Go with the Flow: Choosing a Feeding System for Infants in the Neonatal Intensive Care Unit and Beyond Based on Flow Performance

ObjectiveThe objectives of this study are to determine the flow rate of disposable and commercially available nipples and to develop a continuum of flow rates from slowest to fastest for commonly available nipple/bottle systems.MethodTwenty-five nipples were chosen for investigation. Nipples were tested using a Medela classic breast pump set at a suction rate of 150 mm Hg using water at room temperature. The amount of liquid transferred from nipple to pump collection bottle in 1 minute was recorded. Each bottle was tested three times, and an average was calculated.ResultsCommercially available nipples marketed as “slow flow” have a wide variety of flow rates. Disposable nipples have some variability in flow rate from one trial to the next as well as from one disposable nipple to the next.ConclusionThere are a wide variety of nipples that are marketed as slow flow that have different flow rates. Using the results of this study, clinicians may be able to determine the bottle and nipple that are most appropriate for an individual infant, based on flow rate, and provide guidance to parents for purchasing commercial bottle systems.     

Nipple confusion, alternative feeding methods, and breast-feeding supplementation: State of the science

Mothers of preterm and term infants frequently experience breast-feeding problems that make it necessary for them to use supplemental or complementary feedings. Although bottle feeding is used most frequently, alternatives to bottle feeding are frequently recommended to avoid nipple confusion. This report reviews the evidence of a relationship between exposure to artificial nipples and the development of nipple confusion. It also examines the effects of alternative feeding methods such as cup feeding, finger feeding, spoon feeding and gavage feeding on physiological responses of infants and long-term breast-feeding outcomes. This report recommends further research before alternatives to bottle feeding are routinely implemented. Copyright © 2001 by W.B. Saunders Company     

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.     

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.     

2种添加配方奶的喂养方式对新生儿乳头错觉的影响

目的探讨2种添加配方奶的喂养方式对新生几乳头错觉的影响。方法将出生3d内的80例新生儿分为2组：观察组（40例）新生几用瓶喂养,对照组（40例）新生儿用勺喂养;比较新生儿产生乳头错觉的情况。结果新生儿产生乳头错觉方面观察组低于对照组（P〈0．000）。结论用瓶喂养优于用勺喂养,产生乳头错觉低,可促进母乳喂养,有利于新生儿健康的生长发育。     

凹陷乳头母乳喂养的护理

对94例患有乳头扁平或凹陷的孕妇，产前指导进行乳头伸展法练习，抽吸，抽吸器抽吸法纠正，辅乳器（乳胶奶头）诱导新生儿早吸吮，结果凹陷扁平乳头纠正，纯母乳喂养成功率达100%。     

交叉乳腺瓣修复重度乳头内陷

目的:为了修复重度乳头内陷从1992年至1998年修复重度乳头内陷47例,83只乳头。方法:采用交叉乳腺瓣修复。手术时充分松解乳头深面所有癍痕组织,充填了乳头内不足的组织量;利用4个乳腺瓣交叉重叠缝合,加固了乳头的基底,增加了乳头向外突出;并切除乳头及乳晕部4个交错的三角形区表皮以增加乳头基底部皮肤的环形张力,防止乳头的回缩。结果:经过3月至5年的随访(平均2年),乳头坚挺,持久,无一例复发,无一例乳头坏死及感觉障碍。结论:该术式操作简便,效果良好,是修复重度乳头内陷较好的一种方法。     

内悬吊结合持续牵引法矫正乳头内陷的护理

目的探讨内悬吊结合持续牵引法矫正乳头内陷的护理。方法回顾性分析2010年3-6月在第二军医大学长海医院行手术治疗的18例乳头内陷患者的临床资料。所有患者均采用双重"U+8"形埋线,结合持续牵引4～6周,突出并固定乳头。结果经过手术,18例患者的内陷乳头均获得满意的矫正,无一例患者发生乳头坏死或者感染。术后仅2例患者乳头牵引未满4周;1例患者手术1周后不愿意坚持牵引,两个乳头中一个复发内陷,但程度明显轻于术前,患者表示满意,不愿再次手术。所有患者门诊随访6个月至1年,乳头形态满意,矫正后的乳头呈圆柱状,乳晕清晰,乳头感觉无减退,无勃起功能障碍;切口局部无明显瘢痕,哺乳功能未受影响。结论内悬吊结合持续牵引法操作简单易行、效果确切,加强护理是确保疗效、避免复发的重要措施。     

Method for hand-feeding mouse pups with nursing bottles.

