Dear Lactnetters,
In this months Pediatrics:
http://www.pediatrics.org/cgi/content/abstract/111/3/511?etoc
Randomized Clinical Trial of Pacifier Use and Bottle-Feeding or Cupfeeding
and Their Effect on Breastfeeding Cynthia R. Howard, MD, MPH*, Fred M.
Howard, MD, Bruce Lanphear, MD, MPH, Shirley Eberly, MS||, Elisabeth A.
deBlieck, MPA*, David Oakes, PhD and Ruth A. Lawrence, MD*
Departments of Pediatrics,
Obstetrics and Gynecology
Biostatistics, University of Rochester School of Medicine and Dentistry,
Rochester, New York
|| Department of Pediatrics, Children’s Hospital Medical Center, University
of Cincinnati, Cincinnati, Ohio
Objective. To enhance breastfeeding practices, the World Health Organization
discourages pacifiers and bottle-feeding. However, the effect of artificial
nipples on breastfeeding duration is poorly defined. The effects of 2 types
of artificial nipple exposure on breastfeeding duration were evaluated: 1)
cupfeeding versus bottle-feeding for the provision of in-hospital
supplements and 2) early (2–5 days) versus late (>4 weeks) pacifier
introduction.
Methods. A total of 700 breastfed newborns (36–42 weeks, birth weight 2200
g) were randomly assigned to 1 of 4 intervention groups: bottle/early
pacifier (n = 169), bottle/late pacifier (n = 167), cup/early pacifier (n =
185), or cup/late pacifier (n = 179). The cup/bottle intervention was
invoked for infants who received supplemental feedings: cup (n = 251),
bottle (n = 230). Data were collected at delivery and at 2, 5, 10, 16, 24,
38, and 52 weeks’ postpartum. Intervention effects on breastfeeding duration
were evaluated with logistic regression and survival analyses.
Results. Supplemental feedings, regardless of method (cup or bottle), had a
detrimental effect on breastfeeding duration. There were no differences in
cup versus bottle groups for breastfeeding duration. Effects were modified
by the number of supplements; exclusive and full breastfeeding duration were
prolonged in cup-fed infants given >2 supplements. Among infants delivered
by cesarean, cupfeeding significantly prolonged exclusive, full, and overall
breastfeeding duration. Exclusive breastfeeding at 4 weeks was less likely
among infants exposed to pacifiers (early pacifier group; odds ratio: 1.5;
95% confidence interval: 1.0–2.0). Early, as compared with late, pacifier
use shortened overall duration (adjusted hazard ratio: 1.22; 95% confidence
interval: 1.03–1.44) but did not affect exclusive or full duration.
Conclusions. There was no advantage to cupfeeding for providing supplements
to the general population of healthy breastfed infants, but it may have
benefitted mother–infant dyads who required multiple supplements or were
delivered by cesarean. Pacifier use in the neonatal period was detrimental
to exclusive and overall breastfeeding. These findings support
recommendations to avoid exposing breastfed infants to artificial nipples in
the neonatal period.
Sara Bernard
The Netherlands
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