A New Bottle Design Decreases Hypoxemic Episodes during Feeding in Preterm Infants

Abstract

Oxygen saturation is lower during bottle feeding than during breastfeeding in preterm infants. Our objective was to compare two different bottle systems in healthy preterm infants before discharge in terms of SpO2 and oral feeding efficiency (rate of milk intake). Infants without supplement oxygen needs were evaluated twice on the same day during two consecutive feeds, by the same nurse. Infants served as their own controls for comparison of two systems of bottles, the order of which was randomized. The new bottle's nipple design mimics mom's breast in shape and feel, and the bottle vents to air when the child sucks on the nipple. The other system was the hospital's standard plastic bottle with silicone nipple. The rate of milk intake was calculated as the total volume transferred minus volume lost divided by time of feeding, mL/min. Thirty-four infants (BW: 1, 163 ± 479.1 g) were studied at 35.4 ± 1.3 weeks after-conception. SpO2 was significantly higher in infants fed with the new bottle design. Milk intake rate was significantly higher with the new bottle than with the standard bottle design. The new bottle design improves oral feeding performance in preterm infants near to discharge when compared to that of a standard bottle.

Sucking behaviour using feeding teats with and without an anticolic system: a randomized controlled clinical trial

“…Various studies focus on the influence of a specific bottle or nipple design on a particular health parameter of the infant. These studies comparing BNSs focused, inter alia, on vital parameters such as oxygen saturation during bottle-feeding with a particular feeding teat design [ 7 , 20 , 22 ] and sucking skills [ 7 , 21 ].…”

“…Preterm infants have significant desaturation during bottle-feeding [ 23 ], but it could be shown that oxygen saturation increases significantly if a vented BNS is used [ 20 ]. Interestingly, some authors reported significantly lower SpO2 after feeding and attribute this to aerophagia in terms of burping and gastric distress [ 7 , 24 ].…”

“…The infant tries to compensate for the negative pressure by increasing sucking frequency or amplitude until nipple release after air reflux from the oral cavity. Vented teats allow the nipple to deliver formula in an uninterrupted process [ 20 ].…”

A thickened formula reduces feeding-associated oxygen desaturation and bradycardia in preterm infants

“…[25][26][27] In addition, adapting the flow rate has been shown to have positive effects on sucking patterns and suck-swallowbreathe coordination. 28,29) Therefore, TFs may assist preterm infants with immature physiological functions to achieve more competent rhythmic oral feeding.…”

The impact of preterm adversity on cardiorespiratory function

“…The poor control of breathing is most evident during feeding, which requires a co-ordinated suck-swallow-breathe mechanism. There is evidence of increased apnoeic episodes during feeding in infants born preterm (Thoyre & Carlson, 2003), which may be potentiated in bottlefed babies as a result of increased vacuum with sucking (Jenik et al, 2012). In addition, increased respiratory muscle activation has been observed during feeding desaturation in preterm infants compared with term infants, indicating an increased work of breathing and thoraco-abdominal asynchrony that will be likely to contribute to respiratory fatigue (Kwon, Park, Jeong, Kim, & Lee, 2018).…”