Objective:  This prospective study is the first to compare four supplemental feeding methods to provide evidence regarding the optimal method to facilitate breastfeeding preterm infants. 

Design: Randomized Control Trial

Setting: Community Hospital with a Level III NICU in the Midwest of the United States

Patients/Participants: One hundred thirty-two premature infants, ranging from 26 – 36 weeks gestation at birth were randomized into one of the four supplemental feeding method groups.

Methods: The methods investigated were nasogastric tube with pacifier, bottle with preterm nipple, cup feeding with a 30 ml medicine cup, and the Haberman infant feeder (Medela). The primary hypotheses were that there would be no significant differences in breastfeeding ability at discharge, and infant tolerance to the supplementary method.  Data collected on other outcome measures included: breastfeeding rate at discharge, 2 and 4 weeks post hospitalization, average daily weight gain, hospital length of stay, frequency of skin-to skin care and breastfeeding sessions, and maternal satisfaction with feeding method. 

Results:  The null hypothesis was rejected for both primary outcome measures. Results showed that premature infants in the nasogastric tube with pacifier method had significantly better breastfeeding ability at discharge (p .04). Infants in that feeding group breastfed significantly more frequently than infants in the bottle group. (p.01) Infants in that feeding group breastfed significantly more frequently than infants in the bottle group. (p.01) Infants in the bottle-supplemented group demonstrated a reduction in breastmilk intake per pre/post breastfeeding test weights after the supplemental bottle was introduced. Consequently, the mothers reduced their breastfeeding frequency believing that it would expedite their infants’ hospital discharge. There were no significant differences in hospital length of stay among the 4 methods. Furthermore, infants tolerated the nasogastric with pacifier feeding method better than the bottle group. Bottle-supplemented infants had almost four times the number of apnea, bradycardia, and oxygen desaturation events during the feeding.   The variables of frequency of skin-to-skin and breastfeeding sessions were positively correlated with breastfeeding ability at discharge. Higher levels of breastfeeding ability at discharge predicted continued breastfeeding at four weeks post-discharge. 

Conclusion/Implications for nursing practice: The results of this study showed that supplementing the premature infant by nasogastric tube with a pacifier (when the breastfeeding mother is unable to be at the bedside for feeding) significantly supports breastfeeding ability by hospital discharge and continued breastfeeding to 4 wks post-discharge.

Keywords:  Breastfeeding, Premature Infant, Supplementation, Nasogastric feeding