Systematic Review of Newborn Feeding Method and Outcomes Related to Neonatal Abstinence Syndrome

Abstract

ObjectiveTo critically appraise and synthesize existing studies on the relationship between newborn feeding method and neonatal outcomes related to neonatal abstinence syndrome (NAS). Data SourcesA systematic search of the literature on newborn feeding method in newborns with NAS was conducted with the use of the electronic databases PubMed, CINAHL, Nursing and Allied Health, PyschINFO, Evidence Based Medicine, Web of Science, and MEDLINE (Embase). Study SelectionStudies were eligible for inclusion if the following criteria were met: the authors reported original data on outcomes related to newborn feeding and NAS, the research followed any type of quantitative design that included comparison of breastfed and formula-fed newborns with NAS, and the articles were published in English in peer-reviewed journals from 1990 to February 2018. Data ExtractionTwo authors independently extracted the data from the full-text articles and entered them into a data extraction template developed for the systematic review. The data were synthesized narratively because of the diversity in assessment of newborn feeding methods and outcome measures. Data SynthesisWe identified eight studies in which newborn feeding method and outcomes related to NAS were evaluated in newborns exposed to opioids. The synthesis indicated that for newborns exposed to methadone, breastfeeding was associated with decreased incidence and duration of pharmacologic treatment, shorter hospital length of stay, and decreased severity of NAS. The association between newborn feeding method and NAS among newborns exposed to buprenorphine was unclear. ConclusionBreastfeeding may be effective to mitigate negative outcomes related to NAS among newborns exposed to methadone in utero. Women who are stable on opioid substitution treatment should be provided with appropriate education and support to breastfeed. However, to effectively promote breastfeeding among these mothers, evidence-based strategies are required, and barriers to breastfeeding need to be addressed.