Home visits after discharge help breastfeeding in preterm infants, and intensity may matter

Design

Cochrane systematic review and meta-analysis of randomised trials, GRADE-rated, protocol registered

Population

28 trials contributing data: 12,021 preterm or low-birthweight infants and 10,056 caregivers

Primary outcome

All-cause mortality, neurodevelopment, morbidity, growth and breastfeeding

Effect

Breastfeeding at 6 months RR 1.26 (95% CI 1.16 to 1.37); intensive visits with kangaroo care: mortality HR 0.75 (0.60 to 0.93)

A Cochrane review searched to April 2026 and included 35 randomised trials of home visits after hospital discharge for families of preterm or low-birthweight infants; 28 trials (12,021 infants and 10,056 caregivers) contributed data. Visit content, timing and frequency varied widely. Most trials were from high-income countries, but about 70% of participants in one comparison came from a single large Indian trial.

Against no home visits, visits likely increased breastfeeding at six months (RR 1.26, 95% CI 1.16 to 1.37; four studies, 1,217 infants) and may have increased exclusive breastfeeding (RR 2.31, 0.85 to 6.29). They likely had little to no effect on cognitive or motor development or on growth, and effects on mortality and diarrhoea were very uncertain.

Where basic visits already existed, a more intensive programme with community-initiated kangaroo mother care likely reduced all-cause mortality at six months (HR 0.75, 95% CI 0.60 to 0.93; one study, 8,402 infants) and slightly reduced possible serious bacterial infection at 28 days (RR 0.89, 0.82 to 0.97). That mortality finding comes from one trial, so it needs replication.

• Arrange a home or community follow-up contact within the first days after discharge for a preterm or low-birthweight baby
• Support breastfeeding at each visit and record feeding at every contact
• Promote kangaroo mother care at home where local programmes offer it
• Check weight and signs of infection at each visit, and know the local pathway for urgent referral
• Do not promise developmental benefit from home visits; the review found little evidence for it

Why it matters

Home follow-up is widely offered, and this separates the outcomes it probably improves from those it probably does not.

Don't overread it

The mortality benefit rests on one trial of an intensive package, and the review could not say which components drove it.

The statistics, in plain English

A risk ratio of 1.26 means breastfeeding at six months was about a quarter more likely with visits. The mortality result (HR 0.75) comes from a single large trial, so even though the interval excludes 1, it should be confirmed before it is treated as settled. 'Likely' and 'may' reflect the review's certainty ratings, which ranged from moderate to very low.

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