Effects of remote breastfeeding guidance on breastfeeding rates and neonatal health: a systematic review and meta-analysis

Background Breastfeeding is widely acknowledged as the optimal feeding method for neonatal health. Remote breastfeeding guidance (e.g., using the telephone, text messages, mobile applications, and so on) may improve breastfeeding rates and neonatal outcomes, but its short-term impact and effect across economic regions remain unclear. This systematic review and meta-analysis aimed to assess the effect of remote breastfeeding guidance on neonatal feeding practices and breastfeeding rates. Methods Databases including PubMed, Embase, and the Cochrane Library were screened from inception to November 2024 to identify randomized controlled trials (RCTs) that assessed the effects of remote breastfeeding guidance on breastfeeding rates and neonatal health. Time subgroup analyses evaluated exclusive and any breastfeeding at 3 and 6 months postpartum, together with the effects in developed and less developed regions. Trial Sequential Analysis (TSA) and sensitivity analysis were employed to address heterogeneity and evaluate the robustness of the findings. Results Thirty RCTs involving 8,389 infants were incorporated into this systematic review and meta-analysis. Compared to the control group, remote breastfeeding support significantly increased the prevalence of exclusive breastfeeding at 3 and 6 months ( RR = 1.17, 95% CI 1.11–1.23, P < 0.0001; RR = 1.57, 95% CI 1.38–1.77, P < 0.0001), with modest effects on any breastfeeding ( RR = 1.07, 95% CI 1.02–1.13, P = 0.007; RR = 1.05, 95% CI 0.99–1.11, P = 0.11). Infant weight was significantly higher in the intervention groups at 3 and 6 months ( MD = 334.39, 95% CI 310.93–357.85, P < 0.00001), representing clinically meaningful gains. A subgroup analysis demonstrated that exclusive breastfeeding provided greater benefits in less developed regions ( RR = 1.28, 95% CI 1.23–1.34, P < 0.00001) than in developed regions ( RR = 1.12, 95% CI 1.05–1.19, P < 0.00001). TSA and sensitivity analyses confirmed the robustness of the results. Conclusions Remote breastfeeding guidance plays an important role in increasing breastfeeding rates and promoting physical development, with particularly pronounced effects in less developed regions.