Breastfeeding interventions for low-birth weight and very low birth weight infants in South Asia: A systematic review and meta-analysis

Background This systematic review and meta-analysis evaluate interventions promoting breastfeeding practices among Low Birth Weight (LBW) and Very Low Birth Weight (VLBW) infants in South Asia. Methods A systematic literature search was conducted in five databases (PubMed, Web of Science, Embase, CINHAL, and the Cochrane library). Evidence was synthesized to estimate the duration to establish breastfeeding practices among LBW and VLBW infants. Meta-analysis was performed to estimate the effect size on breastfeeding practices using random effect model. Heterogeneity was explored by sub-group and meta-regression analyses. Risk of bias and strength of evidence was assessed by the RoB2, ROBINS-I and NIH Quality Assessment tools considering the study design of the selected articles. Results From a pool of 2,524 records screened, 16 studies met the inclusion criteria. The systematic review revealed that various interventions aimed at improving breastfeeding practices among LBW infants largely resulted in positive breastfeeding outcomes such as initiation of breasting and exclusive breastfeeding. The Kangaroo Mother Care (KMC) care was intervened in most cases together with other interventions, including Non-nutritive suckling, Premature Infant Oromotor Intervention, Nutrition Education and Mother Baby Friendly Initiatives Plus. Meta-analysis showed mothers who received KMC demonstrated an earlier initiation of breastfeeding (pooled mean difference: -1.08 days, 95% CI: -2.15, -0.01, p<0.001) as compared to mothers who received conventional care. Conclusions: Breastfeeding interventions, particularly KMC, were found to be effective for LBW infants and can be integrated into hospital or community policies, depending on context and available resources.