Effect of bottles, cups, and dummies on breast feeding in preterm infants: a randomised controlled trial Breastfeeding infants who were extremely low birth weight. Transitioning preterm infants with nasogastric tube supplementation: increased likelihood of breastfeeding. A pilot study to assess the viability of a randomised controlled trial of methods of supplementary feeding of breast-fed pre-term babies. A controlled trial of alternative methods of oral feeding in neonates. The Effect of Breast-and Bottle-Feeding on Oxygen Saturation and Body Temperature in Preterm Infants Cup or Bottle for Preterm Infants: Effects on Oxygen Saturation, Weight Gain, and Breastfeeding
Abstract Objective To determine the effect of artificial teats ( bottle and dummy ) and cups on breast feeding in preterm infants . Design R and omised controlled trial . Setting Two large tertiary hospitals , 54 peripheral hospitals . Participants 319 preterm infants ( born at 23 - 33 weeks ' gestation ) r and omly assigned to one of four groups : cup/no dummy ( n = 89 ) , cup/dummy ( n = 72 ) , bottle/no dummy ( n = 73 ) , bottle/dummy ( n = 85 ) . Women with singleton or twin infants < 34 weeks ' gestation who wanted to breastfeed were eligible to participate . Interventions Cup or bottle feeding occurred when the mother was unable to be present to breast feed . Infants r and omised to the dummy groups received a dummy on entry into the trial . Main outcome measures Full breast feeding ( compared with partial and none ) and any breast feeding ( compared with none ) on discharge home . Secondary outcomes : prevalence of breast feeding at three and six months after discharge and length of hospital stay . Results 303 infants ( and 278 mothers ) were included in the intention to treat analysis . There were no significant differences for any of the study outcomes according to use of a dummy . Infants r and omised to cup feeds were more likely to be fully breast fed on discharge home ( odds ratio 1.73 , 95 % confidence interval 1.04 to 2.88 , P = 0.03 ) , but had a longer length of stay ( hazard ratio 0.71 , 0.55 to 0.92 , P = 0.01 ) . Conclusions Dummies do not affect breast feeding in preterm infants . Cup feeding significantly increases the likelihood that the baby will be fully breast fed at discharge home , but has no effect on any breast feeding and increases the length of hospital stay OBJECTIVE To compare the clinical effect of breastfeedings and bottle feedings in extremely low birth weight ( ELBW ) infants ( birth weight < /=800 g ) . METHODS A total of 12 ELBW infants ( mean birth weight , 672 + /- 95 g ; mean gestation , 26 + /- 2 weeks ) served as their own controls in this prospect i ve study comparing physiologic parameters during bottle and breastfeeding . The infants were put to breast the same week they began on bottle feedings of human milk or premature infant formula ( mean gestation , 35 weeks ) . One breastfeeding and one bottle feeding were observed each day for 10 days . Pre- and postfeeding weights were measured , and oxygen saturation , respiratory rate , heart rate , and axillary temperature were monitored continuously and recorded every minute during feedings . RESULTS The infants demonstrated a higher oxygen saturation and a higher temperature during breastfeeding than during bottle feeding , and were less likely to desaturate to < 90 % oxygen during breastfeeding . Mean weight gain was greater during bottle feeding than during breastfeeding ( 31 vs 9 g ) . CONCLUSIONS Breastfeeding the ELBW infant is desirable from a st and point of improved physiologic responses , but such practice requires breastfeeding support and possible supplementation to optimize weight gain OBJECTIVE To compare nasogastric tube and bottle supplementation as two means of transitioning preterm infants to breastfeeding within an established breastfeeding support program . DESIGN Prospect i ve , r and omized controlled trial ; mothers and health care providers , who were not blinded . SETTING Metropolitan private regional perinatal center ; 40-bed intensive-care nursery . PARTICIPANTS Eighty-four preterm breastfed infants whose birth weight was 1,000 - 2,500 g. MAIN OUTCOME MEASURES Rates of exclusive and partial breastfeeding at discharge from the intensive-care nursery , and at 3 days , 3 months , and 6 months after discharge . RESULTS Compared with infants receiving bottle supplements , infants receiving nasogastric tube supplements were more likely to be breastfeeding at discharge and at 3 days , 3 months and 6 months , after adjusting for confounding variables . Odds ratios ( confidence intervals = 95 % ) showed that the group receiving nasogastric supplements was 4.5 times ( 1.4 to 15 ) more likely to be breastfed at discharge and 9.4 times more likely to be fully breastfed ( 3.1 to 28.4 ) . There were significantly fewer apnea and bradycardia episodes in the group receiving nasogastric supplements , although they had more episodes that required stimulation for resolution . Groups were not different with respect to length of hospitalization and infant weight at discharge . CONCLUSIONS Using nasogastric tube supplementation during transition to oral feedings increases the likelihood of breastfeeding at discharge , 3 days , 3 months , and 6 months . This intervention requires a program with skilled personnel and an environment that allows the mother and infant to be in close physical proximity . Further study should investigate differences in the effects on maternal confidence , imprinting , and suck mechanism when preterm infants are bottle fed and breastfed OBJECTIVES to compare the impact of two methods of supplementary feeding of pre-term babies ( bottle vs cup ) on