A Cochrane review [Abstract] 1 included 7 studies with a total of 1 152 preterm infants. Five studies used a cup feeding strategy, 1 used a tube feeding strategy and 1 used a novel teat (designed to more closely mimic the sucking action of breast feeding) when supplements to breast feeds were needed. Adherence with cup feeding was poor in 1 study, indicating dissatisfaction with this method by staff and/or parents; the remaining 4 cup feeding studies provided no such reports of dissatisfaction or low adherence. Meta-analyses showed that avoiding bottles increased breast feeding at discharge home and at 3 months and 6 months post discharge (table T1). This effect was evident at all time points for the tube alone strategy and for all except any breast feeding at 3 months post discharge for cup feeding. No clear benefit was reported when the novel teat was used. There was no difference in length of hospital stay between supplemental feeds by other than bottle and supplemental feeds by bottle (MD 2.25 days, 95% CI -3.36 days to 7.86 days; statistical heterogeneity, I2 =73%; 4 studies, n=1 004). No other benefits or harms were evident.
| Outcome | Relative effect (95% CI) | Assumed risk - bottle | Corresponding risk (95% CI) - other than bottle | Participants (studies) |
|---|---|---|---|---|
| Full breast feeding at discharge | RR 1.47(1.19 to 1.80)1) | 44 per 100 | 64 per 100(52 to 79) | 1 074(6 studies) |
| Any breast feeding at discharge | RR 1.11(1.06 to 1.16) | 79 per 100 | 88 per 100(84 to 92) | 1 138(6 studies) |
| Full breast feeding at 3 months post discharge | RR 1.56(1.37 to 1.78) | 36 per 100 | 57 per 100(50 to 65) | 986 (4 studies) |
| Any breast feeding at 3 months post discharge | RR 1.31(1.01 to 1.71)2) | 60 per 100 | 78 per 100(60 to 100) | 1 063(5 studies) |
| Full breast feeding at 6 months post discharge | RR 1.64(1.14 to 2.36)3) | 31 per 100 | 51 per 100(35 to 73) | 887(3 studies) |
| Any breast feeding at 6 months post discharge | RR 1.25(1.10 to 1.41)4) | 45 per 100 | 56 per 100(49 to 63) | 886 (3 studies) |
| 1) statistical heterogeneity, I2 =52%; 2) I2 =73%; 3) I2 =52%; 4) I2 =50% | ||||
Comment: The quality of evidence is downgraded by study limitations (lack of blinding and high loss to follow-up) and by inconsistency (variability in results).
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