Effects of Feeding Nozzle and Cup Feeding on Reaching the Time of Full Oral Feeding in the Premature Infants in the Neonatal Intensive Care Unit

Open Access Original Article Effects of Feeding Nozzle and Cup Feeding on Reaching the Time of Full Oral Feeding in the Premature Infants in the Neonatal Intensive Care Unit Sara Rahmani1, Amir Mohammad Armanian2, Mahboobeh Namnabati3* 1. Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran 2. Division of Neonatology, Department of Pediatrics, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran 3. Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran ABSTRACT Background: Oral feeding problems are among the most common issues in preterm infants. Various methods and feeding support tools are used in this regard, such as cup feeding and feeding nozzle. The present study aimed to determine the preferred method between cup feeding and feeding nozzle to support oral feeding in premature neonates. Methods: This clinical trial was conducted on 70 preterm infants with the gestational age of 30 -33 weeks in Isfahan, Iran. Infants were divided into two groups of cup feeding and feeding nozzle application. The studied variables were the duration needed to reach the time of full oral feeding, weight changes since birth until full oral feeding, and length of hospital stay. Results: Mean duration to start full oral feeding was 4.03 and 5.1 days in the cup feeding and feeding nozzle groups, respectively (P<0.05). Mean changes in the weight of the neonates since the initiation of oral feeding until full oral feeding was 49.5 grams in the cup feeding group and 89 grams in the feeding nozzle group. Analysis of covariance was performed by adjusting the duration since initiating the intervention until starting full oral feeding, and no significant difference was observed between the groups in this regard (P>0.05). Mean length of hospital stay was 23.1 and 21.9 days in the cup feeding and feeding nozzle groups, respectively (P>0.05) . Conclusion: According to the results, the time needed to reach full oral feeding was shorter in the cup feeding group compared to the feeding nozzle group. However, the mean length of hospital stay was two days shorter in the feeding nozzle group compared to the cup feeding group. Therefore, feeding nozzle could be utilized as a supportive method in the feeding of preterm infants. Keywords: Breastfeeding, Enteral feeding, Feeding methods, Infant, Iran, NICU, Premature, Weight gain Introduction Survival rate of preterm infants has improved with the advances in neonatal special care, as well as the enhanced quality of the treatments of fetal diseases. However, many of these newborns are faced with several medical issues, such as respiratory disorders, instable body temperature, and nutritional complications (1). Oral feeding problems are among the most common issues in preterm infants, which occur due to underdeveloped oral-motor skills and lack of coordination in suckling, swallowing, and respiration (2). Suckling and swallowing abilities develop by week 28 of the fetal period and are coordinated by weeks 32-34 (3). Suckling and eating abilities of infants are essential their survival and maintenance of their growth aspects (4). It is often stated that premature infants should have acceptable weight gain and proper feeding in order to be discharged. Ideally, these infants should be breastfed or bottle-fed (5). Findings of previous studies have indicated that preterm infants have specific problems in feeding after discharge. As a result, their parents, especially mothers, must * Corresponding author: Mahboobeh Namnabati, Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran. Tel: 09133288250; Email: Please cite this paper as: Rahmani S, Armanian AM, Namnabati M. Effects of Feeding Nozzle and Cup Feeding on Reaching the Time of Full Oral Feeding in the Premature Infants in the Neonatal Intensive Care Unit. Iranian Journal of Neonatology. 2018 Mar: 9(1). DOI: 10.22038/ijn.2018.26771.1357 Rahmani S et al be able to feed these infants during hospitalization (6-9). Preterm infants could be successfully breastfed at the gestational age of 32 weeks (10). However, infants aged less than 32 weeks cannot be exclusively breastfed. Consequently, invasive have been proposed in this regard, including the use of feeding tubes or supportive feeding interventions, such as cup feeding, bottle feeding, use of a syringe, and feeding by spoon (11). According to the literature, despite the advanced natural evolution, preterm infants should be fed before becoming independent in suckling. In addition, the maturity of these neonates along with feeding training might enable preterm neonates to be fully oral fed earlier than the expected time. The mentioned factors highlight the need for early interventions in order to facilitate oral-motor skills in premature infants (12). In a study, Shamsher et al. (2012) assessed the feeding behaviors and performance of preterm infants on paladai feeding. The mentioned research was conducted on 20 infants with the gestational age of 28-30 weeks. According to the results, the frequency of interventions had a more significant effect on the oral-pharyngeal ability of the neonates compared to their maturity status at birth and gestational age (13). Cup feeding is a supportive method of feeding, which is applicable in the infants who cannot suckle properly despite having the swallowing ability (14). Infants with the gestational age of 30-33 weeks can usually be fed using a cup. According to the Neonatal Health Department of Iran Ministry of Health, although cup feeding is a suitable method for the feeding of infants, it has some limitations, such as the waste of milk due to dropping from the infant’s mouth. Moreover, long-term cup feeding without the effective stimulation of suckling might postpone breastfeeding (15), and the mothers of these infants tend to utilize syringes, which may injure the gums of the infants if the mothers are not able to apply the syringe properly. Feeding nozzle could facilitate syringe application for mothers without irritating the gums of the infant (Figure 1). Therefore, use of feeding nozzles is considered an efficient approach for the feeding of infants since the tool seems to cause no problems (e.g., milk aspiration). Furthermore, 66 Comparison of Feeding Nozzle and Cup Feeding in Premature Infants Figure 1. Infant Feeding by a Feeding Nozzle the technique might improve suckling in infants (16). Based on the experience of the researchers, feeding by a nozzle is an appropriate substitute for cup feeding and syringe application. Despite the paramount importance of feeding in premature infants, no studies have investigated and compared the feeding methods in the current literature. With this background in mind, the present study aimed to compare the effects of cup feeding and (...truncated)