Leading expert Professor Mary Renfrew laments the lack of quality research to better understand the impact of breastfeeding on sick and vulnerable newborns in health facilities and proposes a way forward.

1. Why invest in research?
Professor Mary J Renfrew FRSE
Director, Mother and Infant Research Unit
University of Dundee, Scotland
m.renfrew@dundee.ac.uk

2. 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

3. 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

4. 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

5. 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

6. 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
m.renfrew@dundee.ac.uk