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Podrška za majke koje doje zdravu djecu rođenu na termin

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Abstract

Background

There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended infants be exclusively breastfed until six months of age, with breastfeeding continuing as an important part of the infant’s diet till at least two years of age. However, breastfeeding rates in many countries currently do not reflect this recommendation.

Objectives

To assess the effectiveness of support for breastfeeding mothers.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (3 October 2011).

Selection criteria

Randomised or quasi‐randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care.

Data collection and analysis

Two review authors independently assessed trial quality and extracted data.

Main results

Of the 67 studies that we assessed as eligible for inclusion, 52 contributed outcome data to the review (56,451 mother‐infant pairs) from 21 countries. All forms of extra support analysed together showed an increase in duration of 'any breastfeeding' (includes partial and exclusive breastfeeding) (risk ratio (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.88 to 0.96). All forms of extra support together also had a positive effect on duration of exclusive breastfeeding (RR at six months 0.86, 95% CI 0.82 to 0.91; RR at four to six weeks 0.74, 95% CI 0.61 to 0.89). Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Maternal satisfaction was poorly reported.

Authors' conclusions

All women should be offered support to breastfeed their babies to increase the duration and exclusivity of breastfeeding. Support is likely to be more effective in settings with high initiation rates, so efforts to increase the uptake of breastfeeding should be in place. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face‐to‐face support are more likely to succeed. Support that is only offered reactively, in which women are expected to initiate the contact, is unlikely to be effective; women should be offered ongoing visits on a scheduled basis so they can predict that support will be available. Support should be tailored to the needs of the setting and the population group.

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.

Najbolji oblik podrške za dojilje

Svjetska zdravstvena organizacija preporučuje ekskluzivno dojenje novorođenčadi tijekom prvih 6 mjeseci života, nakon čega bi dojenje također trebalo nastaviti kao važan dio djetetove prehrane najmanje do druge godine života. Razlozi za takvu preporuku leže u nizu dokaza koji pokazuju da izostanak dojenja uzrokuje različite kratkoročne i dugoročne rizike i kod majke i kod djeteta. Brojne žene prestanu dojiti prije nego to žele zbog niza problema, od kojih se mnogi mogu spriječiti dobrom skrbi i podrškom. Takvo preuranjeno prekidanje dojenja može uzrokovati razočaranje i stres kod majke te zdravstvene probleme i kod majke i kod djeteta. Podrška za dojilje uključuje davanje podrške, pohvale, informacija i priliku za razgovor i odgovaranje na pitanja. Ovaj Cochrane sustavni pregled je analizirao kliničke pokuse provedene na tu temu kako bi se ispitalo da li pružanje dodatne podrške dojiljama, od strane zdravstvenih radnika ili educiranih laika, može pomoći dojiljama da nastave dojiti u usporedbi sa standardnom skrbi za dojilje. U sustavni pregled uključeno je 52 randomiziranih kontroliranih studija (u kojima su ispitanice nasumično podijeljene u više skupina) koje su provedene u 21 zemlje i u koje je bilo uključeno više od 56.000 žena. Kad su analizirani zajedno svi oblici dodatne podrške pokazali su povećanje duljine vremena tijekom kojeg je žena nastavila dojiti i duljine vremena tijekom kojeg je žena dojila bez uvođenja drugih vrsta tekućine ili hrane. Podrška educiranih laika, kao i zdravstvenih radnika, imala je pozitivan učinak na pokazatelje dojenja. Osobna podrška licem u lice imala je veći učinak nego podrška preko telefona. Nije vjerojatno da je učinkovita podrška koja se pruža samo onda kad je žena zatraži. Ti rezultati pokazuju da bi se ženama koje doje trebalo omogućiti zakazane i kontinuirane posjete osoba koje joj mogu pružiti podršku u dojenju. Intervencije koje uključuju dodatnu podršku imale su veći efekt kad su stope početka dojenja bile velike. Stavovi žena o intervencijama za podršku dojenju nisu dobro opisani u pronađenim studijama. Podršku dojiljama trebalo bi prilagoditi pojedinom okruženju i potrebama pojedinih skupina stanovništva. Potrebna su daljnja istraživanja kako bi se utvrdilo koji su vidovi podrške bili najdjelotvorniji.