Factors Influencing Breastfeeding Outcomes Following Neonatal Hypoxic Ischaemic Encephalopathy: A Mixed Methods Systematic Review.
Sarah Edney, Anna Basu, Anne Breaks and 6 others
PMID 41928737WHAT IT FOUND
After neonatal hypoxic ischaemic encephalopathy, breastfeeding was more likely with moderate than severe injury, and enteral feeds during cooling were associated with earlier milk and discharge breastfeeding.
Evidence was mixed and low quality.
Key findings
01Infants with moderate HIE were more likely to be exclusively breastfed at discharge than infants with severe HIE (62% vs. 25%, p = .001), and brain MRI scores significantly predicted exclusive breastfeeding (area under the curve 0.73, p < .001).
02A population-based cohort reported enteral feeding during therapeutic hypothermia was associated with earlier first parent's own milk feed (median 3.3 vs. 5.4 days, p < .001) and higher full or partial direct breastfeeding at discharge (54.6% vs. 46.5%, p < .001), but another cohort found no significant difference in breastfeeding rates at 4 months (17% vs. 7%, p = .73).
03Parents described needing clear information about expressing milk and said some received insufficient information or were not monitored; qualitative studies also reported that parent-infant closeness, including the CoolCuddle device, was felt to support breastfeeding and lactation.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included only 17 papers, and many studies were single-centre with small samples. All included papers had methodological problems, and some magnesium sulphate studies were rated high risk of bias. The studies did not use formal feeding measures, so specific breastfeeding or lactation problems could not be quantified. Breastfeeding outcomes were defined differently across studies, making comparisons difficult. Qualitative studies did not explore breastfeeding or lactation in depth; they included these topics within broader experiences of neonatal admission and therapeutic hypothermia. Only two infant medical factors were examined, and no studies examined social or environmental factors or support services. All eligible papers were in English, and unpublished literature was not searched. Many cohort and non-randomised studies did not describe how confounding was handled. Cohort studies used routinely collected clinical data with potential poor data quality. Groups in some studies came from different hospitals or time periods.
The easy way to misread this
Do not read magnesium sulphate as a proven breastfeeding intervention. It was given alongside a routine birth asphyxia protocol, and the studies were rated high risk of bias.