Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed

 

Abstract

Background

Breast milk provides optimal nutrition for newborn infants, and the ideal way for infants to receive breast milk is through suckling at the breast. Unfortunately, this may not always be possible, as there are numerous reasons why a newborn infant may not be able to breastfeed and, as a result, require supplemental feeding. Currently, there are a variety of ways in which newborn infants can receive supplemental feeds. Traditionally, bottles and nasogastric tubes have been used; however, more recently, cup feeding has become a popular practice in many nurseries in an attempt to improve breastfeeding rates. There is no consistency to guide the choice of supplementation.

Objectives

To determine the effects of cup feeding versus other forms of supplemental enteral feeding on weight gain and achievement of successful breastfeeding in newborn infants who are unable to fully breastfeed.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2006), CINAHL (1982 - April 2006) and MEDLINE (1966 - April 2006).

Selection criteria

Randomised or quasi-randomised controlled trials comparing cup feeding to other forms of enteral feeding for the supplementation of newborn infants.

Data collection and analysis

Quality assessments and data extraction for included trials were conducted independently by the review authors. Outcomes reported from these studies were: weight gain, proportion not breastfeeding at hospital discharge, proportion not feeding at three months of age, proportion not feeding at six months of age, proportion not fully feeding at hospital discharge, proportion not fully breastfeeding at three months of age, proportion not fully breastfeeding at six months of age, average time per feed (minutes), length of stay and physiological events of instability such as bradycardia, apnea, and low oxygen saturation. For continuous variables such as weight gain, mean differences and 95% confidence intervals were reported. For categorical outcomes such as mortality, the relative risks (RR) and 95% confidence intervals were reported.

Main results

Four studies were eligible for inclusion. The experimental intervention was cup feeding and the control intervention was bottle feeding in all four studies included in this review. There was no statistically significant difference in the incidence of not breastfeeding at hospital discharge in three included studies (typical RR 0.82, 95% CI 0.62, 1.09) and not breastfeeding at three months in two included studies (typical RR 0.88, 95% CI 0.76, 1.03) or six months for the one study that reported this outcome (RR 0.91, 95% CI 0.78, 1.05). There was a statistically significant difference in not fully breastfeeding at hospital discharge (from three included studies) in favour of cup feeding (typical RR 0.75, 95% CI 0.61, 0.92). However, this was not statistically significant at three months (one study, RR 1.18, 95% CI 0.88, 1.58) or six months (one study, RR 1.31, 95% CI 0.89, 1.92). There was no statistically significant difference in weight gain from one study that reported this outcome (MD -0.60, 95% CI -3.21, 2.01). In the one study that assessed it, there was a significantly increased length of hospital stay in the cup fed infants [mean difference between groups was 10.1 days (95% CI 3.9, 16.3)]. Time to full breastfeeding was not assessed in any study.

Authors' conclusions

Cup feeding cannot be recommended over bottle feeding as a supplement to breastfeeding because it confers no significant benefit in maintaining breastfeeding beyond hospital discharge and carries the unacceptable consequence of a longer stay in hospital.

 

Plain language summary

Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed

Is cup feeding a better way to feed babies, rather than giving bottles or feeding with a tube, when mothers are unable to fully breastfeed? We wanted to identify the best way of offering feeds to babies when mothers are unable to breastfeed, or initially have difficulty with breastfeeding. Alternative feeding methods include using a cup, bottle or feeding tube. Four included studies compared cup and bottle feeding: the results of three of these studies demonstrate that infants who were cup fed were more likely to be exclusively breastfed at hospital discharge. However, at three and six months, there was no difference in the number of infants fully or partially breastfeeding, whether initially fed by cup, bottle or feeding tube. The results of one study demonstrated that those infants feed by cup spent approximately ten days longer in hospital. Therefore, based on available evidence, we cannot recommend cup feeding.

