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Table 4 GRADE outcomes for studies on expressed breast milk and the expression of breast milk. Patient or population: Infants (≤ 28 days old); Setting: Hospitals; Intervention: Expressed breast milk or expression of breast milk; Comparison: other or no intervention

From: Expressed breast milk and maternal expression of breast milk for the prevention and treatment of neonatal hypoglycemia: a systematic review and meta-analysis

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect (95% CI)

№ of participants (studies)

Certainty of the evidence (GRADE)

Comments

Risk with other or no intervention

Risk with Expressed breast milk

Expressed breast milk

 Neonatal hypoglycaemia

0 per 1 000

0 per 1 000 (0 to 0)

not estimable

20 (1 RCT)

⨁◯◯◯ Very lowa,b

For neonatal hypoglycemia, the benefit or harm of giving infants EBM could not be estimated as there were no hypoglycemic episodes in either group

Expression of breast milk

 Neonatal hypoglycaemia

454 per 1 000

418 per 1 000 (350 to 499)

RR 0.92 (0.77 to 1.10)

630 (1 RCT)

⨁⨁⨁⨁ High

Antenatal expression of breast milk results in little to no difference in neonatal hypoglycemia

 Separation from mother for any treatment

144 per 1 000

156 per 1 000 (108 to 222)

RR 1.08 (0.75 to 1.54)

668 (2 RCTs)

⨁⨁◯◯ Lowc,d

For separation of infant from mother for any treatment, benefit or harm with expression of breast milk could not be excluded

 Separation from mother for treatment of hypoglycaemia

364 per 1 000

422 per 1 000 (251 to 709)

RR 1.16 (0.69 to 1.95)

89 (1 RCT)

⨁⨁◯◯ Lowd,e

For separation of infant from mother for any treatment, benefit or harm with expression of breast milk could not be excluded

  1. *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval
  2. GRADE Working Group grades of evidence: High certainty: we are very confident that the true effect lies close to that of the estimate of the effect; Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different, Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect, Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect
  3. Explanations: aDowngraded one level due to risk of bias as a result of no details on the randomization process
  4. bDowngraded two levels due to imprecision as a result of the small sample size to detect differences and no event occurring in either group
  5. cDowngraded one level due to risk of bias as one of the included studies is at high risk of bias because of missing outcome data and its measurement
  6. dDowngrade one level due to imprecision as a result of the small sample size to detect differences
  7. eDowngraded one level due to risk of bias as some concerns in the domain of deviations from the intended interventions
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Maternal Health, Neonatology and Perinatology

ISSN: 2054-958X

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