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Subject:
From:
Molly Brannigan <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 2 Dec 2007 20:50:12 -0800
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I seem to recall someone asking recently about whether or not we have evidence about any form of supplemental feeding and its relationship to breastfeeding.

I ran across this in the Cochrane Library (though do not have access to read it in its full form, and therefore can't remark on the contents):


Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed
A Flint, K New, MW Davies
Cochrane Database of Systematic Reviews 2007 Issue 4
Copyright © 2007 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.


      
      Background
Breast milk provides optimal nutrition for newborn infants, and the
ideal way for infants to receive breast milk is through suckling at the
breast. Unfortunately, this may not always be possible, as there are
numerous reasons why a newborn infant may not be able to breastfeed
and, as a result, require supplemental feeding. Currently, there are a
variety of ways in which newborn infants can receive supplemental
feeds. Traditionally, bottles and nasogastric tubes have been used;
however, more recently, cup feeding has become a popular practice in
many nurseries in an attempt to improve breastfeeding rates. There is
no consistency to guide the choice of supplementation.


      
      Objectives
      To determine the effects of cup feeding versus other forms of supplemental enteral feeding on weight gain and achievement
      of successful breastfeeding in newborn infants who are unable to fully breastfeed.


      
      Search strategy
We searched the Cochrane Central Register of Controlled Trials
(CENTRAL, The Cochrane Library, Issue 2, 2006), CINAHL (1982 - April
2006) and MEDLINE (1966 - April 2006).


      
      Selection criteria
Randomised or quasi-randomised controlled trials comparing cup feeding
to other forms of enteral feeding for the supplementation of newborn
infants.


      
      Data collection and analysis
Quality assessments and data extraction for included trials were
conducted independently by the review authors. Outcomes reported from
these studies were: weight gain, proportion not breastfeeding at
hospital discharge, proportion not feeding at three months of age,
proportion not feeding at six months of age, proportion not fully
feeding at hospital discharge, proportion not fully breastfeeding at
three months of age, proportion not fully breastfeeding at six months
of age, average time per feed (minutes), length of stay and
physiological events of instability such as bradycardia, apnea, and low
oxygen saturation. For continuous variables such as weight gain, mean
differences and 95% confidence intervals were reported. For categorical
outcomes such as mortality, the relative risks (RR) and 95% confidence
intervals were reported.


      
      Main results
Four studies were eligible for inclusion. The experimental intervention
was cup feeding and the control intervention was bottle feeding in all
four studies included in this review. There was no statistically
significant difference in the incidence of not breastfeeding at
hospital discharge in three included studies (typical RR 0.82, 95% CI
0.62, 1.09) and not breastfeeding at three months in two included
studies (typical RR 0.88, 95% CI 0.76, 1.03) or six months for the one
study that reported this outcome (RR 0.91, 95% CI 0.78, 1.05). There
was a statistically significant difference in not fully breastfeeding
at hospital discharge (from three included studies) in favour of cup
feeding (typical RR 0.75, 95% CI 0.61, 0.92). However, this was not
statistically significant at three months (one study, RR 1.18, 95% CI
0.88, 1.58) or six months (one study, RR 1.31, 95% CI 0.89, 1.92).
There was no statistically significant difference in weight gain from
one study that reported this outcome (MD -0.60, 95% CI -3.21, 2.01). In
the one study that assessed it, there was a significantly increased
length of hospital stay in the cup fed infants [mean difference between
groups was 10.1 days (95% CI 3.9, 16.3)]. Time to full breastfeeding
was not assessed in any study.


      
      Authors' conclusions
Cup feeding cannot be recommended over bottle feeding as a supplement
to breastfeeding because it confers no significant benefit in
maintaining breastfeeding beyond hospital discharge and carries the
unacceptable consequence of a longer stay in hospital.
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