The 2013 updated guidelines on management of severe acute malnutrition in infants and children recommends the support of exclusive breastfeeding. These guidelines are inconsistently applied in low and middle income countries (LMICs) due to barriers including unclear implementation guides, technical support and epidemiological factors. Peer support strategies have been used to offer psychological support to families with infants in NICU and improve mental health outcomes. Breastfeeding peer supporters (BFPS) have been shown to be effective in improving breastfeeding outcomes in community settings however, their success within hospital settings in LMICs is unknown. We conducted a scoping review to explore implementation of breastfeeding peer support strategies as have been applied to hospitalized infants globally and highlight their implementation strategies in order to guide future research and practice. A scoping review of the literature was conducted using the Arksey and O’Malley framework. A search was conducted in five online databases (PubMed, Cochrane library, Hinari, Google Scholar and Open Grey library). Data were extracted and charted in data extraction tables to capture general characteristics, modes of peer support delivery, implementation details and evaluation procedures. From the online search 276 articles were identified, however only 18 met the inclusion criteria for the study. The majority of these articles were reports on in-patient breastfeeding peer support interventions applied in Europe and the United States of America and only two were from LMICs. The articles described peer supporters’ identification, training (n = 13) and supervision (n = 14). The majority of the BFPS were employed (n = 10) compared to volunteers (n = 3) and support was mainly one-to-one (n = 11) rather than group support. Process and impact evaluation (n = 13) reported positive breastfeeding outcomes associated with breastfeeding peer support. Breastfeeding peer support strategies are applied in different hospital settings and can be used to improve breastfeeding outcomes. However, to achieve integration, scalability and comparability of impact and outcomes, there is a need to standardize training, develop consistent implementation and supervision plans of in-patient peer supporters’ strategies. Further research to assess sustainability and evaluate cost-effectiveness of in-patient breastfeeding peer support strategies will improve uptake and scalability of these potentially lifesaving interventions.

中文翻译：

---

在医院环境中应用的母乳喂养同伴支持模式的范围审查

2013 年更新的婴幼儿严重急性营养不良管理指南建议支持纯母乳喂养。由于实施指南不明确、技术支持和流行病学因素等障碍，这些指南在低收入和中等收入国家 (LMIC) 的应用不一致。同伴支持策略已被用于为 NICU 中有婴儿的家庭提供心理支持并改善心理健康结果。母乳喂养同伴支持者 (BFPS) 已被证明可有效改善社区环境中的母乳喂养结果，但是，他们在中低收入国家的医院环境中是否成功尚不清楚。我们进行了一项范围界定审查，以探索已应用于全球住院婴儿的母乳喂养同伴支持策略的实施，并强调其实施策略以指导未来的研究和实践。使用 Arksey 和 O'Malley 框架对文献进行了范围审查。在五个在线数据库（PubMed、Cochrane 图书馆、Hinari、Google Scholar 和 Open Gray 图书馆）中进行了搜索。数据被提取并绘制在数据提取表中，以获取一般特征、同伴支持交付模式、实施细节和评估程序。从在线搜索中确定了 276 篇文章，但只有 18 篇符合研究的纳入标准。这些文章中的大多数是关于在欧洲和美国应用的住院母乳喂养同伴支持干预的报告，只有两篇来自中低收入国家。这些文章描述了同伴支持者的识别、培训（n = 13）和监督（n = 14）。与志愿者 (n = 3) 相比，大多数 BFPS 被雇用 (n = 10) 并且支持主要是一对一 (n = 11) 而不是团体支持。过程和影响评估（n = 13）报告了与母乳喂养同伴支持相关的积极母乳喂养结果。母乳喂养同伴支持策略适用于不同的医院环境，可用于改善母乳喂养结果。然而，为了实现影响和结果的整合、可扩展性和可比性，需要标准化培训，为住院同伴支持者的策略制定一致的实施和监督计划。评估住院患者母乳喂养同伴支持策略的可持续性和成本效益的进一步研究将提高这些可能挽救生命的干预措施的采用率和可扩展性。