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A Comparison of the Safety of Cupfeedings and Bottlefeedings in Premature Infants Whose Mothers Intend to Breastfeed

Journal of Perinatology volume 21, pages 350–355 (2001)Cite this article

Abstract

OBJECTIVE: To compare the safety of cupfeeding, an alternative feeding method, to bottlefeeding, the current standard of artificial feeding in the United States, in preterm infants whose mothers intend to breastfeed.

STUDY DESIGN: In a prospective, randomized crossover study, 56 infants ≤34 weeks at birth, whose mothers indicated a desire to breastfeed, were studied. Skin-to-skin care and attempts at breast were encouraged frequently when babies were physiologically stable. When infants were ≥34 weeks' corrected gestational age, the order of the first two non–breast oral feedings was randomized by coin toss to one cupfeeding and one bottlefeeding. Trained Neonatal Intensive Care Unit nurses provided the feedings. Heart rate, respiratory rate, and oxygen saturation were recorded at 1-minute intervals for 10 minutes before and during the feeding. Volume taken, time required to complete the feed, and any apnea, bradycardia, choking, or spitting episodes were recorded.

RESULTS: Heart rate ( p<0.0001) and respiratory rate ( p<0.0001) increased and oxygen saturation decreased ( p=0.0002) during both cup and bottlefeedings compared to pre-feeding baselines. The amount of change in these three parameters from baseline to feeding period was similar for both feeding methods. The fraction of O 2 saturation <90% during baseline compared to the study period was different between these two feeding methods ( p=0.02). There was a 10-fold increase in desaturations <90% during bottlefeeds compared to no change during cupfeeds. When comparing cupfeeding periods to bottlefeeding periods, heart rates were higher ( p=0.009) and oxygen saturations lower ( p=0.02) during bottlefeeds. There were no differences between methods in respiratory rate, choking, spitting or apnea, and bradycardia. Volumes taken were lower ( p=0.001) and duration of feeds longer ( p=0.002) during cupfeedings.

CONCLUSION: During cupfeedings, premature infants are more physiologically stable, with lower heart rates, higher oxygen saturations, and less desaturations, than during bottlefeedings. However, cupfed infants took less volume, over more time, than bottlefed for these initial feedings. Based on better physiologic stability and no difference in untoward effects, cupfeeding is at least as safe, if not safer, than bottlefeeding in this population. This study supports the use of cupfeeding as a safe alternative feeding method for premature infants learning to breastfeed.

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Acknowledgements

We thank Susan Zaremba for help with data and chart review Linda Kaczmarczyk, research librarian, Mark Bamberger for his invaluable assistance with data management, and Victor Herson for his thoughtful review of this manuscript. We are indebted to the staff of the NICU for their patience and assistance in carrying out this study, and especially to the study nurses whose devotion to supporting breastfeeding mothers enabled us to introduce cupfeeding to our NICU.

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Authors and Affiliations

  1. Division of Neonatology, Connecticut Children's Medical Center, Hartford, CT

    Kathleen A Marinelli MD, IBCLC & Virginia L Dodd MS, RNC

  2. Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT

    Kathleen A Marinelli MD, IBCLC & Georgine S Burke PhD

  3. Division of Research, Connecticut Children's Medical Center, Hartford, CT

    Georgine S Burke PhD

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  1. Kathleen A Marinelli MD, IBCLC
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  3. Virginia L Dodd MS, RNC
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Marinelli, K., Burke, G. & Dodd, V. A Comparison of the Safety of Cupfeedings and Bottlefeedings in Premature Infants Whose Mothers Intend to Breastfeed. J Perinatol 21, 350–355 (2001). https://doi.org/10.1038/sj.jp.7210539

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