Intervention Review

Avoidance of bottles during the establishment of breast feeds in preterm infants

  1. Carmel T Collins1,*,
  2. Maria Makrides2,
  3. Jennifer Gillis3,
  4. Andrew J McPhee4

Editorial Group: Cochrane Neonatal Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 22 JUL 2008

DOI: 10.1002/14651858.CD005252.pub2


How to Cite

Collins CT, Makrides M, Gillis J, McPhee AJ. Avoidance of bottles during the establishment of breast feeds in preterm infants. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD005252. DOI: 10.1002/14651858.CD005252.pub2.

Author Information

  1. 1

    Women's and Children's Health Research Institute, Flinders Medical Centre and Women's and Children's Hospital; Discipline of Paediatrics, The University of Adelaide, Child Nutrition Research Centre, Bedford Park, South Australia, Australia

  2. 2

    Women's and Children's Health Research Institute, Child Health Research Institute, North Adelaide, SA, Australia

  3. 3

    Children, Youth & Women's Health Service, Special Care Baby Unit, North Adelaide, South Australia, Australia

  4. 4

    Women's and Children's Hospital, Neonatal Medicine, North Adelaide, South Australia, Australia

*Carmel T Collins, Child Nutrition Research Centre, Women's and Children's Health Research Institute, Flinders Medical Centre and Women's and Children's Hospital; Discipline of Paediatrics, The University of Adelaide, Flinders Medical Centre, Bedford Park, South Australia, 5042, Australia. carmel.collins@health.sa.gov.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 OCT 2008

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Preterm infants start milk feeds by gavage tube. As they mature, sucking feeds are gradually introduced. Women who choose to breast feed their preterm infant are not always available and an alternative approach to feeding is needed. Most commonly, milk (expressed breast milk or formula) is given by bottle. There is some controversy about whether using bottles during the establishment of breast feeds is detrimental to breastfeeding success.

Objectives

To determine the effect of avoidance of bottle feeds during the establishment of breastfeeding on the likelihood of successful breastfeeding and to determine if alternatives to bottle feeds are safe.

Search methods

We searched the Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL and EMBASE in any language. The search was updated in July 2008.

Selection criteria

Randomised or quasi randomised controlled trials comparing avoidance of bottles with use of bottles in women who have chosen to breast feed their preterm infant.

Data collection and analysis

Two review authors independently assessed trial quality and extracted data. When appropriate, we contacted study authors for additional information. Standard methods of the Cochrane Collaboration and the Cochrane Neonatal Review Group were used.

Main results

Five trials of 543 infants were included. Four trials used a cup feeding strategy and one trial used a tube feeding strategy when supplements to breast feeds were needed. The single study of tube feeding had a high risk of bias. In the analysis of all five trials, significant heterogeneity was evident in two of the primary outcomes. This was reduced when the tube feeding trial was removed from analyses.

Cup feeding significantly decreased 'no breastfeeding or only partial breast feeding' on discharge home (summary RR 0.75, 95% CI 0.61 to 0.91). However, cup feeding significantly increased length of hospital stay by 10 days (95% CI 3.87 to 16.29). There was a high degree of noncompliance in the largest study of cup feeding indicating dissatisfaction with this method by staff and/or parents.

The one trial of a tube alone approach significantly reduced 'no breastfeeding or only partial breastfeeding' and 'no breastfeeding at all' at all time periods but the results need to be interpreted with caution due to the high risk of bias.

Authors' conclusions

Supplementing breast feeds by cup confers no breastfeeding benefit beyond discharge home and delays discharge considerably. There is currently insufficient evidence on which to base recommendations for a tube alone approach to supplementing breast feeds. Further research is needed to evaluate a tube alone approach.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Avoidance of bottles during the establishment of breast feeds in preterm infants

