{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T17:03:38Z","timestamp":1780938218830,"version":"3.54.1"},"reference-count":31,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nursing Reports"],"abstract":"<jats:p>Background\/Objectives: Maintaining oral hygiene in infants in neonatal and pediatric intensive care is essential for preventing ventilator-associated pneumonia (VAP). Chlorhexidine (CHX) is widely used in adults but its safety and efficacy in infants remain uncertain, and it is not recommended for children under 6 years due to rinsing difficulties and mucosal irritation risk. Expressed breast milk (EBM), rich in immunological and antimicrobial components, has been explored as a biologically appropriate alternative. This review synthesizes evidence on EBM effectiveness and safety and contextualizes it against limited indirect evidence for CHX, as no head-to-head comparative trials were identified. Methods: A systematic search of PubMed, EMBASE, Cochrane Library, CINAHL, and Web of Science (January 2015\u2013January 2026) identified randomized and non-randomized studies involving infants \u2264 12 months receiving EBM, colostrum, or CHX for oral care. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for non-RCTs. Due to substantial clinical and methodological heterogeneity (differing populations, dosages, frequencies, delivery methods, and outcome definitions), a narrative synthesis was performed. Results: Seventeen studies met inclusion criteria (11 RCTs, n = 1185; 6 non-RCTs, n &gt; 3000). EBM and oropharyngeal colostrum were associated with trends toward lower VAP incidence trends (0\u20134%), reduced bacterial colonization, improved oral health indices, shorter mechanical ventilation time, and reduced ICU\/hospital stays, with no reported adverse events. Evidence for CHX in infants was limited to a single paediatric RCT and bundled interventions, showing no significant VAP reduction and associations with mucosal irritation. The risk of bias was generally low to moderate. Conclusions: Indirect evidence suggests EBM is a potentially beneficial option for infant oral hygiene, with favourable trends for infection-related outcomes and recovery parameters. However, all EBM\u2013CHX comparisons are indirect, and CHX evidence in infants is limited by the risk of bias and heterogeneity. High-quality head-to-head randomized controlled trials are needed to determine optimal strategies and inform guidelines.<\/jats:p>","DOI":"10.3390\/nursrep16060195","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T16:25:16Z","timestamp":1780935916000},"page":"195","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of Expressed Breast Milk Mouthwash for Infant Oral Hygiene"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-9565-3563","authenticated-orcid":false,"given":"Reda","family":"Elsahy","sequence":"first","affiliation":[{"name":"Nursing Department, Al Jalila Children\u2019s Hospital, Dubai Health, Dubai P.O. Box 2556, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3052-103X","authenticated-orcid":false,"given":"Thaer","family":"Momani","sequence":"additional","affiliation":[{"name":"Hind Bint Maktoum College of Nursing and Midwifery, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai P.O. Box 505055, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"163","DOI":"10.4103\/jpcc.jpcc_49_23","article-title":"Ventilator-associated pneumonia","volume":"10","author":"Sanketh","year":"2023","journal-title":"J. Pediatr. Crit. Care"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Herr, L., Chung, J., Lee, K.E., Han, J.H., Shin, J.E., Jung, H.I., and Kang, C.M. (2023). 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