Breastfeeding and congenital heart disease: A critical review of the methodology

Dear Sir, After carefully reviewing the article titled: “Systematic survey of breastfeeding practices in mothers of babies with congenital heart disease who had heart surgery” by Yenduri et al.,[1] which reports a high incidence of interruption of breastfeeding before the surgery, mainly attributed to the perception of insufficient milk production. The survey also reveals a delay on the resumption of breastfeeding during the post surgery phase, concluding that there is an urgent need on specifically support for breastfeeding and nutritional interventions. Breastfeeding in infants with congenital heart disease is a fundamental aspect of comprehensive management, although it is often overshadowed by the surgical approach. However, we believe that this study has certain methodological limitations that should be acknowledged and highlighted to evaluate the findings properly. In the research conducted by Yenduri et al.,[1] the term “systematic survey” was used in the title; however, systematic reviews are clear, structured summaries, prepared to answer a specific clinical question. This determines the selection of relevant articles that allow the research question to be answered, and once the data are obtained, critical and statistical analyses are performed. In this sense, the use of the term “systematic survey” in the article title is inappropriate, as the study did not conduct a systematic review but rather a descriptive observational study in two phases: a retrospective telephone survey and a prospective observational study. These phases focused on collecting primary data on breastfeeding practices in a specific group of mothers.[2] Therefore, in future work using this research design, we recommend omitting the term “systematic survey” and replacing it with “descriptive survey” to better align with the article. On the other hand, Yenduri et al.[1] employed a methodology based on a retrospective telephone survey and a prospective observational study. The heterogeneous combination of these methodologies represents a significant limitation. The lack of uniformity in data collection can significantly affect the interpretation and validity of the results. Furthermore, it is crucial to point out that the use of retrospective telephone surveys in this study introduces significant bias, as data collection relies heavily on the mothers’ memory and understanding of the questions, increasing the likelihood of recall bias and affecting data reliability. Therefore, we recommend that future studies similar to that of Yenduri et al.[1] utilize a prospective cohort design that addresses pre- and postoperative nutritional status in patients with congenital heart disease. This will allow for greater validity of the findings by directly minimizing recall bias.[3] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.