Physiological responses of preterm infants to breast-feeding and bottle-feeding with the orthodontic nipple

BACKGROUND: Although the orthodontic nipple has been recommended for many years to supplement breast-feeding infants, it is not known if this nipple is suitable for hospitalized preterm infants whose mothers wish to breast-feed. OBJECTIVES: To describe and compare short-term physiologic responses of preterm infants serving as their own controls for two feeding methods, breast-feeding and bottle-feeding with the orthodontic nipple. METHOD: The sample consisted of eight preterm infants, mean birth weight of 1,370 grams and mean gestational age at birth of 30.2 weeks' gestation, who served as their own controls for breast- and bottle-feeding sessions. The dependent variables, sucking, breathing, and oxygen saturation, were measured noninvasively throughout breast- and bottle-feeding sessions and recorded on a polygraph. Data were analyzed quantitatively and qualitatively for 14 breast-feeding sessions and 15 bottle-feeding sessions. RESULTS: Statistically significant differences were found in that infants breathed more during sucking bursts for breast-feeding sessions when compared to bottle-feeding sessions and had fewer episodes of oxygen desaturation during breast-feeding. A characteristic sucking waveform associated with organized breathing was observed for some infants during bottle-feeding with the orthodontic nipple. CONCLUSIONS: These data suggest that the orthodontic nipple is appropriate for supplementing breast-feeding for some preterm infants. Further research is needed to examine long-term outcomes.     

Nipple confusion and breastfeeding: a literature review

Among the ten steps to successful breastfeeding advocated by the WHO and UNICEF, steps six and nine clearly state that formula supplementation and pacifier use, except when medically necessary, should be avoided. Early formula supplementation may not only interfere with the mother's lactation but also result in nipple confusion on the part of the baby. To avoid nipple confusion, the encouragement of cup feeding and the non-provision of pacifiers or bottles are required nursing practice in baby-friendly hospitals. However, the relationship between nipple confusion and the duration of breastfeeding has not been well examined. The purpose of this paper is to explore the relationships between three methods of feeding (i.e. pacifier, bottle feeding, and cup feeding), nipple confusion, and duration of breastfeeding. A hypothetical framework is proposed to explain these relationships on the basis of a review of the literature.     

The effect of music-reinforced nonnutritive sucking on feeding rate of premature infants

Premature infants are fed by gavage tube before 34 weeks adjusted gestational age and when nipple feeding results in detrimental changes in respiration and heart rate. Nipple feeding skill must be developed and correlates with length of hospitalization and neurobehavioral development. This study provided music reinforcement for nonnutritive sucking and assessed nipple feeding rates pre- and posttreatment for 32 infants referred as poor feeders. A pacifier fitted with a pressure transducer activated 10 seconds of recorded music in a one-trial, 15-minute intervention given to experimental infants (n = 16) 30 to 60 minutes before the late afternoon bottle feeding. Feeding rates were collected for bottle feedings pre- and postintervention and for a similar interval for a no-contact control group (n = 16). Results showed that the intervention significantly increased feeding rates. Music functioned as reinforcement and the sucking behavior transferred from a nonnutritive to a nutritive event.     

Milk Flow Rates From Bottle Nipples: What We Know and Why It Matters

Feeding difficulties are common in infants hospitalized in the NICU and can be a challenge to manage. The purpose of this article is to explain how and why the flow rate from the bottle nipple affects physiologic stability in infants and to describe the current evidence available on the flow rates of nipples used in the hospital and after discharge. Study results have indicated that flow rate varies widely among different types of nipples. Within the same type of nipple, there can be significant variability in flow from one nipple to another. Other factors, such as type of infant formula and thickening, also affect flow. Altering the flow rate of the bottle nipple is a relatively simple intervention that may support safe oral feeding.     

