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breastfeeding, methadone, neonatal abstinence syndrome, opioid-related disorders, review



  1. Chu, Liangliang
  2. McGrath, Jacqueline M.
  3. Qiao, Jianhong
  4. Brownell, Elizabeth
  5. Recto, Pamela
  6. Cleveland, Lisa M.
  7. Lopez, Emme
  8. Gelfond, Jonathan
  9. Crawford, Allison
  10. McGlothen-Bell, Kelly


Background: Neonatal abstinence syndrome (NAS) rates have dramatically increased. Breastfeeding is a nonpharmacological intervention that may be beneficial, reducing NAS symptom severity and thus the need for and duration of pharmacological treatment and length of hospital stay.


Objectives: Conduct meta-analysis to determine whether breastfeeding results in better outcomes for NAS infants. Variables included symptom severity, need for and duration of pharmacological treatment, and length of hospital stay.


Methods: PubMed, Scopus, Embase, and Cochrane Library were searched from 2000 to 2020, and comparative studies examining breastfeeding for NAS infants were extracted. Randomized trials and cohort studies were included. Data were extracted and evaluated with Review Manager Version 5.3. A random-effects model was used to pool discontinuous outcomes using risk ratio and 95% confidence intervals. Continuous outcomes were evaluated by mean differences and 95% confidence intervals.


Results: Across 11 studies, 6,375 neonates were included in the meta-analysis. Using a random-effects analysis, breastfeeding reduced initiation of pharmacological treatment, reduced duration of pharmacological treatment, and reduced length of stay. No differences were detected for severity of NAS symptoms. Most studies only reported one to two variables of interest. For most studies, these variables were not the primary study outcomes. All studies were found to be of low risk and good quality based on the Cochrane Risk Assessment Tools. Varying breastfeeding definitions limit generalizability.


Discussion: Breastfeeding is associated with decreased initiation and duration of pharmacological treatment and length of stay.