The purpose of this study was to establish a hand-feeding method for the mouse by using nursing bottles. Five different-sized nipples were tested. The largest nipple used for pups from 12 to 15 days of age was 5.5 mm in diameter and 10 mm long, with a tip of 1.5 mm in diameter. The size of the nipple was much larger than that of the mothers, and bloating due to air accumulation was observed in the artificially-reared pups. To prevent bloat, the nipple size was increased, and a piece of sponge was stuffed in the nipple. Among the 30 pups fed from 1 day of age, 26 were weaned and 4 died. Three pups died due to aspiration of milk into the lung, and the remaining one died due to bloating. The development of nursing bottles with nipples may be potentially useful for the studies of nutrition, behavior, immunology, psychology, and toxicology.     

乳腺癌保乳手术保留乳头塑型对乳房外形的影响

【目的】探讨乳腺癌手术患者保持乳头外形重塑对乳房外形的影响。【方法】选择本院乳腺癌实行保乳手术患者28例,评估术后乳头塑型的美观效果,从双乳头水平、双乳头距同侧腋前线垂直距离、瘢痕对乳房外观的影响、乳头外观对保留乳房外形的重塑效果评价及对乳房外形的影响因素进行分析。【结果】术后切口达一期愈合24例,占85．71％,优良率为78．57％（22／28）;乳房外形未达理想标准者6例,占21．43％,其中切口瘢痕致乳房畸形3例,占10．71％,乳头不自然挺立、乳头歪斜及两侧乳头水平高度存在差距各1例,各占3．57％（1／28）。多因素非条件Logistic回归分析结果显示：切除乳腺组织的量、手术切口的设计、术中皮瓣的厚薄、术后切口包扎松紧度与术后乳头塑型影响因素显著相关。【结论】乳腺癌保乳手术乳头外形重塑是影响手术成功满意率的重要因素,术中保留乳腺组织的切除量、术前手术切口的设计、术后切口包扎、术中应瓣的犀薄与术后乳房外形影响因素显著相关。     

“井”字缝合局部皮瓣成形矫正乳头内陷

目的:探寻治疗乳头内陷的较佳手术方案。方法:2002年3月至2006年8月对29只乳头内陷畸形用"井"字缝合或加作局部"Z"字成形、乳腺真皮瓣填充矫正手术。结果:术后外形好,乳头感觉正常,切口瘢痕不明显。随访3～17个月,重度内陷畸形病例有3个乳头轻度回缩,余无复发。结论:该方法对于有哺乳要求的患者不失为一种可选择的有效方法。     

Reexamination of ultra‐thin nipple shield use,infant growth and maternal satisfaction

Aims and objectives. The primary objective of the multi‐site, international study was to examine trends in weight gain for term infants breastfed with and without ultra‐thin silicone nipple shields to determine the effect of nipple shield use on infant weight gain over two months. Additionally, the study examined maternal satisfaction with nipple shield use using a structured survey. Background. The nipple shield may facilitate successful breastfeeding outcomes when indicated. There has been question regarding infant weight gain with nipple shield use. A published pilot study using within‐subject design indicated no significant difference in infant test weights and maternal prolactin levels when breastfeeding with and without nipple shields. The current study builds and expands upon the pilot study. Design. Prospective, multi‐site, non‐randomised, between‐subject study. Method. Maternal‐infant dyads (n = 54) who used a nipple shield for breastfeeding were studied. Results. Results demonstrate no statistically significant difference in infant weight gain at two weeks, one month and two months between infants who breastfed with and infants who breastfed without a nipple shield. A majority (89·8%) of the women reported a positive experience with nipple shield use and 67·3% of the women reported that the nipple shield helped prevent breastfeeding termination. Conclusion. Infant weight gain was similar in maternal‐infant dyads using nipple shields for two months compared to those not using the shields. Maternal positive report of nipple shield use lends to the clinical importance of nipple shield use when appropriately indicated. Relevance to clinical practice. Nipple shield use may facilitate breastfeeding when clinically indicated in maternal‐infant dyads without risk of decreased infant weight gain.     

Meta analysis: effects of interventions on premature infants feeding

Nipple feeding of premature infants presents a challenge to neonatal nurses who are trying to prepare the infants for eventual discharge from the hospital. To determine what empirical evidence there was to support interventions that positively influence feeding performance and feeding efficiency a meta-analysis is presented. The effects of NPO, nasogastric tubes, different nipples, breast versus bottle feeding, gestational age, oral support, oral stimulation, and nonnutritive sucking on volume intake are evaluated. The results suggest that nursing care should: (a) consider the infant's gestational age; (b) maturational ability and development; (c) keep track of and attempt to minimize the length of time an infant is NPO; and (d) provide prefeeding oral stimulation and oral support.     