Feeding outcomes and influences within the neonatal unit

This study examined the feeding intention of mothers (n = 100), and the factors and beliefs, and changes in those factors or beliefs that influenced their choices, in the challenging environment of the neonatal unit. Mothers' experience and the frequency of nurse-assisted feeding activities were examined in mothers intending and not intending to breast-feed on discharge. Eighty-one per cent of mothers were either partially or fully breast-feeding or intending to do so on discharge. The most important factors identified as influencing this feeding choice included personal choice, with other influences being special benefits, more natural and feeling closer to the baby. Experiences such as infants receiving their first sucking feed from either the breast or bottle (inclusive of breast milk) and mothers expressing breast milk more frequently, were found to be significantly different and increased in frequency, in mothers intending to breast-feed. Differences in the mean weighted total daily nurse-assisted feeding score confirmed that these activities varied with gestational age (< or = 32 weeks [2.57], 32 to less than 35 weeks [3.86], and > or = 35 weeks [4.91]; F = 7.04, d.f. 55, P = 0.002), although there was insufficient power to determine differences between breast-feeding and non-breast-feeding mothers. The use of the Feeding Activities Calendar may have contributed to increased activity and high levels of breast-feeding in this preterm group.     

Effects of single-hole and cross-cut nipple units on feeding efficiency and physiological parameters in premature infants

The purpose of this study was to compare the amount of total milk intake, feeding time, sucking efficiency, heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2) of premature infants when fed with either signal-hole or cross-cut nipple units. Twenty stable infants admitted to a level II nursery in a tertiary care center with gestational ages averaging 32.2+/-3.2 wks were enrolled. Subjects had an average postmenstrual age of 34.1+/-1.6 wks, and average body weight of 1996+/-112 gm. A crossover design was used and infants were observed for two consecutive meals separated by a four-hour interval. They were bottle fed with equal feeding amounts using a single-hole and cross-cut nipple administered in random order. Results showed that infants fed with single-hole nipple units took more milk (57.5+/-8.3 ml vs. 51.6+/-9.5 ml, p=.011), had a shorter feeding time per meal (11.5+/-4.9 min vs. 20.9+/-5.0 min, p<.001), and sucked more efficiently (5.8+/-2.5 ml/min vs. 2.7+/-1.0 ml/min, p<.001) compared to those fed through cross-cut nipples. Infants using cross-cut nipple units had a higher RR (44.4+/-4.6 breaths/minutes vs. 40.8+/-4.9 breaths/minutes, p=.002) and SpO2 (96.1+/-1.4% vs. 94.6+/-3.2%, p=.044) than those using single-hole nipples. Oxygen desaturation (SpO2<90% and lasting for longer than 20 sec) and bradycardia were not recorded in either group of infants during feeding. Compared to using cross-cut nipple units, premature infants using single-hole nipple units take more milk and tend to tolerate feedings better. A single-hole nipple may be a choice for physiologically stable bottle-fed premature infants.     

Determinants of early infant weaning: a multivariate approach

This research provides a multivariate analysis of factors associated with prolonged breast-feeding and conversely early infant weaning. Infant care practices associated with early infant weaning during the first four months of life were: early introduction to artificial milk, the infant sleeping in its own crib versus with its mother, and in general a more rigid feeding schedule. The weaned infant lived in a family with higher economic means, also maternal employment and the availability of a support person to care for the infant were variables more frequently found among infants weaned early. These infants had greater than average numbers of curative health care visits and gained less weight during the first four months of life than breast-fed infants. This study's findings suggest that as changes in life styles and cultural norms are molded by levels of modernization and urbanization, with greater participation of women in the workforce, the tendency to wean early may become even greater.     

一例皮-罗序列征新生儿的早期经口喂养护理与指导

总结1例皮-罗序列征新生儿早期经口喂养护理与指导要点.建立多学科团队,制定护理干预措施,包括:选择侧卧结合45°俯卧位以保持呼吸道通畅;实施促进喂养技术结合口腔运动进行综合干预;根据吸吮情况及奶量选择滴管喂养及唇腭裂婴儿专用特需喂哺瓶;严格管理新生儿摄入量等.该例新生儿于出生后3d开始经口喂养,于第6天出院.3个月回访...     

