Literature review for - Flourish Paediatrics

Additional Notes
1. Clinical Evidence 2009 What are the effects of interventions to reduce the risk of
SIDS? (Hauck and Tanabe 2009)
Reduction in incidence of SIDS
Advice to breastfeed compared with no advice
Advice to breastfeed or breastfeed plus other advice may reduce the incidence of SIDS (very
low-quality evidence).
Note:
We found no clinically important results from RCTs comparing advice to breastfeed with no
advice. RCTs investigating the effects of advice to breastfeed may be considered unethical.
Benefits: We found no systematic review or RCTs comparing advice to encourage
breastfeeding versus no advice (see comment below).
National advice campaigns:
We found one non-systematic review of national campaigns (3 observational studies; 1 of
which reported separately) and three additional observational studies conducted after the
national advice campaigns. The review and additional observational studies found that the
campaigns were all followed by a reduced incidence of SIDS during the data collection
periods. However, the campaigns all included additional advice combined with promoting
breastfeeding, and in some countries the incidence of SIDS had started to fall before the
campaign started.
The second additional observational study found that the incidence of mothers choosing not
to breastfeed reduced significantly after the campaign (from 21% before the campaign to 7%
after the campaign; P < 0.001). The third additional observational study found that rates of
children solely being breastfed increased from 53% to 67% after the campaign.
Harms: The studies reported no evidence on harms associated with advice to encourage
breastfeeding.
Comment: RCTs investigating the effects of promotion of breastfeeding would be unethical,
given the evidence of benefits associated with breastfeeding.
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