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

  1. Anndrea Flint1,*,
  2. Karen New2,
  3. Mark W Davies3

Editorial Group: Cochrane Neonatal Group

Published Online: 18 APR 2007

Assessed as up-to-date: 10 DEC 2006

DOI: 10.1002/14651858.CD005092.pub2

How to Cite

Flint A, New K, Davies MW. Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD005092. DOI: 10.1002/14651858.CD005092.pub2.

Author Information

  1. 1

    Royal Women's Hospital, Centre for Clinical Nursing, Level 2, Brisbane, Queensland, Australia

  2. 2

    Royal Brisbane & Women's Hospital, Grantley Stable Neonatal Unit, Brisbane, Queensland, Australia

  3. 3

    Royal Brisbane and Women's Hospital, Dept of Neonatology, Brisbane, Queensland, Australia

*Anndrea Flint, Centre for Clinical Nursing, Level 2, Royal Women's Hospital, Butterfield St, Herston, Brisbane, Queensland, 4029, Australia. Anndrea.Flint@health.qld.gov.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 APR 2007

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Characteristics of included studies [ordered by study ID]
Collins 2004

MethodsRandomised controlled trial.
Allocation concealment (blinding of randomisation): Yes
Blinding of intervention: No
Completeness of follow up: Yes
Blinding of outcome measurement: No


Participants319 Preterm infants (Cup feeding group n=161; bottle feeding group n=158) (mean gestational ages 29.3 and 30.0 weeks); Conducted in Australia; Involved 2 tertiary hospitals and 54 peripheral hospitals (this number of peripheral hospitals were involved as they were the receiving hospitals for the babies from the tertiary hospitals).
Eligibility criteria: preterm infants less than 34 weeks gestational age whose mothers wanted to breastfeed.


InterventionsRandomised to supplemental feeds via cup or bottle


OutcomesNot breastfeeding at hospital discharge: number assessed - cup feeding group N=151; bottle feeding group N=152.
Not breastfeeding at 3 months: number assessed - cup feeding group N=144; bottle feeding group N=139
Not breastfeeding at 6 months: number assessed - cup feeding group N=142; bottle feeding group N=139
Not fully breastfeeding at hospital discharge: number assessed - cup feeding group N=151; bottle feeding group N=152
Not fully breastfeeding at 3 months: number assessed - cup feeding group N=144; bottle feeding group N=139
Not fully breastfeeding at 6 months: number assessed - cup feeding group N=142; bottle feeding group N=139
Length of hospital stay: number assessed - cup feeding group N=149; bottle feeding group N=152


NotesResults are an evaluation of infants followed at 3 & 6 months and not all infants randomised


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesA - Adequate

Gilks 2004

MethodsRandomised Controlled Trial
Allocation concealment (blinding of randomisation): Yes (assignments concealed in sequentially numbered opaque envelopes held in an independent ward to the nursery within each hospital).
Blinding of intervention: No
Completeness of follow up: Yes at hospital discharge; no thereafter
Blinding of outcome measurement: No


Participants54 Preterm infants (Cup feeding group n=27; bottle feeding group n=27) (mean gestational ages 31.0 and 32.0 weeks); Conducted in the UK; single centre trial
Eligibility Criteria: preterm infants who were less than 35 weeks completed gestation and more than 30 weeks gestation whose mothers intended to breastfeed.


InterventionsRandomised to supplemental feeds via cup or bottle


OutcomesNot breastfeeding at hospital discharge: number assessed - cup feeding group N=27; bottle feeding group N=27
Not fully breastfeeding at hospital discharge: number assessed - cup feeding group N=27; bottle feeding group N=27.
This study also looked at the following outcomes: breast feeding rates at term, at six weeks post term and post conceptional age.


Notes


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesA - Adequate

Mosley 2001

MethodsRandomised Controlled Trial
Allocation concealment (blinding of randomisation): Yes (concealed cards in envelopes)
Blinding of intervention: No
Completeness of follow up: Yes at hospital discharge; no thereafter
Blinding of outcome measurement: No


Participants16 Preterm infants (Cup feeding group n=8; bottle feeding group n=8) (mean gestational age of 35.2 to 35.5 weeks); Conducted in the UK; single centre trial
Eligibility Criteria: preterm infants who were between 30 and 37 weeks gestation, admitted to the special care nursery, whose mothers intended to breastfeed.


