Cup Feeding as a Supplemental, Alternative Feeding Method for Preterm Breastfed Infants: An Integrative Review
Background The benefits of human milk for the preterm infant are well established. Preterm infants have lower breastfeeding rates and often face breastfeeding challenges. It is important that feeding practices for preterm infants optimize their chances of breastfeeding. Objective The purpose of this integrated review is to synthesize and critically analyze research related to the safety and efficacy of cup feeding as an alternative, supplemental feeding method for breastfed infants. Data Sources The electronic data bases of PubMed, CINAHL and were used to identify studies published in English from 1998- 2017. Design Using inclusion and exclusion criteria, 27 articles were initially assessed. After further screening 19 articles were included in the full review and of these 5 more were excluded. Lastly, an in-depth review of these 14 studies resulted in 2 more exclusions, for a total of 12 studies that met full inclusion and exclusion criteria. Review Methods Studies were examined for information on safety and efficacy of cup feeding as an alternative, supplemental feeding method for preterm breastfed infants. Studies were grouped into categories of outcomes that included (a) safety and physiologic properties; (b) breastfeeding outcomes. Results Use of cup feeding resulted in more stable heart rate and oxygen saturation than bottle feeding with similar weight gain. Additionally, breastfeeding rates were higher at discharge with continued higher rates at 3 and 6 months post-discharge for cup fed infants. Conclusions Premature infants face more breastfeeding obstacles than term infants. The potential for cup feeding as an alternative to bottle-feeding for breast fed preterm infants is positively supported by these results It is fundamentally important for NICU professionals to establish a protocol, education and training for the potential use of this feeding method for this vulnerable population.
KeywordsBreastfeeding Preterm Cup feeding Alternative feeding Infants
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no competing interests.
- Abouelfettoh, A., Dowling, D., Dabash, S., Elguindy, S., & Seoud, I. (2008). Cup versus bottle feeding for hospitalized late preterm infants in Egypt: A quasi-experimental study. International Breastfeeding Journal, 3(1), 27. https://doi.org/10.1186/1746-4358-3-27.CrossRefPubMedPubMedCentralGoogle Scholar
- Academy of Breastfeeding Medicine Protocol Committee. (2009). ABM clinical protocol #3: Hospital guidelines for the use of supplementary feedings in the healthy term breastfed neonate, revised 2009. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 4(3), 175–182. https://doi.org/10.1089/bfm.2009.9991.
- American Academy of Pediatrics (AAP). (2009). Sample hospital breastfeeding policy for newborns. Retrieved from http://www2.aap.org/breastfeeding/curriculum/documents/pdf/Hospital%20Breastfeeding%20Policy_FINAL.pdf
- American Academy of Pediatrics. (2012). Breastfeeding and the use of human milk. Retrieved from http://pediatrics.aappublications.org/content/early/2012/02/22/peds.2011-3552.
- Association of Women’s Health Obstetric and Neonatal Nursing. (2007). Breastfeeding. Retrieved from file:///C:/Users/francie/Downloads/Resources-Documents-pdf-5_Breastfeed%20(3).pdf.Google Scholar
- Australian Breastfeeding Association. (2016). Retrieved from https://www.breastfeeding.asn.au/bfinfo/cup-feeding.
- Baby-Friendly USA, Inc. (2012). Baby friendly hospital initiative. Retrieved from http://www.babyfriendlyusa.org/eng/index.htm.
- Bier, J. A., Oliver, T., Ferguson, A. E., & Vohr, B. R. (2002). Human milk improves cognitive and motor development of premature infants during infancy. Journal of Human Lactation: Official Journal of International Lactation Consultant Association, 18(4), 361–367. https://doi.org/10.1177/089033402237909.CrossRefGoogle Scholar
- Cloherty, M., Alexander, J., Holloway, I., Galvin, K., & Inch, S. (2005). The cup-versus-bottle debate: A theme from an ethnographic study of the supplementation of breastfed infants in hospital in the united kingdom. Journal of Human Lactation: Official Journal of International Lactation Consultant Association, 21(2), 151–162.CrossRefGoogle Scholar
- Cristofalo, E. A., Schanler, R. J., Blanco, C. L., Sullivan, S., Trawoeger, R., Kiechl-Kohlendorfer, U., … Abrams, S. (2013). Randomized trial of exclusive human milk versus preterm formula diets in extremely premature infants. The Journal of Pediatrics, 163(6), 1592–1595. https://doi.org/10.1016/j.jpeds.2013.07.011.CrossRefPubMedGoogle Scholar
- Eidelman, A. I., & Schanler, R. J. (2012). Executive summary: Breastfeeding and the use of human milk. Pediatrics, 129(3), 600–603.Google Scholar
