A Meta-Analysis of Breastfeeding Effects for Infants With Neonatal Abstinence Syndrome.
Liangliang Chu, Jacqueline M McGrath, Jianhong Qiao and 7 others
PMID 34596065WHAT IT FOUND
Breastfeeding or expressed human milk was not associated with lower neonatal abstinence syndrome symptom scores, but pooled data found it associated with less medication initiation, shorter medication treatment and shorter hospital stay.
Key findings
01Pooled analysis found no significant difference between breastfeeding and nonbreastfeeding groups for decreasing NAS symptom severity (RR = −0.27, 95% CI [−0.56, 0.02], p = .07).
02Breastfeeding was associated with a lower need for initiation of pharmacological treatment (RR = 0.77, 95% CI [0.66, 0.90], p = .001).
03Breastfeeding was associated with shorter duration of pharmacological treatment (MD = −0.43, 95% CI [−0.68, −0.17], p = .0009) and shorter length of stay (MD = −0.47, 95% CI [−0.75, −0.18], p = .001).
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How it was doneWhat they foundWhat it means for RNs
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What it does not show
Most included studies were retrospective cohorts, so association is not proof of causation. Breastfeeding definitions varied widely and often included expressed human milk or predominant feeding; no included study had exclusively breastfed infants. A study with exclusively breastfed infants was excluded because needed data were unavailable. Co-interventions and care changes, such as Finnegan scoring practices, medication choices, skin-to-skin contact and parental involvement, were not consistently controlled, so breastfeeding's separate effect cannot be isolated. Heterogeneity was high for treatment duration and length of stay. Only English-language studies were included, and some relevant studies could not be pooled because data were unavailable. Risk of bias was low to moderate overall, but the randomized trial was small. The symptom severity result was null, so the paper does not show breastfeeding reduces NAS scores.
Declared interests
The authors report no conflicts of interest.
The easy way to misread this
Do not conclude that breastfeeding alone caused these outcomes. The paper states breastfeeding was not implemented in isolation and lists care variations including changes in Finnegan scoring, pharmacological treatment decisions, skin-to-skin contact, parental involvement, rooming-in, low-stimuli environments and dedicated breastfeeding support. The contribution of any single component cannot be separated.