Avoidance of bottles during the establishment of breast feeds in preterm infants

Preterm infants start milk feeds by tube and as they mature they are able to manage sucking feeds. The number of sucking feeds each day are gradually increased as the baby matures. For women who choose to breast feed their preterm infant it is not always possible for them to be there every time the baby needs a sucking feed. Conventionally, bottles with mother's milk or formula are used. It has been suggested that using bottles may interfere with breast feeding success. Five trials have investigated alternatives to bottles in the establishment of breast feeds; four trials used cup feeds and one trial used tube feeds. The one study that used tube feeds was of poor quality and the results of this study need to be interpreted cautiously. When cup feeds were used, more women were discharged home fully breastfeeding, but there was no effect on any (fully and partially combined) breastfeeding. Using cup feeds also increased the length of hospital stay by 10 days. In the one study of tube feeds, breastfeeding (both fully and partially) was increased at discharge and at three and six months after discharge with no effect on length of hospital stay. However, because of the poor quality of this one study, we cannot recommend a tube feeding strategy until further studies of high quality are undertaken.