Breastfeeding Sick and Vulnerable Newborns, Why Invest in Research?: Mary Renfrew
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BREASTFEEDING FOR INFANTS BORN TOO SOON OR TOO SMALL Why invest in research? Professor Mary J Renfrew FRSE Director, Mother and Infant Research Unit University of Dundee, Scotland [email protected]
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Transcript of Breastfeeding Sick and Vulnerable Newborns, Why Invest in Research?: Mary Renfrew
BREASTFEEDING FOR INFANTS BORN TOO SOON OR TOO
SMALL
Why invest in research?
Professor Mary J Renfrew FRSEDirector, Mother and Infant Research Unit
University of Dundee, [email protected]
The challenge of infant feeding Nutritional, immunological, developmental inferiority of
breastmilk substitutes Small, preterm, sick babies and their mothers most
vulnerable – special protection needed Yet denied rights accepted unconditionally for healthy
term infants and mothers Routine practices in neonatal units contribute to
environment antagonistic to breastfeeding Limitations in current research are important barrier to
enabling breastfeeding for these babies & mothers Concerted action long overdue
Problems with current evidence Mainly from high income settings These babies and mothers often excluded Usual methodological problems compounded
eg measurement of exposure, randomisation, confounding factors
Relatively small numbers of infants Diverse feeding modalities, changing over time – content
and methods Routine care practices interfere Long term outcomes seldom measured RCTs of breasmilk substitutes look more ‘scientific’ Knowledge needed on how to change entrenched practices
What do we know? Increased sepsis, necrotising enterocolitis,
mortality, cognitive deficit associated with breastmilk substitutes
Reduced procedural pain when breastfed Reduced mortality, length of stay, improved
growth, attachment with kangaroo mother care including breastfeeding support
Related economic impact
What steps are needed? Include in surveys, routine data collection: report separately Definitions of diverse feeding modalities: content & method High quality studies addressing methodological challenges
where staff confident, parents involved, barriers removed Longer term follow up
clinical, psycho-social, economic outcomes Identify ways of implementing WHO Code in neonatal
environment Basic science to explore mechanisms
immunology, endocrinology, neurology, epigenetics, psychology Ways of creating transformative, sustainable change Multidisciplinary teams, substantive long term funding
Thank you! and key references Renfrew MJ 2016 Enabling breastfeeding for infants born
too soon or too small: a new research agenda is needed http://www.healthynewbornnetwork.org/blog/enabling-breastfeeding-infants-born-soon-small-new-research-agenda-needed/
Renfrew MJ, Craig D, Dyson L et al. Breastfeeding promotion for infants in neonatal units: a systematic review and economic analysis. Health Technol Assess 2009;13(40) http://www.journalslibrary.nihr.ac.uk/__data/assets/pdf_file/0008/64718/FullReport-hta13400.pdf