InterventionsRandomised to supplemental feeds via cup or bottle


OutcomesNot fully breastfeeding at hospital discharge: number assessed - cup feeding group N=6; bottle feeding group N=8.


Notes


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesA - Adequate

Rocha 2002

MethodsRandomised Controlled Trial
Allocation concealment (blinding of randomisation): Yes (sealed numbered opaque envelope)
Blinding of intervention: No
Completeness of follow up: Yes at hospital discharge; no thereafter
Blinding of outcome measurement: No


Participants83 Preterm infants (Cup feeding group n=46; bottle feeding group n=37) (mean gestational age of 32.5 to 32.7 weeks); Conducted in Brazil; single centre trial
Eligibility Criteria: preterm infants who were born between 32 and 36 weeks gestation, and weighting less than 1700 g, admitted to the intensive care nursery, whose mothers intended to breastfeed.


InterventionsRandomised to supplemental feeds via cup or bottle


OutcomesNot breastfeeding at hospital discharge: number assessed - cup feeding group N=44; bottle feeding group N=34.
Not breastfeeding at 3 months: number assessed - cup feeding group N=44; bottle feeding group N=34.
Weight gain: number assessed - cup feeding group N=44; bottle feeding group N=34.
Average time per feed: number assessed - cup feeding group N=44; bottle feeding group N=34.
Other outcomes assessed: differences between oxygen saturation levels in bottle, cup and breast-fed infants.


Notes


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearB - Unclear

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Brown 1999Was neither a randomised controlled trial nor a non-randomised controlled trial using quasi-randomised group allocation. A retrospective chart review.

Davis 1948Was neither a randomised controlled trial nor a non-randomised controlled trial using quasi-randomised group allocation.

Dowling 2001Was neither a randomised controlled trial nor a non-randomised controlled trial using quasi-randomised group allocation. Descriptive literature on nipple confusion and alternative feeding methods.

Dowling 2002Was neither a randomised controlled trial nor a non-randomised controlled trial using quasi-randomised group allocation. A non-experimental convenience sample.

Fredeen 1948Was neither a randomised controlled trial nor a non-randomised controlled trial using quasi-randomised group allocation. A descriptive report on experience with cup feeding of newborn infants

Freer 1999Was neither a randomised controlled trial nor a non-randomised controlled trial using quasi-randomised group allocation. A convenience sample of newborn infants exposed to breast and cup feeding

Gupta 1999Was neither a randomised controlled trial nor a non-randomised controlled trial using quasi-randomised group allocation. A retrospective chart review.

Howard 1999A randomised controlled trial of formula feeding infants only. Infants randomised to either receive feeds via cup or bottle. A group of exclusively breast feeding infants were used as a comparison group.

Howard 2003This study did not meet the inclusion criteria for this review as participants were not infants that were unable to fully breastfeed. Participants were infant-mother dyads. Unborn infants were randomised on maternal admission to either early or late pacifier use or cup or bottle supplemental feeding if required. A large proportion of the babies randomised were part of the study because of maternal choice to offer supplemental feeds not because the infants were unable to fully breastfeed.

Malhotra 1999Was neither a randomised controlled trial nor a non-randomised controlled trial using quasi-randomised group allocation. Crossover design was employed.

Marinelli 2001Was neither a randomised controlled trial nor a non-randomised controlled trial using quasi-randomised group allocation. Crossover design was employed.

 
Comparison 1. Supplemental feed using cup versus bottle

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Weight gain (g/kg/day)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

 2 Not breastfeeding at hospital discharge3435Risk Ratio (M-H, Fixed, 95% CI)0.82 [0.62, 1.09]

 3 Not breastfeeding at three months2361Risk Ratio (M-H, Fixed, 95% CI)0.88 [0.76, 1.03]

 4 Not breastfeeding at six months1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 5 Not fully breastfeeding at hospital discharge3371Risk Ratio (M-H, Fixed, 95% CI)0.75 [0.61, 0.92]

 6 Not fully breastfeeding at three months1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 7 Not fully breastfeeding at six months1Risk Ratio (M-H, Fixed, 95% CI)Totals not selected

 8 Average time per feed (minutes)1Mean Difference (IV, Fixed, 95% CI)Totals not selected

 9 Length of stay (days)1Mean Difference (IV, Fixed, 95% CI)Totals not selected