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Cochrane Database of Systematic Reviews

Early additional food and fluids for healthy breastfed full‐term infants

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Information

DOI:
https://doi.org/10.1002/14651858.CD006462.pub3Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 25 November 2014see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Pregnancy and Childbirth Group

Copyright:
  1. Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Genevieve E Becker

    Correspondence to: Unit for Health Services Research and International Health, WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy

    [email protected]

    BEST Services, Galway, Ireland

  • Tracey Remmington

    Department of Women's and Children's Health, University of Liverpool, Liverpool, UK

Contributions of authors

Previous version of the review

Sharon Remmington conceived the review and with Tracey Remmington wrote the protocol. Genevieve Becker joined the team after the protocol was published. Tracey Remmington co‐ordinated the review and with Sharon Remmington screened the search results. All authors extracted the data. Tracey Remmington and Sharon Remmington appraised the quality of papers and Tracey Remmington entered data and led the analysis. Sharon Remmington and Tracey Remmington wrote the first draft and Genevieve Becker wrote the subsequent drafts with inputs from Tracey Remmington. All authors reviewed the final draft (Becker 2011).

Current version of the review

Genevieve Becker co‐ordinated the review update. Genevieve Becker and Tracey Remmington assessed study eligibility independently extracted data and entered data. Genevieve Becker wrote the first draft with input from Tracey Remmington.

Sources of support

Internal sources

  • Unit for Health Services Research and International Health, WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.

    For part of the time of this update, G Becker was employed by the Unit for Health Services Research and International Health with time allocated to work on this review.

External sources

  • No sources of support supplied

Declarations of interest

None known.

Acknowledgements

We are grateful to Sharon Remmington for her contribution to the initial version of this review (Becker 2011).

We are grateful to the study authors and their colleagues who provided further information, and to those people who noticed the requests and directed us to additional studies and ways of contacting authors.

Thanks are also due to Sonja Henderson (previous Managing Editor), Frances Kellie (Managing Editor), and Leanne Jones (Associate Editor), over the years of this review and their colleagues in the Review Group office of the Cochrane Pregnancy and Childbirth Group.

As part of the pre‐publication editorial process, this review has been commented on by two peers (an editor and referee who is external to the editorial team), a member of the Pregnancy and Childbirth Group's international panel of consumers and the Group's Statistical Adviser (2011).

Version history

Published

Title

Stage

Authors

Version

2016 Aug 30

Early additional food and fluids for healthy breastfed full‐term infants

Review

Hazel A Smith, Genevieve E Becker

https://doi.org/10.1002/14651858.CD006462.pub4

2014 Nov 25

Early additional food and fluids for healthy breastfed full‐term infants

Review

Genevieve E Becker, Tracey Remmington

https://doi.org/10.1002/14651858.CD006462.pub3

2011 Dec 07

Early additional food and fluids for healthy breastfed full‐term infants

Review

Genevieve E Becker, Sharon Remmington, Tracey Remmington

https://doi.org/10.1002/14651858.CD006462.pub2

2007 Apr 18

Early additional food and fluids for healthy breastfed full‐term infants

Protocol

Sharon Remmington, Tracey Remmington

https://doi.org/10.1002/14651858.CD006462

Differences between protocol and review

We updated the Background section and refocused to reflect exclusive breastfeeding as the norm and supplementation as an intervention, as well as more justification for the outcomes selected for examination.

Outcomes as listed in the protocol amended to (primary) physiological jaundice, absence or presence, and if present, duration (days), and (secondary) phototherapy in hospital or home setting if required, absence or presence, and if present, duration (days). This was changed in recognition that some participants are likely not to be jaundiced or to need phototherapy.

We have updated the methods in accordance with the updated Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011).

Notes

In the next update, we will consider an amendment to the stated outcome of "Weight change" to change to "Measures of growth and development" so as to include measures such as height, head circumference, and developmental aspects that may be included in trials. We will also consider amendment of the outcome "Maternal self‐confidence in breastfeeding" to "Confidence in breastfeeding" in order to include trials that examined confidence of fathers and other family members or those with significant influence on the mother.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.
Figures and Tables -
Figure 1

Methodological quality graph: review authors' judgements about each methodological quality item presented as percentages across all included studies.