 

摘要

背景

對於尚無法完全乳房哺育的新生兒，杯子餵食(Cup feeding)和其他形式的腸道餵食(enteral feeding)差別

母乳提供新生兒最佳營養，而理想的方式接受母乳則是靠吸吮乳房。不幸的是，有很多原因使新生嬰兒可能無法得到乳房哺育，導致需要其他的哺育方式。目前有各種不同的方法使新生兒能夠得到替代的哺育方式。傳統上會使用奶瓶和鼻胃管，然而，最近杯子餵養在很多托兒所已成為一種流行的做法，來提高母乳餵養率。現在沒有一致性的指導原則以供替代哺育法的選擇。

目標

為決定尚無法完全乳房哺育的新生兒，杯子餵食(Cup feeding)和其他形式的腸道餵食(enteral feeding)在體重增加和達成成功的乳房哺育之效果

搜尋策略

我們搜尋了Cochrane中心註冊的對照試驗(CENTRAL, The Cochrane Library, 2006年，第2期), CINAHL (1982 – 2006年4月) and MEDLINE (1966 – 2006年4月).

選擇標準

隨機或半隨機對照試驗比較新生兒杯子餵食(Cup feeding)和其他形式的腸道餵食(enteral feeding)做為替代餵食法

資料收集與分析

Review作者們獨立地進行試驗品質評估和擷取數據。這些研究成果報告的結果有：體重增加，出院時沒有母乳哺育的比例，年紀在三個月時和六個月時不吃母奶的比例，出院時非純餵母乳的比例，年紀在三個月和六個月時非純餵母乳的比例，平均餵食時間(分鐘)，住院時間和不穩定的生理活動，如心動過緩，呼吸暫停，血氧飽和度低。對於連續性變量，如體重增加，則分析平均差和95%信賴區間。對於類別性的結果，如死亡率，則分析相對危險比(RR)和95%信賴區間。

主要結論

有4項研究符合收案條件。實驗組是杯子餵食法(cup feeding)，對照組是奶瓶餵食(bottlefeeding)。相關分析包括有三個研究統計出院時沒有餵食母乳的發生率(typical RR 0.82, 95% CI 0.62, 1.09)、兩個研究統計在三個月大沒有餵食母乳的比例(typical RR 0.88, 95% CI 0.76, 1.03)和一個研究統計在六個月時(RR 0.91, 95% CI 0.78, 1.05)沒有餵食母乳的比例，皆沒有顯著差異。在三個研究中，以杯子餵食法會有較多的寶寶在出院時非完全母乳哺育(typical RR 0.75, 95% CI 0.61, 0.92)。然而在三個月大(one study, RR 1.18, 95% CI 0.88, 1.58)和六個月大(one study, RR 1.31, 95% CI 0.89, 1.92)時卻沒有顯著的統計學意義。一個研究顯示在體重增加上沒有統計學意義(MD −0.60, 95% CI −3.21, 2.01)。而在一項研究中以杯子餵養法會造成有意義的住院天數增加[平均差是10.1天(95% CI 3.9, 16.3)]。至於何時可以達到完全的乳房哺育，則在任一個研究中都沒有探討。

作者結論

杯子餵食法取代奶瓶無法被推薦，因為在出院後維持乳房哺育上沒有顯著的好處，此外也會造成住院天數較長。

翻譯人

本摘要由臺中榮民總醫院薛榮華翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

當母親無法提供完全的乳房哺育時，杯子餵食法是比奶瓶或管灌餵食更好？我們想了解當母親無法提供完全的乳房哺育時或一開始哺育困難時，最好的替代方式。而替代方式有杯子餵食、奶瓶或餵食管。四個收案的研究比較杯子和奶瓶，其中三個研究結果顯示用杯子餵食法的嬰兒有較高的機率在出院時乳房哺育。但不管是一開始使用杯子或餵食管餵食，在三和六個月時完全或部分乳房哺育的嬰兒數就沒有差異。有項研究的結果指出杯子餵食法的嬰兒需要約多花十天留在醫院。故根據現有的證據我們無法推薦杯子餵食法。