先天性唇腭裂患儿手术前后的喂养护理

目的：研究先天性唇腭裂患儿手术前后的特殊喂养护理。方法：对３６例患儿分别采取母乳喂养、奶瓶喂养和汤匙喂养,并对喂养中容易出现的问题及时采取对策,预防并发症。结果：３６例患儿顺利渡过了手术前后的特别喂养阶段,患儿身高、体重增加。结论：针对患儿的特点,选择适合患儿的喂养方法是保证患儿手术前后喂养成功的关键。     

早产儿母乳喂养调查分析

[目的]了解早产儿出院后4个月内母乳喂养状况及其影响因素.[方法]采用回顾性调查法,对2000年3月-2001年3月我院新生儿科收治的早产儿及其母亲进行调查.[结果]4个月早产儿的母乳喂养率为29.2%,其中纯母乳喂养率仅为7.7%.[结论]早产儿的母乳喂养率低,主要影响因素为母乳不足、早产儿吸吮力弱、母亲未掌握喂哺技巧、母婴分离时间较长.     

喂哺用具的改革与预防新生儿乳头错觉的临床研究

目的　客观评价补奶方法 ,研究最适宜于新生儿的喂哺用具 ,以有效预防新生儿乳头错觉 ,切实提高母乳喂养率。方法　将 30 0例暂时乳汁不足需要补奶的婴儿随机分组 ,分别选用WHO所推荐的小杯、小匙和WHO所禁用的奶瓶、奶头 ,以及自己配制的一次性输液软管 ,连接吸有奶液的注射器 ,固定于母亲乳头旁 ,使婴儿直接吸吮母亲乳头获取乳汁 ,观察新生儿乳头错觉发生情况及母乳充盈时间和完全母乳喂养时间 ,获得数据以统计学方法处理。结果　小杯、小匙喂哺法 ,乳头错觉发生 6 1例 ,母乳充盈和完全母乳喂养时间为产后 6 2h、5 6h。奶瓶、奶头喂哺法乳头错觉发生 4 8例 ,母乳充盈和完全母乳喂养时间为产后 6 0h、5 4h。注射器连接软管喂哺法乳头错觉发生仅为 2例 ,母乳充盈及完全母乳喂养时间各为 38h、2 9h ,P<0 .0 1。结论　一次性输液软管连接注射器的喂哺方法 ,既能很好地落实早吸吮 ,促进母乳分泌 ,又能有效防止新生儿乳头错觉发生 ,且操作简单、方便、安全 ,是科学的喂哺方法及用具。     

The Dynamic Process of Assessing Infant Feeding Readiness

For many preterm and convalescing infants in the neonatal intensive care unit, often one of the last barriers to going home is being able to successfully feed from the breast or bottle. Parents frequently ask staff: when will my baby be ready to go to breast or start taking a bottle? In the past, the answer was based on the infant's medical condition and age alone. However, this approach to infant feeding readiness is changing and it is now acknowledged as a dynamic and multifactorial process.     

母乳喂养乳头替代装置临床应用效果观察

目的探讨乳头异常致母乳喂养困难者理想的解决方法。方法将101例乳头异常产妇随机分为对照组37例,观察Ⅰ组12例,观察Ⅱ组52例。按照常规的护理指导协助母乳喂养为对照组,使用硅胶50度材质和硅胶20度材质的辅助"乳头替代装置"为观察Ⅰ组和观察Ⅱ组,记录各组母乳喂养的效果。结果对照组母乳喂养成功有效率为27.03%,观察Ⅰ组母乳喂养成功有效率为8.33%,观察Ⅱ组母乳喂养成功有效率为100%。结论选用合理材质的"乳头替代装置"有助于提高临床母乳喂养的成功率。     

Maternal cigarette smoking, breast-feeding, and respiratory tract infections in infancy. A population-based cohort study.