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

Comparison 1 Exclusive breastfed infants versus non‐exclusive breastfed infants (artificial milk), Outcome 1 Breastfeeding duration.
Figures and Tables -
Analysis 1.1

Comparison 1 Exclusive breastfed infants versus non‐exclusive breastfed infants (artificial milk), Outcome 1 Breastfeeding duration.

Comparison 1 Exclusive breastfed infants versus non‐exclusive breastfed infants (artificial milk), Outcome 2 Incidence of fever.
Figures and Tables -
Analysis 1.2

Comparison 1 Exclusive breastfed infants versus non‐exclusive breastfed infants (artificial milk), Outcome 2 Incidence of fever.

Comparison 1 Exclusive breastfed infants versus non‐exclusive breastfed infants (artificial milk), Outcome 3 Maternal self‐confidence.
Figures and Tables -
Analysis 1.3

Comparison 1 Exclusive breastfed infants versus non‐exclusive breastfed infants (artificial milk), Outcome 3 Maternal self‐confidence.

Comparison 2 Exclusive breastfed infants versus non‐exclusive breastfed infants (water), Outcome 1 Breastfeeding duration.
Figures and Tables -
Analysis 2.1

Comparison 2 Exclusive breastfed infants versus non‐exclusive breastfed infants (water), Outcome 1 Breastfeeding duration.

Comparison 2 Exclusive breastfed infants versus non‐exclusive breastfed infants (water), Outcome 2 Maximum temperature (ºC).
Figures and Tables -
Analysis 2.2

Comparison 2 Exclusive breastfed infants versus non‐exclusive breastfed infants (water), Outcome 2 Maximum temperature (ºC).

Comparison 2 Exclusive breastfed infants versus non‐exclusive breastfed infants (water), Outcome 3 Minimum temperature (ºC).
Figures and Tables -
Analysis 2.3

Comparison 2 Exclusive breastfed infants versus non‐exclusive breastfed infants (water), Outcome 3 Minimum temperature (ºC).

Comparison 2 Exclusive breastfed infants versus non‐exclusive breastfed infants (water), Outcome 4 Episodes of hypoglycaemia (glycaemia < 2.2 mmol/l).
Figures and Tables -
Analysis 2.4

Comparison 2 Exclusive breastfed infants versus non‐exclusive breastfed infants (water), Outcome 4 Episodes of hypoglycaemia (glycaemia < 2.2 mmol/l).

Comparison 2 Exclusive breastfed infants versus non‐exclusive breastfed infants (water), Outcome 5 Mean capillary blood glucose levels of infants (mmol/l).
Figures and Tables -
Analysis 2.5

Comparison 2 Exclusive breastfed infants versus non‐exclusive breastfed infants (water), Outcome 5 Mean capillary blood glucose levels of infants (mmol/l).

Comparison 2 Exclusive breastfed infants versus non‐exclusive breastfed infants (water), Outcome 6 Weight change (g).
Figures and Tables -
Analysis 2.6

Comparison 2 Exclusive breastfed infants versus non‐exclusive breastfed infants (water), Outcome 6 Weight change (g).

Comparison 2 Exclusive breastfed infants versus non‐exclusive breastfed infants (water), Outcome 7 Weight loss (%).
Figures and Tables -
Analysis 2.7

Comparison 2 Exclusive breastfed infants versus non‐exclusive breastfed infants (water), Outcome 7 Weight loss (%).

Comparison 2 Exclusive breastfed infants versus non‐exclusive breastfed infants (water), Outcome 8 Maximum serum bilirubin levels umol/L.
Figures and Tables -
Analysis 2.8

Comparison 2 Exclusive breastfed infants versus non‐exclusive breastfed infants (water), Outcome 8 Maximum serum bilirubin levels umol/L.

Comparison 3 Exclusive breastfed infants versus non‐exclusive breastfed infants (foods), Outcome 1 Fever (% of days).
Figures and Tables -
Analysis 3.1

Comparison 3 Exclusive breastfed infants versus non‐exclusive breastfed infants (foods), Outcome 1 Fever (% of days).