subsequent breast feeding and to assess the feasibility of using a r and omised controlled trial ( RCT ) to investigate the topic . DESIGN AND METHOD small scale prospect i ve RCT . Data on breast feeding , as defined as the exclusive method of feeding , were collected . A range of relevant bio- data was also collected and their impact on breast feeding assessed . SETTING a special care baby unit in a District General Hospital in the UK . PARTICIPANTS over a three-month period , all pre-term babies ( 32 - 37 weeks ' gestation ) who fulfilled the inclusion criteria and has been born to mothers who had expressed a pre-partum desire to breast feed , who had consented to take part , were included ( n=14 ) . PROCEDURE the eligible babies were r and omly allocated to supplementary feeding of breast milk , via either a cup or a bottle . Whether or not the baby was being breast fed at discharge was noted . FINDINGS the study suggested that this RCT framework is a viable method of investigating baby feeding . Because of the small-scale nature of the project , the actual data base must be treated with extreme caution . No significant differences were found between the two groups in terms of breast feeding . However , the mothers reported high levels of support and also the breast-feeding rates were above the national averages . These two findings could have contributed to the non-significant results observed in this analysis . CONCLUSIONS if the present findings could be supported by further research , then the non-significant results relating method of supplementary feeds to subsequent breast feeding could be explained by reference to three factors . Firstly , there is , in fact , no real effect of method of supplementary feeding and subsequent breast feeding ; secondly , the method adopted differed from existing research and thus may be expected to produce non-corroborative results ; and finally , the overall levels of breast feeding within the Unit generally were higher than the national average . The relevance of the RCT for investigating this subject is also discussed with reference to the present data set . Further experimental work to develop these ideas and to identify causal links is required BACKGROUND Some neonatal units are introducing use of cup and traditional feeding devices for feeding young infants although they have been not been evaluated objective ly . Hence this controlled trial of the use of the bottle , cup and a traditional feeding device ( ' paladai ' ) was undertaken in neonates . METHOD The study comprised of 100 infants including full-term normal weight infants ( n = 66 ) , term growth retarded infants ( n = 20 ) , and preterm infants ( n = 14 ) . All three methods were tried on every infant by the same nurse for a particular baby , so that each infant served as his/her control and in order to avoid the effect of major influencing factors . Parameters evaluated were the volume ingested , duration of the feed , degree of spilling and satiety . RESULTS The infants took the maximum volume in the least time and kept quiet longest with the paladai . The findings were particularly significant in the group including all the categories of infants . Spilling was the highest with the cup , especially with preterm infants From July 1997 to June 1998 , 25 preterm infants ( birth weight < 1800 g ) were included in a prospect i ve study to compare the clinical effects of breast- and bottle-feeding . Oxygen saturation , heart rate , respiratory rate , and body temperature were recorded every minute for 20 minutes during feeding periods . Eighty pairs of breast- and bottle-feeding sessions were observed at the chronological age of 9.3 ± 4.3 ( range=2.1 - 25.3 ) weeks . Oxygen saturation and body temperature of the preterm infants were significantly higher when they were directly breastfed . There were 2 episodes of apnea ( breath pause more than 20 seconds ) and 20 episodes of oxygen desaturation ( PaO 2 < 90 % ) during bottle-feeding and none during breastfeeding . We conclude that breastfeeding is a more physiological feeding method for the preterm infant and bottle-feeding may be more stressful The impact of cup-feeding or bottle-feeding on weight gain , oxygen saturation , and breastfeeding rates of preterm infantswas studied in 34 bottle-fed and 44 cup-fed preterm infants . At initiation of oral feeding , postconceptional age and weight were 37.2 ± 2.2 weeks and 1676 ± 83 g for the bottle-fed group ( BF ) and 37.0 ± 1.6 weeks and 1637 ± 40 g for the cup-fed ( CF ) group , respectively . No significant differences between groups were found with regard to time spent feeding , feeding problems , weight gain , or breastfeeding prevalence at discharge or at 3-month follow-up . Possible beneficial effects of cup-feeding were lower incidence of desaturation episodes ( 13.6 % vs 35.3 % , CF vs BF , P= .024 ) and a higher prevalence of breastfeeding at 3 months among those still breastfeeding at the first follow-up visit ( 68.4 % vs 33.3 % , CF vs BF , P= .04 )
BACKGROUND Preterm infants start milk feeds by gavage tube .
As they mature , sucking feeds are gradually introduced .
Women who choose to breast feed their preterm infant are not always able to be in hospital with their baby and need an alternative approach to feeding .
Most commonly , milk ( expressed breast milk or formula ) is given by bottle .
Whether using bottles during establishment of breast feeds is detrimental to breast feeding success is a topic of ongoing debate .
OBJECTIVES To identify the effects of avoidance of bottle feeds during establishment of breast feeding on the likelihood of successful breast feeding , and to assess the safety of alternatives to bottle feeds .