Breastfeeding promotion in special care and neonatal intensive care units (SCBU/NICU); an evidence synthesis


Starting and continuing to breastfeed, or to express breast milk, is particularly difficult in special and intensive care settings, where care is dominated by medical procedures, parents are likely to be anxious and distressed, and mothers are often separated from their babies. There is currently no policy initiative in the UK about breastfeeding in special and intensive care units. This study used systematic review methodology to assess which interventions effectively promoted the initiation and duration of breastfeeding in special and intensive care settings. It examined trials of intervention strategies that both directly (e.g. support for parents) and indirectly (e.g. provision of facilities for expression and storage of breast milk) affected breastfeeding. The study also aimed to identify interventions that may be potentially harmful. An analysis of the cost-effectiveness of implementing effective interventions was carried out. Based on this information, we made recommendations for future research and, where possible, for practice and policy.


Despite the limitations of the evidence base, kangaroo skin-to-skin contact, peer support, simultaneous breastmilk pumping, multidisciplinary staff training and the Baby Friendly accreditation of the associated maternity hospital have been shown to be effective, and skilled support from trained staff in hospital has been shown to be potentially cost-effective. All these point to future research priorities. Many of these interventions inter-relate: it is unlikely that specific clinical interventions will be effective if used alone. There is a need for national surveillance of feeding, health and cost outcomes for infants and mothers in neonatal units; to assist this goal, we propose consensus definitions of the initiation and duration of breastfeeding/breastmilk feeding with specific reference to infants admitted to neonatal units and their mothers.

Conducted by: MJ Renfrew1, D Craig2, L Dyson1, F McCormick1, S Rice2, SE King1, K Misso2, E Stenhouse3, AF Williams4

1. Mother and Infant Research Unit, Department of Health Sciences, University of York; 2. Centre for Reviews and Dissemination; 3. Faculty of Health and Social Work, University of Plymouth; 4. St George's Hospital Medical School, University of London

Further details

Project page on NIHR HTA Programme website


Renfrew MJ, Craig D, Dyson L, McCormick F, Rice S, King SE, Misso K, Stenhouse E, Williams AF. Breastfeeding promotion in special care baby units and neonatal intensive care units (SCBU/NICU): an evidence synthesis. Health Technol Assess. 2009; 13(40): 1-146


Commissioned by the NIHR HTA Programme