Comparison 3 Exclusive breastfed infants versus non‐exclusive breastfed infants (foods), Outcome 2 Cough (% of days).
Figures and Tables -
Analysis 3.2

Comparison 3 Exclusive breastfed infants versus non‐exclusive breastfed infants (foods), Outcome 2 Cough (% of days).

Comparison 3 Exclusive breastfed infants versus non‐exclusive breastfed infants (foods), Outcome 3 Congestion (% of days).
Figures and Tables -
Analysis 3.3

Comparison 3 Exclusive breastfed infants versus non‐exclusive breastfed infants (foods), Outcome 3 Congestion (% of days).

Comparison 3 Exclusive breastfed infants versus non‐exclusive breastfed infants (foods), Outcome 4 Nasal discharge (% of days).
Figures and Tables -
Analysis 3.4

Comparison 3 Exclusive breastfed infants versus non‐exclusive breastfed infants (foods), Outcome 4 Nasal discharge (% of days).

Comparison 3 Exclusive breastfed infants versus non‐exclusive breastfed infants (foods), Outcome 5 Hoarseness (% of days).
Figures and Tables -
Analysis 3.5

Comparison 3 Exclusive breastfed infants versus non‐exclusive breastfed infants (foods), Outcome 5 Hoarseness (% of days).

Comparison 3 Exclusive breastfed infants versus non‐exclusive breastfed infants (foods), Outcome 6 Weight change (g).
Figures and Tables -
Analysis 3.6

Comparison 3 Exclusive breastfed infants versus non‐exclusive breastfed infants (foods), Outcome 6 Weight change (g).

Comparison 3 Exclusive breastfed infants versus non‐exclusive breastfed infants (foods), Outcome 7 Weight change (z score).
Figures and Tables -
Analysis 3.7

Comparison 3 Exclusive breastfed infants versus non‐exclusive breastfed infants (foods), Outcome 7 Weight change (z score).

Table 1. Martin‐Calama 1997. Primary outcome: breastfeeding duration

% of mothers who continued either exclusive or partial breastfeeding

Exclusive breastfeeding on day 1‐3 group (non‐glucose water) (n = 87)

Glucose water on day 1‐3 (n = 83)

At 4 weeks

93%

77%

At 8 weeks

81%

64%

At 12 weeks

75%

51%

At 16 weeks

67%

43%

At 20 weeks

57%

40%

These figures were estimated from a graph (Figure 2) on page 212 of the Martin‐Calama 1997 paper.

Figures and Tables -
Table 1. Martin‐Calama 1997. Primary outcome: breastfeeding duration
Comparison 1. Exclusive breastfed infants versus non‐exclusive breastfed infants (artificial milk)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Breastfeeding duration Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 Exclusive breastfeeding at 1 week

1

39

Risk Ratio (M‐H, Fixed, 95% CI)

0.58 [0.37, 0.92]

1.2 Exclusive breastfeeding at 3 months

1

38

Risk Ratio (M‐H, Fixed, 95% CI)

0.44 [0.26, 0.76]

1.3 Any breastfeeding at 3 months

1

37

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.56, 1.03]

2 Incidence of fever Show forest plot

1

38

Risk Ratio (M‐H, Fixed, 95% CI)

1.5 [0.28, 7.99]

3 Maternal self‐confidence Show forest plot

1

39

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.34, 0.54]

Figures and Tables -
Comparison 1. Exclusive breastfed infants versus non‐exclusive breastfed infants (artificial milk)
Comparison 2. Exclusive breastfed infants versus non‐exclusive breastfed infants (water)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Breastfeeding duration Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 At 4 weeks

1

170

Risk Ratio (M‐H, Fixed, 95% CI)

1.21 [1.06, 1.38]

1.2 At 8 weeks

1

170

Risk Ratio (M‐H, Fixed, 95% CI)

1.26 [1.04, 1.53]

1.3 At 12 weeks

1

170

Risk Ratio (M‐H, Fixed, 95% CI)