- Flacking, R., Nyqvist, K. H., Ewald, U., & Wallin, L. (2003). Long-term duration of breastfeeding in swedish low birth weight infants. Journal of Human Lactation: Official Journal of International Lactation Consultant Association, 19(2), 157–165. https://doi.org/10.1177/0890334403252563.CrossRefGoogle Scholar
- Freer, Y. (1999). A comparison of breast and cup feeding in preterm infants: Effects on physiological parameters. Journal of Neonatal Nursing, 5(1), 16–21.Google Scholar
- Gilks, J., & Watkinson, M. (2004). Improving breast feeding rates in preterm babies: Cup feeding versus bottle feeding.. Journal of Neonatal Nursing, 10(4), 118–120.Google Scholar
- Gunn, T. R., Thompson, J. M., Jackson, H., McKnight, S., Buckthought, G., & Gunn, A. J. (2000). Does early hospital discharge with home support of families with preterm infants affect breastfeeding success? A randomized trial. Acta Paediatrica (Oslo, Norway: 1992), 89(11), 1358–1363.CrossRefGoogle Scholar
- Holmes, A., McLeod, A., & Bunik, M. (2013). ABM clinical protocol #5: Peripartum breastfeeding management for the healthy mother and infant at term, revision 2013. Breastfeeding Medicine: The Official Journal of the Academy of Breastfeeding Medicine, 8(6), 469–473. https://doi.org/10.1089/bfm.2013.9979.CrossRefGoogle Scholar
- Maastrup, R., Hansen, B. M., Kronborg, H., Bojesen, S. N., Hallum, K., Frandsen, A., … Hallstrom, I. (2014). Breastfeeding progression in preterm infants is influenced by factors in infants, mothers and clinical practice: The results of a national cohort study with high breastfeeding initiation rates. PLoS ONE, 9(9), e108208. https://doi.org/10.1371/journal.pone.0108208.CrossRefPubMedPubMedCentralGoogle Scholar
- Mannan, I., Rahman, S. M., Sania, A., Seraji, H. R., Arifeen, S. E., Winch, P. J., Darmstadt, G., & Baqui, A., Bangladesh Projahnmo Study Group (2008). Can early postpartum home visits by trained community health workers improve breastfeeding of newborns? Journal of Perinatology: Official Journal of the California Perinatal Association, 28(9), 632–640. https://doi.org/10.1038/jp.2008.64.CrossRefGoogle Scholar
- Marinelli, K., Burke, G., & Dodd, V. (2001). A comparison of the safety of cupfeedings and bottlefeedings in premature infants whose mothers intend to breastfeed. Journal of Perinatology: Official Journal of the California Perinatal Association, 21(6), 350–355. https://doi.org/10.1038/sj.jp.7210539.CrossRefGoogle Scholar
- Neo-BFHI The Baby-friendly Hospital Initiative for Neonatal Wards: Three guiding principles and ten expanded steps to protect, promote and support breastfeeding (2015). Retrieved from http://www-conference.slu.se/neobfhi2015/Neo-BFHI_Core_document_2015_Edition.pdf.
- Roze, J. C., Darmaun, D., Boquien, C. Y., Flamant, C., Picaud, J. C., Savagner, C., Claris, O., Lapillonne, A., Mitanchez, M., Branger, B., Simeoni, U., Kaminski, M., & Ancel, P. Y. (2012). The apparent breastfeeding paradox in very preterm infants: Relationship between breast feeding, early weight gain and neurodevelopment based on results from two cohorts, EPIPAGE and LIFT. British Medical Journal Open. https://doi.org/10.1136/bmjopen-2012-000834.CrossRefGoogle Scholar
- Sisk, P. M., Lovelady, C., Dillard, R., Gruber, K., & O’Shea, T. (2007). Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. Journal of Perinatology: Official Journal of the California Perinatal Association, 27(7), 428–433.CrossRefGoogle Scholar
- Sullivan, S., Schanler, R. J., Kim, J. H., Patel, A. L., Trawoger, R., Kiechl-Kohlendorfer, U., Chan, G. M., Blanco, C. L., Abrams, S., Cotton, M. C., Laroia, N., Ehrenkranz, R. A., Dudell, G., Cristofal, E. A., Meier, P., Lee, M. L., Rechtman, D. J., & Lucas, A. (2010). An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products. The Journal of Pediatrics, 156(4), 562–567. https://doi.org/10.1016/j.jpeds.2009.10.040.CrossRefPubMedGoogle Scholar
- United Nations Children’s Fund (1999), Breastfeeding: foundation for a healthy future. Retrieved from https://www.unicef.org/publications/files/pub_brochure_en.pdf.
- Vohr, B. R., Poindexter, B. B., Dusick, A. M., McKinley, L. T., Wright, L. L., Langer, J. C., & Poole, W. K., NICHD Neonatal Research Network (2006). Beneficial effects of breast milk in the neonatal intensive care unit on the developmental outcome of extremely low birth weight infants at 18 months of age. Pediatrics, 118(1), e115–e123.CrossRefGoogle Scholar
- World Health Organization. (2012). Exclusive breastfeeding. Retrieved from http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/.
- World Health Organization. (2014). Global Nutrition Targets 2025: Breastfeeding policy brief. Retrieved from http://www.who.int/nutrition/publications/globaltargets2025_policybrief_breastfeeding/en/.
- Yilmaz, G., Caylan, N., Karacan, C. D., Bodur, I., & Gokcay, G. (2014). Effect of cup feeding and bottle feeding on breastfeeding in late preterm infants: A randomized controlled study. Journal of Human Lactation: Official Journal of International Lactation Consultant Association. https://doi.org/10.1177/0890334413517940.CrossRefGoogle Scholar