Abstract：
The introduction of fluids other than breast milk during the first few days of life or later neonatal period has been identified as a risk factor for suboptimal breastfeeding (BF) outcomes in numerous studies using varying study designs. However, the relationship between early introduction of fluids other than breast milk and BF outcomes has not been systematically assessed using only prospective studies that can establish temporality, which is critical for determining whether observed associations are causal. We conducted a systematic review and meta-analysis of prospective studies to assess if there is a difference in BF outcomes as a result of the introduction of: (a) milk-based prelacteals, (b) water-based prelacteals and (c) breast milk substitutes (BMS) between 4 days and 4 weeks postpartum. We searched PubMed, Lilacs, Web of Science and other repositories for original research investigating the relationship between early introduction of prelacteals and/or BMS and BF outcomes. Forty-eight studies met the inclusion criteria for the systematic review. Of the 39 prelacteal feeding studies, 27 had the prerequisite statistical information for inclusion in the meta-analysis. Findings from the meta-analysis showed a relationship between prelacteals and exclusive BF cessation (RR 1.44; 1.29-1.60) and any BF cessation (2.23; 1.63-3.06) among infants under 6 months old. Nine studies focusing on the introduction of BMS during the neonatal period identified this practice as a statistically significant risk factor for a shorter BF duration. Effective interventions are needed to prevent the introduction of unnecessary milk-based prelacteals and BMS during the perinatal and neonatal periods to improve BF outcomes.
摘要：
在许多使用不同研究设计的研究中，在生命的头几天或新生儿后期引入母乳以外的液体已被确定为次优母乳喂养（BF）结果的风险因素。然而,早期引入除母乳以外的液体与BF结局之间的关系尚未仅使用可确定时间性的前瞻性研究进行系统评估,这对于确定观察到的关联是否是因果关系至关重要。我们对前瞻性研究进行了系统评价和荟萃分析，以评估是否由于引入：（a）基于牛奶的乳前，（b）水性乳前和（c）母乳替代品（BMS）产后4天至4周。我们搜索了PubMed,丁香花,WebofScience和其他原始研究库，用于调查早期引入的泌乳和/或BMS与BF结果之间的关系。48项研究符合系统评价的纳入标准。在39项泌乳前喂养研究中，27具有纳入荟萃分析的先决条件统计信息。荟萃分析的结果显示，在6个月以下的婴儿中，泌乳前与排他性BF停止（RR1.44;1.29-1.60）和任何BF停止（2.23;1.63-3.06）之间存在关系。九项研究专注于在新生儿期引入BMS，将这种做法确定为较短BF持续时间的统计学上显着的风险因素。需要有效的干预措施，以防止在围产期和新生儿期间引入不必要的基于牛奶的乳前和BMS，以改善BF结局。
