Using the Delphi Method to Develop Breastfeeding Quality Indicators for Very Preterm Infants

Background: Human milk protects very preterm infants from many complications. While quality indicators are crucial for evaluating and improving breastfeeding practices, those specifically tailored for very preterm infants are lacking. Research Aim: To develop a set of practical and reliable indicators for evaluating and improving the quality of breastfeeding for very preterm infants. Methods: This study employed a longitudinal, prospective survey design utilizing a two-round Delphi method employing the RAND Corporation/University of California Los Angeles Appropriateness Method. A systematic search of the literature was performed across multiple databases, including PubMed, Cochrane, Embase, and Wanfang, to identify potential quality indicators for breastfeeding in very preterm infants. A multidisciplinary expert panel then evaluated these through two Delphi rounds to establish relevance and feasibility. Results: Twenty-two candidate quality indicators of breastfeeding were extracted for the Delphi process. The experts’ authority coefficients for the two rounds were 0.84 and 0.83, respectively. Eleven indicators, encompassing breastfeeding outcome indicators ( n = 1), mother’s lactation status indicators ( n = 3), the breastfeeding process indicators ( n = 3), and balancing indicators ( n = 4), were considered relevant and feasible and were incorporated into the set of quality indicators for breastfeeding. Conclusions: This study developed a set of practical and reliable indicators for evaluating and improving the quality of breastfeeding for very preterm infants, based on the collective opinion of content experts. These quality indicators may facilitate an objective and quantitative assessment of breastfeeding quality for this vulnerable population.