Non‐exclusive breastfeeding (artificial milk) versus exclusive breastfeeding

Patient or population: healthy breastfeeding full‐term infants
Setting: hospital settings USA, Sweden and the Czech Republic
Intervention: non‐exclusive breastfeeding infants (artificial milk)
Comparison: exclusive breastfeeding infants

Any breastfeeding at discharge

RR 1.02 (0.97 to 1.08)

100
(1 RCT)

⊕⊕⊝⊝
LOW ^{1, 2, 3}

Any breastfeeding at 3 months

RR 1.21
(1.05 to 1.41)

137
(2 RCTs)

⊕⊕⊝⊝
LOW ^{1, 2, 4, 5}

Infant morbidity ‐ allergy symptoms ‐ Infants with allergy symptoms at 18 months of age

RR 0.56
(0.35 to 0.91)

207
(1 RCT)

⊕⊝⊝⊝
VERY LOW ^{5, 7}

Weight change

This outcome was not reported.

Maternal self‐confidence

Modified breastfeeding self‐efficacy score at 1 week. Items rated on a scale from 1 (“Strongly Disagree”) to 5 (“Strongly Agree”), with positive scores associated with increased breastfeeding self‐efficacy.

‐

39
(1 RCT)

⊕⊕⊝⊝
LOW ^{1, 2, 6}

Modified breastfeeding self‐efficacy score at 1 week. Items rated on a scale from 1 (“Strongly Disagree”) to 5 (“Strongly Agree”) with higher scores associated with more breastfeeding self‐efficacy

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Non‐exclusive breastfeeding (water or glucose water) versus exclusive breastfeeding

Patient or population: healthy breastfeeding full‐term infants
Setting: hospital setting in Spain and UK
Intervention: non‐exclusive breastfeeding infants (water or glucose water)
Comparison: exclusive breastfeeding infants

Any breastfeeding at 12 weeks

RR 0.68
(0.53 to 0.87)

170
(1 RCT)

⊕⊕⊝⊝
LOW ^{1, 2}

Estimated from the graph the percentage of mothers breastfeeding at each time period (see Table 1).

Hypoglycaemia episodes at 12 hours of life (glycaemia < 2.2 mmol/L)

RR 0.07 (0.00 to 1.20)

170
(1 RCT)

⊕⊝⊝⊝
VERY LOW ^{1, 3, 4}

Trialists used a cut‐off point as serum glucose less than 2.2 mmol/L whereas some researchers define a lower cut‐off level (1.7 mmol/L). Trialists report there was no case of serum glucose levels under 1.7 mmol/L in either of the 2 groups and no cases presented hypoglycaemic symptoms.

Hypoglycaemia episodes at 24 hours of life (glycaemia < 2.2 mmol/L)

RR 1.57
(0.27 to 9.17)

170
(1 RCT)

⊕⊝⊝⊝
VERY LOW ^{1, 3, 4}

Trialists used a cut‐off point as serum glucose less than 2.2 mmol/L whereas some researchers define a lower cut‐off level (1.7 mmol/L). Trialists report there was no case of serum glucose levels under 1.7 mmol/L in either of the 2 groups and no cases presented hypoglycaemic symptoms.

Weight change (loss) (g) at 48 hours

‐

170
(1 RCT)

⊕⊕⊝⊝
LOW ^{1, 2}

This mean difference of 32.5 g is not clinically meaningful.

Weight change (loss) (g) at 72 hours

‐

170
(1 RCT)

⊕⊝⊝⊝
VERY LOW ^{1, 3}

Weight loss (%) day 3

(percentage of birthweight)

‐

47
(1 RCT)

⊕⊝⊝⊝
VERY LOW ^{1, 3}

We combined the glucose and water supplement arms of the Nicoll 1982 trial.

Weight loss (%) day 5

(percentage of birthweight)

‐

47
(1 RCT)

⊕⊝⊝⊝
VERY LOW ^{1, 3}

We combined the glucose and water supplement arms of the Nicoll 1982 trial.

Confidence in breastfeeding (maternal or of those influencing the mother)

This outcome was not reported.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; MD: mean difference; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Non‐exclusive breastfeeding (foods) versus exclusive breastfeeding

Patient or population: healthy breastfeeding full‐term infants
Setting:home setting in Honduras, Iceland and the UK
Intervention: non‐exclusive breastfeeding infants (foods)
Comparison: exclusive breastfeeding infants

Duration of breastfeeding (at different time points)

This outcome was not reported in a format that could be analysed.

Fever (% of days) ‐ 4 to 6 months

‐

119
(1 RCT)

⊕⊕⊝⊝
LOW ^{1, 2}

“Food allergy” to 1 or more foods between 1 to 3 years of age

RR 0.80
(0.51 to 1.25)

1162
(1 RCT)

⊕⊕⊕⊝
MODERATE ²

There was low adherence to the protocol in the intervention group

Visible eczema at 12‐month visit stratified by visible eczema at enrolment

RR 0.86
(0.51 to 1.44)

284
(1 RCT)

⊕⊕⊕⊝
MODERATE ²

There was low adherence to the protocol in the intervention group

Food protein enterocolitis syndrome positive response to challenge (number of children)

RR 2.00
(0.18 to 22.04)

1303
(1 RCT)

⊕⊕⊕⊝
MODERATE ²

There was low adherence to the protocol in the intervention group

Weight change (gain) (g) ‐ 4 to 6 months

‐

260
(2 RCTs)

⊕⊕⊝⊝
LOW ^{1 2}

Weight change (z score)

as standard deviations of an overall population distribution of infant weight gain at 4 ‐ 6 months

‐

100
(1 RCT)

⊕⊕⊕⊝
MODERATE ³

The differences in weight change from 4 to 6 months are negligible between the groups

Confidence in breastfeeding (maternal or of those influencing the mother)

This outcome was not reported in a format that could be analysed.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; MD: mean difference; RR: Risk ratio

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect