to the NICU of a tertiary care hospital in Bogotá, Colombia. The primary outcome was exclusive breastfeeding at discharge. Secondary outcomes included parental stress, breastfeeding self-efficacy, breastfeeding knowledge, and risk of postpartum depression. The intervention combined parental education, structured support from healthcare providers, and a mobile application delivering breastfeeding-related educational content. Propensity score matching was used to control for potential confounders, and conditional logistic regression was applied to estimate adjusted odds ratios (ORs) for the primary outcome. Paired odds ratios (admission-discharge) and Becker's d coefficient were calculated for secondary outcomes. RESULTS:Newborns whose mothers received the intervention had substantially higher odds of being discharged with exclusive breastfeeding compared with those whose mothers did not receive the intervention (adjusted OR [aOR] = 10.35; 95% confidence interval [CI]: 4.95-21.7; p < 0.001). In the no-intervention group, the risk of postpartum depression increased significantly during hospitalization (paired OR = 9.4; 95% CI: 3.7-23.6;p < 0.001), whereas a significant reduction was observed in the intervention group (paired OR = 0.04; 95% CI: 0.005-0.29; p < 0.001). No statistically significant changes in parental stress were observed in either group (no intervention: OR = 0.33; 95% CI: 0.07-1.65; p = 0.29; intervention: OR = 0.73; 95% CI: 0.30-1.80; p = 0.64). Breastfeeding self-efficacy declined significantly in the absence of intervention (OR = 0.23; 95% CI: 0.11-0.49, p < 0.001) and improved significantly among mothers who received the intervention (OR = 2.73; 95% CI: 1.36-5.42; p = 0.002). Effect sizes for breastfeeding knowledge were - 0.84 in the no-intervention group and 0.65 in the intervention group. CONCLUSIONS:The multimodal intervention was associated with significantly higher odds of exclusive breastfeeding at NICU discharge. Additionally, the intervention reduced the risk of postpartum depression and improved breastfeeding self-efficacy and knowledge among mothers.
Breastfeeding is the gold standard for infant nutrition, yet maternal stress and anxiety, especially in the Neonatal Intensive Care Unit (NICU) or due to postnatal pain, can inhibit the oxytocin-mediated milk ejection reflex, leading to reduced milk production and early cessation. Music intervention has been proposed as a non-pharmacological strategy to mitigate these stress responses. This systematic review and meta-analysis aims to evaluate the effect of music interventions on objective breastfeeding outcomes (milk volume and composition), salivary cortisol stress marker, and psychological well-being in breastfeeding mothers. Unlike previous studies, this review and analysis includes both term and preterm infants across diverse clinical settings and examines the impact of music on physiological (breast milk volume and composition, breastfeeding duration) and psychological outcomes (maternal stress and anxiety levels). A comprehensive search of Scopus, PubMed, CINAHL, and Web of Science was conducted for Randomized Controlled Trials (RCTs) published up to 2024. Following PRISMA 2020 guidelines, studies were selected based on their investigation of the effects of music on breastfeeding mothers. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool and GRADE framework for certainty of evidence. Data were synthesized both narratively and through meta-analysis where applicable. Six RCTs with a total of 696 participants met the inclusion criteria. Quality assessment confirmed that all trials somewhat adhered to protocols with “Some Concerns”. Meta-analysis indicated that music significantly increased breast milk volume both immediately and cumulatively (Z > 1.96, p < 0.0001) with low heterogeneity (I² = 4