软组织扩张术乳头再造法治疗乳头缺失疗效观察

目的 探讨软组织扩张术乳头再造法治疗乳头缺失的可行性。方法 采用软组织扩张法，即在残存乳头及乳晕区皮肤软组织下埋置扩张器，注水扩张，进而形成乳腺组织瓣作支撑，行乳头再造。结果 本组5例患者，行10侧乳头再造术后均取得了良好效果。结论 软组织扩张术乳头再造法能充分利用局部组织材料资源，减少额外创伤，且符合人体生理结构，是一种较理想的乳头再造方式。     

乳癌患者乳头受累危险因素的研究

从1987年7月至1989年6月,对我科104例乳癌患者的术后乳头离体标本作了病理切片检查,以了解乳头受癌肿累及的危险因素。104例患者中20例(19.2％)乳头受累及。乳癌的临床分期、癌肿——乳头距、乳头外观改变及腋淋巴结转移数因素为乳癌患者乳头受累的有统计学显著意义的危险因素。     

超声诊断乳头疾病

目的 探讨超声诊断和鉴别诊断女性乳头疾病的价值.方法 回顾性分析25例超声首诊乳头异常患者,其中16例经病理证实,4例经随访证实,5例为临床诊断,分析不同乳头疾病的超声特征.结果 16例中,乳头佩吉特病9例,均经病理证实,包括混合型6例、单纯型3例,超声诊断准确率88.89％(8/9);乳头炎症6例,2例经手术活检证实...     

Pacifiers: a microbial reservoir

The permanent contact between the nipple part of pacifiers and the oral microflora offers ideal conditions for the development of biofilms. This study assessed the microbial contamination on the surface of 25 used pacifier nipples provided by day-care centers. Nine were made of silicone and 16 were made of latex. The biofilm was quantified using direct staining and microscopic observations followed by scraping and microorganism counting. The presence of a biofilm was confirmed on 80% of the pacifier nipples studied. This biofilm was mature for 36% of them. Latex pacifier nipples were more contaminated than silicone ones. The two main genera isolated were Staphylococcus and Candida. Our results confirm that nipples can be seen as potential reservoirs of infections. However, pacifiers do have some advantages; in particular, the potential protection they afford against sudden infant death syndrome. Strict rules of hygiene and an efficient antibiofilm cleaning protocol should be established to answer the worries of parents concerning the safety of pacifiers.     

276例6月龄以下婴儿ABO血型IgM抗体分析

本研究探讨6个月以下婴儿ABO血型IgM抗体产生频率。选取我院6个月龄以下住院患儿309例，采集EDTAK3抗凝静脉血标本，依据患儿年龄不同分为5组：出生1周以内的早期新生儿为Ⅰ组；出生8天至2周的新生儿为Ⅱ组；出生15天至1个月新生儿为Ⅲ组；2个月至3个月龄的婴儿为Ⅳ组；4个月至6个月龄的婴儿为Ⅴ组。应用单克隆抗A、抗B血清、A细胞、B细胞及O细胞进行试管法血型检定。结果表明：在检测新生儿及婴儿标本309例中舍去AB型标本33例，其余276例标本中Ⅰ组患儿46例，其中29例检出抗体，正反定型符合率63％（29／46）；Ⅱ组患儿64例，其中41例检出抗体，正反定型符合率64％（41／64）；Ⅱ组患儿74例，其中47例检出抗体，正反定型符合率63％（47／74）；Ⅳ组患儿45例，其中28例检出抗体，正反定型符合率62％（28／45）。Ⅴ组患儿47例，其中40例检出抗体，正反定型符合率85％。结论：有相当一部分新生儿和6月龄以下婴儿体内已产生ABO血型IgM抗体，这可作为婴儿ABO血型检定的重要佐证。     

双“U”字缝合和自体脂肪填充矫正乳头内陷

目的探寻治疗乳头内陷的较好方法。方法对17例（31只）乳头内陷患者采用双＂U＂字缝合和自体脂肪填充矫正手术。结果术后外形好,乳头感觉正常,无瘢痕。随访6～12个月,重度内陷病例有2例乳头轻度回缩,其余无复发。结论该方法对外观要求高或有哺乳要求的女性乳头内陷患者不失为一种较好方法。     

高纯度羊脂膏预防乳头皲裂的应用效果观察

目的探讨高纯度羊脂膏预防乳头皲裂的应用效果。方法按随机数字表将210例孕产妇分为A组、B组和C组,各70例。A组产后用初乳涂抹乳头和乳晕处,B组产后用高纯度羊脂膏涂抹乳头和乳晕处,C组产前、产后均用高纯度羊脂膏涂抹乳头和乳晕处。产后判断产妇乳头皲裂情况,同时采用皲裂程度评分及视觉模拟疼痛评分对产妇进行评估。结果两两比较,C组乳头皲裂发生率低于A组及B组,差异有统计学意义,A组与B组比较,差异无统计学意义;C组的乳头疼痛程度轻于A组及B组,差异有统计学意义,A组与B组比较,差异无统计学意义。3组发生乳头皲裂的产妇乳头皲裂程度两两比较,差异无统计学意义。结论产前、产后应用高纯度羊脂膏预防乳头皲裂效果好。