Factors influencing direct breastfeeding of preterm infants in neonatal wards and the provision of breastfeeding support: a qualitative systematic review protocol

Objective: The objective of this review is to synthesize the qualitative evidence on factors that influence direct breastfeeding of preterm infants in neonatal wards and the provision of breastfeeding support. Introduction: Breastmilk is critical for the health of preterm neonates, and infants who directly feed at the breast are more likely to receive breastmilk exclusively for longer periods. Direct breastfeeding is associated with improved maternal coping and development of maternal identity. Preterm infants are significantly less likely to breastfeed than their term counterparts. An understanding of barriers and facilitators of direct breastfeeding and breastfeeding support in neonatal wards is lacking. Inclusion criteria: The proposed qualitative systematic review will include studies using qualitative methods and mixed methods, exploring the perceptions of breastfeeding parents, neonatal health care staff, and/or support people about the barriers and facilitators to direct breastfeeding (ie, suckling breastmilk directly from the parent’s breast) among preterm infants (infants born at less than 37 weeks’ gestation) admitted to a neonatal ward. Articles written in English or French will be considered. Methods: MEDLINE (Ovid), CINAHL (EBSCOhost), Embase (Ovid), PsycINFO (Ovid), Scopus, and the Cochrane Library will be searched, with no time restrictions applied. Two independent reviewers will screen and extract data using a tool developed for this purpose. The findings will be coded and pooled using the meta-aggregation approach. The findings will be mapped to specific domains of the Theoretical Domains Framework using an iteratively developed coding manual. Studies will be appraised using the JBI critical appraisal tool for qualitative research, and confidence in the overall findings will be assessed using the ConQual approach. Review registration: PROSPERO CRD42024557250