Critical Factors Influencing the Uptake of Breastfeeding Support Interventions in Neonatal Intensive Care Units: A Scoping Review

Background: Breastfeeding is considered the optimal source of nutrition for infants admitted to Neonatal Intensive Care Units (NICUs). Despite these well-documented benefits, establishing and sustaining breastfeeding in NICU settings remains challenging due to inadequate uptake of breastfeeding support measures. This scoping review aimed to examine the evidence on factors influencing the uptake of breastfeeding support practices in NICUs. Methods: The search was undertaken across four electronic databases: PubMed, MEDLINE, CINAHL, and the Cochrane Library. Primary studies published in English between 1994 and 2025 were included. Eligible studies focused on factors influencing breastfeeding support, implementation, or uptake of breastfeeding-related interventions in NICU settings. Exclusion criteria included studies not involving NICU populations, studies not addressing breastfeeding outcomes or support, secondary literature, and non-English publications. A total of 30 peer-reviewed studies met the inclusion criteria. Data were charted and synthesized using thematic analysis. Results: A total of 30 studies met the inclusion criteria. Four major themes influencing breastfeeding support uptake in NICUs were identified: (1) institutional commitment to the Neonatal Baby-Friendly Hospital Initiative (Neo-BFHI), (2) NICU breastfeeding protocols and care practices, (3) breastfeeding training for NICU staff and mothers, and (4) parental breastfeeding motivation and family support. Across studies, breastfeeding support was strengthened by organizational breastfeeding policies, staff education, lactation support services, family-centred care practices, and parental involvement. However, variations in NICU resources, institutional practices, and staff support contributed to inconsistencies in breastfeeding implementation and continuation. Conclusions: Breastfeeding support in NICUs is influenced by interconnected organizational, clinical, educational, and psychosocial factors. The findings highlight the importance of integrated breastfeeding-supportive approaches that combine institutional commitment, standardized NICU practices, healthcare provider education, and family-centred care to improve breastfeeding support for vulnerable infants in NICU settings.