Preterm infants start milk feeds by tube and as they mature they are able to manage sucking feeds. The number of sucking feeds each day are gradually increased as the baby matures. For women who choose to breast feed their preterm infant it is not always possible for them to be there every time the baby needs a sucking feed. Conventionally, bottles with mother's milk or formula are used. It has been suggested that using bottles may interfere with breast feeding success. Five trials have investigated alternatives to bottles in the establishment of breast feeds; four trials used cup feeds and one trial used tube feeds. The one study that used tube feeds was of poor quality and the results of this study need to be interpreted cautiously. When cup feeds were used, more women were discharged home fully breastfeeding, but there was no effect on any (fully and partially combined) breastfeeding. Using cup feeds also increased the length of hospital stay by 10 days. In the one study of tube feeds, breastfeeding (both fully and partially) was increased at discharge and at three and six months after discharge with no effect on length of hospital stay. However, because of the poor quality of this one study, we cannot recommend a tube feeding strategy until further studies of high quality are undertaken.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

避免早產兒在建立乳房哺育時使用奶瓶

早產兒開始餵奶是用胃管。當他們成熟,漸漸的培養吸吮餵食的能力。選擇乳房哺育早產兒的婦女,因為並非隨時都可以哺乳,故有時會以其他的方式餵食。最常見的餵食方式(母乳或配方奶)就是用奶瓶。而在建立乳房哺育時期使用奶瓶是否是一個不利的乳房哺育的因素是一個據爭議性的議題。

目標

確定乳房哺育時期不使用奶瓶餵食以達到成功乳房哺育的可能性和確定使用奶瓶是否安全

搜尋策略

搜尋Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL與 EMBASE。更新搜尋到July 2008年七月。不設語言限制

選擇標準

比較以乳房哺育早產兒的婦女在使用與不使用奶瓶哺育差別的隨機或類隨機對照試驗

資料收集與分析

兩位作者獨立評估試驗的品質和擷取的數據。在適當的時候,我們聯絡研究的作者以索取更多的信息。並使用Cochrane Collaboration 與Cochrane Neonatal Review Group的標準方法

主要結論

共納入5個試驗含143名嬰兒。當乳房哺育需要輔助時,其中四個試驗使用杯子餵食,另一個使用管灌餵食。使用管灌餵食的唯一試驗有高度偏誤。分析這五個試驗發現,有兩個主要結果有顯著異質性。當管灌餵食這個試驗被剔除後,異質性就降低。用杯子餵食明顯降低出院時「沒有或只有部分乳房哺育」(summary RR 0.75, 95% CI 0.61至 0.91),但也增加了住院天數10天(95% CI 3.87至16.29)。研究發現,在杯子餵食試驗中最大的試驗卻具有高度的不依順性,這表示杯子餵食法不管是工作人員或是父母都不喜歡。而使用管灌餵食的試驗明顯降低了任何時期的「沒有或只有部分乳房哺育」和「完全沒有乳房哺育」,但因為這個試驗具有高度的偏誤,故需要謹慎解讀

作者結論

使用杯子餵食來作為乳房哺育時的交替方式,不但在出院後沒有益處也會延遲出院時間。而目前尚無足夠的證據來支持建議使用管灌餵食作為乳房哺育的交替方式。需要進一步研究來評估之。

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

避免早產兒在建立乳房哺育時使用奶瓶:早產兒一開始是使用管灌餵食,而當嬰兒成熟時就可以有吸吮的能力,且攝入的量也與日俱增。使用乳房哺育早產兒的婦女無法隨時隨地哺育。傳統上是使用奶瓶承裝母乳或配方奶來餵食嬰孩。有說法指出使用奶瓶哺育會干擾乳房哺育的成功。有五個試驗做過相關的研究,其中四個是使用杯子餵食法,一個使用管灌餵食。用管灌餵食的試驗,試驗品質不佳所以得到的結果需要小心的解讀。當使用杯子餵食法時,有較多的女性出院後可以完全使用乳房哺育,但若以完全和部份乳房哺育來看,則沒有這樣的效果。另外使用杯子餵食法會造成住院天數增加(10天)。使用管灌餵食法則出院時、出院後第三和第六個月的完全和部份乳房哺育皆有增加,但對於住院天數則沒有影響。但因管灌餵食的試驗品質不佳,故在未有更進一步高品質的實驗前,我們逕予推薦