2 Research recommendations

In 2006, the Guideline Development Group made the following recommendations for research, based on its review of evidence, to improve NICE guidance and patient care in the future. The Guideline Development Group's full set of research recommendations is detailed in the full guideline.

2.1 Routine monitoring of the weight of babies

Does routine monitoring of the weight of all low‑risk babies during the first 6−8 weeks after birth reduce the incidence of serious morbidities?

Why this is important

Healthy babies normally lose weight in the first week of life. This weight loss is usually transient and of no significance, but may be exaggerated if there is difficulty establishing feeding or if the baby is ill. In the past, all babies were routinely weighed at least twice in the first 10 days after birth. There is debate about the benefits and harms of routine weighing in the first weeks of life.

The existing evidence base relies on findings from population‑based surveillance systems and small‑scale evaluations. A large‑scale randomised controlled trial is therefore required to evaluate whether there is a significant difference in the incidence of important outcomes between routine regular and expectant weighing of babies at low risk of complications in the first 6−8 weeks after birth.

2.2 Evaluation of Baby Friendly Initiative

What is the impact of the use of the Baby Friendly Initiative (BFI) on breastfeeding uptake and duration in English and Welsh hospitals and community settings?

Why this is important

The health and social benefits of breastfeeding to both mother and baby are multidimensional, yet, despite consorted and prolonged policy deigned to improve breastfeeding rates, UK rates are among the lowest in Europe. The BFI sets rigorous standards for healthcare organisations to adopt, with the aim of improving breastfeeding rates. Positive evaluations of the initiative have been published in Scotland, and other countries outside the UK but cost‑effectiveness studies that deal with the Baby Friendly Hospital Initiative have yet to be carried out in England and Wales.

This postnatal care guideline recommends that 'All healthcare providers (hospitals and community) should implement an externally evaluated structured programme that encourages breastfeeding, using the Baby Friendly Initiative (BFI) as a minimum standard.'

Further research to evaluate the cost‑effectiveness of BFI compared to another programme, or to standard care, should be carried out. Outcomes should include necessarily initiation, duration and exclusive breastfeeding rates and may also attempt to construct Health Economic measures of outcome, such as the QALY.

2.3 The effect of peer support on severity of postnatal depression

Is the severity of postnatal depression among socially isolated women reduced by the provision of peer social support compared with standard care?

Why this is important

Postnatal depression affects 10−15% of mothers and can lead to cognitive and emotional disturbance in the baby alongside the effects on the mother. Children of depressed mothers are more likely to access Child and Adolescent Mental Health Services (CAMHS) and suffer mental health problems as adolescents and adults. Social isolation is a known risk factor for postnatal depression and reducing this may have a range of clinical and psycho‑social benefits.

A randomised controlled trial is proposed to evaluate the effect on the rate of postnatal depression of providing enhanced peer support compared to standard care for women who are at risk of social isolation after childbirth.

Outcomes should include quality of life and clinical measures: maternal and infant/child psychological wellbeing, depression, social wellbeing, physical health

This research would complement research funded by the Health Technology Assessment programme evaluating different models of care in the postnatal period.