This population-based study comprised 192 mothers and their infants; 58 mothers were smokers and 134 non-smokers. At the 18-month infant check-up at the child health clinic, mothers were questioned about the length of the breast-feeding period, both exclusively breast-feeding and overall breast-feeding time. The numbers of antibiotic-treated respiratory tract infections (RTIs) during the first year of life were noted during a scrutiny of records at the district physician's surgery and child health clinic of the Health Centre, and at the paediatric and ENT departments of the Central Hospital. We were unable to find any connection between the duration of breast-feeding and the number of antibiotic-treated RTIs in the infants. This applied to both exclusively breast-feeding period and overall breast-feeding period. Further, it was shown that infants of smokers were affected by RTIs more often than those of non-smokers, the incidence figures being 1.16 vs. 0.76 antibiotic courses per infant and year, respectively. Moreover, infants of smokers were breast-fed for a shorter period than those of non-smokers, the mean values being 3.3 vs. 4.3 months, respectively, for the period of exclusively breast-feeding, and 5.0 vs. 7.2 months, respectively, for the overall breast-feeding period.     

Breast-feeding increases sleep duration of new parents

OBJECTIVES: This study describes sleep patterns for mothers and fathers after the birth of their first child and compares exclusive breast-feeding families with parents who used supplementation during the evening or night at 3 months postpartum. METHODS: As part of a randomized clinical trial, the study utilized infant feeding and sleep data at 3 months postpartum from 133 new mothers and fathers. Infant feeding type (breast milk or formula) was determined from parent diaries. Sleep was measured objectively using wrist actigraphy and subjectively using diaries. Lee's General Sleep Disturbance Scale was used to estimate perceived sleep disturbance. RESULTS: Parents of infants who were breastfed in the evening and/or at night slept an average of 40-45 minutes more than parents of infants given formula. Parents of infants given formula at night also self-reported more sleep disturbance than parents of infants who were exclusively breast-fed at night. CONCLUSIONS: Parents who supplement their infant feeding with formula under the impression that they will get more sleep should be encouraged to continue breast-feeding because sleep loss of more than 30 minutes each night can begin to affect daytime functioning, particularly in those parents who return to work.     

Concurrent validity of a new instrument for measuring nutritive sucking in preterm infants.

The purpose of this study was to examine the concurrent validity of the Whitney strain gage for the measurement of nutritive sucking in preterm infants. Ten preterm infants were studied continuously during at least one entire bottle feeding per week, from admission into the study until discharge from the nursery. Sucking was measured simultaneously by an adapted nipple and the Whitney gage. The two instruments were compared on the following measures: number of sucking bursts, number of sucks per burst, and duration of bursts and pauses between bursts. Total percent agreement for the occurrence of a sucking burst was 99.3% (K = .99). Sucks per burst varied from 2 to 113, with 89.3% of the pairs of sucking bursts differing by < or = 1 suck per burst. The mean absolute difference between the two instruments for the duration of sucking bursts and pauses was .64 s and .72 s, respectively. These results demonstrate the concurrent validity of the Whitney gage for measurement of sucking events in preterm infants.     

Fluids, electrolytes, and nutrition in the low-birth-weight infant.

The management of fluids, electrolytes, and nutrition in the low-birth-weight and premature infant is an essential component of nursing care. The discussion of this crucial aspect of care includes the implications of physiologic immaturity and current recommendations for intervention as infants progress from intravenous fluids and electrolytes to parenteral nutrition, gavage feeding, and bottle feeding. It is hoped that breastfeeding is achieved.     

State of the science: feeding readiness in the preterm infant

Finding ways to consistently prepare preterm infants and their families for more timely discharge must continue as a focus for everyone involved in the care of these infants in the neonatal intensive care unit. The gold standards for discharge from the neonatal intensive care unit are physiologic stability (especially respiratory stability), consistent weight gain, and successful oral feeding, usually from a bottle. Successful bottle-feeding is considered the most complex task of infancy. Fostering successful oral feeding in preterm infants requires consistently high levels of skilled nursing care, which must begin with accurate assessment of feeding readiness and thoughtful progression to full oral feeding. This comprehensive review of the literature provides an overview of the state of the science related to feeding readiness and progression in the preterm infant. The theoretical foundation for feeding readiness and factors that appear to affect bottle-feeding readiness, progression, and success are presented in this article.