1.48 [1.16, 1.89]

1.4 At 16 weeks

1

170

Risk Ratio (M‐H, Fixed, 95% CI)

1.54 [1.15, 2.05]

1.5 At 20 weeks

1

170

Risk Ratio (M‐H, Fixed, 95% CI)

1.45 [1.05, 1.99]

2 Maximum temperature (ºC) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 At 72 hours

1

170

Mean Difference (IV, Fixed, 95% CI)

0.10 [0.01, 0.19]

3 Minimum temperature (ºC) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 At 72 hours

1

170

Mean Difference (IV, Fixed, 95% CI)

0.10 [0.02, 0.18]

4 Episodes of hypoglycaemia (glycaemia < 2.2 mmol/l) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 At 6 hours of life

1

170

Risk Ratio (M‐H, Fixed, 95% CI)

2.39 [0.48, 11.96]

4.2 At 12 hours of life

1

170

Risk Ratio (M‐H, Fixed, 95% CI)

14.32 [0.83, 246.80]

4.3 At 24 hours of life

1

170

Risk Ratio (M‐H, Fixed, 95% CI)

0.64 [0.11, 3.71]

4.4 At 48 hours of life

1

170

Risk Ratio (M‐H, Fixed, 95% CI)

2.86 [0.30, 26.97]

5 Mean capillary blood glucose levels of infants (mmol/l) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

5.1 At 6 hours of life

1

170

Mean Difference (IV, Fixed, 95% CI)

‐0.29 [‐0.56, ‐0.02]

5.2 At 12 hours of life

1

170

Mean Difference (IV, Fixed, 95% CI)

‐0.47 [‐0.70, ‐0.24]

5.3 At 24 hours of life

1

170

Mean Difference (IV, Fixed, 95% CI)

‐0.34 [‐0.60, ‐0.08]

5.4 At 48 hours of life

1

170

Mean Difference (IV, Fixed, 95% CI)

‐0.24 [‐0.51, 0.03]

6 Weight change (g) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

6.1 At 6 hours of life

1

170

Mean Difference (IV, Fixed, 95% CI)

7.0 [0.76, 13.24]

6.2 At 12 hours of life

1

170

Mean Difference (IV, Fixed, 95% CI)

11.5 [1.71, 21.29]

6.3 At 24 hours of life

1

170

Mean Difference (IV, Fixed, 95% CI)

13.40 [0.43, 26.37]

6.4 At 48 hours of life

1

170

Mean Difference (IV, Fixed, 95% CI)

32.5 [12.91, 52.09]

6.5 At 72 hours of life

1

170

Mean Difference (IV, Fixed, 95% CI)

‐3.0 [‐26.83, 20.83]

7 Weight loss (%) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 Day 3

1

47

Mean Difference (IV, Fixed, 95% CI)

1.03 [‐0.18, 2.24]

7.2 Day 5

1

47

Mean Difference (IV, Fixed, 95% CI)

0.20 [‐1.18, 1.58]

8 Maximum serum bilirubin levels umol/L Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 Day 6

1

47

Mean Difference (IV, Fixed, 95% CI)

‐18.84 [‐39.03, 1.35]

Figures and Tables -
Comparison 2. Exclusive breastfed infants versus non‐exclusive breastfed infants (water)
Comparison 3. Exclusive breastfed infants versus non‐exclusive breastfed infants (foods)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fever (% of days) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 4 to 6 months

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Cough (% of days) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

2.1 At 4 to 6 months

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Congestion (% of days) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 At 4 to 6 months

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Nasal discharge (% of days) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1 At 4 to 6 months

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 Hoarseness (% of days) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5.1 At 4 to 6 months

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Weight change (g) Show forest plot

2

260

Mean Difference (IV, Fixed, 95% CI)

39.48 [‐49.48, 128.43]

6.1 At 4 to 6 months

2

260

Mean Difference (IV, Fixed, 95% CI)

39.48 [‐49.48, 128.43]

7 Weight change (z score) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

7.1 4 to 6 months

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 3. Exclusive breastfed infants versus non‐exclusive breastfed infants (foods)