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Evidence summaries

Avoidance of Bottles during the Establishment of Breast Feeds in Preterm Infants

Supplementing breast feeds by cup compared to bottle may increase the extent and duration of breast feeding in preterm infants. Level of evidence: "C"

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.

Breast feeding with supplemental feeds by other than bottle compared with breast feeding with supplemental feeds by bottle

OutcomeRelative effect (95% CI)Assumed risk - bottleCorresponding risk (95% CI) - other than bottleParticipants (studies)
1) statistical heterogeneity, I2 =52%; 2) I2 =73%; 3) I2 =52%; 4) I2 =50%
Full breast feeding at dischargeRR 1.47(1.19 to 1.80)1) 44 per 10064 per 100(52 to 79)1 074(6 studies)
Any breast feeding at dischargeRR 1.11(1.06 to 1.16)79 per 10088 per 100(84 to 92)1 138(6 studies)
Full breast feeding at 3 months post dischargeRR 1.56(1.37 to 1.78)36 per 10057 per 100(50 to 65)986 (4 studies)
Any breast feeding at 3 months post dischargeRR 1.31(1.01 to 1.71)2) 60 per 10078 per 100(60 to 100)1 063(5 studies)
Full breast feeding at 6 months post dischargeRR 1.64(1.14 to 2.36)3) 31 per 10051 per 100(35 to 73)887(3 studies)
Any breast feeding at 6 months post dischargeRR 1.25(1.10 to 1.41)4) 45 per 10056 per 100(49 to 63)886 (3 studies)

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).

    References

    • Allen E, Rumbold AR, Keir A et al. Avoidance of bottles during the establishment of breastfeeds in preterm infants. Cochrane Database Syst Rev 2021;(10):CD005252.[PubMed]

Primary/Secondary Keywords