Feeding Neonates by Cup: A Systematic Review of the Literature

Abstract

Objective WHO and UNICEF recommend cup feeding for neonates unable to breastfeed in low-resource settings. In developed countries, cup feeding in lieu of bottle feeding in the neonatal period is hypothesized to improve breastfeeding outcomes for those initially unable to breastfeed. Our aim was to synthesize the entire body of evidence on cup feeding. Methods We searched domestic and international databases for original research. Our search criteria required original data on cup feeding in neonates published in English between January 1990 and December 2014. Results We identified 28 original research papers. Ten were randomized clinical trials, 7 non-randomized intervention studies, and 11 observational studies; 11 were conducted in developing country. Outcomes evaluated included physiologic stability, safety, intake, duration, spillage, weight gain, any and exclusive breastfeeding, length of hospital stay, compliance, and acceptability. Cup feeding appears to be safe though intake may be less and spillage greater relative to bottle or tube feeding. Overall, slightly higher proportions of cup fed versus bottle fed infants report any breastfeeding; a greater proportion of cup fed infants reported exclusive breastfeeding at discharge and beyond. Cup feeding increases breastfeeding in subgroups (e.g. those who intend to breastfeed or women who had a Caesarean section). Compliance and acceptability is problematic in certain settings. Conclusions Further research on long-term breastfeeding outcomes and in low-resource settings would be helpful. Research data on high risk infants (e.g. those with cleft palates) would be informative. Innovative cup feeding approaches to minimize spillage, optimize compliance, and increase breastfeeding feeding are needed.

A randomized crossover trial comparing the Nifty cup to a medicine cup in preterm infants who have difficulty breastfeeding at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana

“…Spillage in this study was low for both cups at less than 10% per feed. The spillage proportion reported in this study which is similar to reports using the paladai (a cup widely used in South India) [17], which studies report as 6% to 12% [24,30], however it is substantially lower than for other cups at 25% to 30% [23,24].…”

“…The World Health Organization and United Nations Children’s Fund recommend hand expression of breast milk and the use of a small cup to feed newborns with breastfeeding difficulties in low-resource settings [12–14]. The body of evidence supporting cup feeding is growing [15–17]. A systematic review of studies from middle- and high-income countries concluded that feeding infants by cup is safe, although acceptability and compliance may be more challenging in high-income settings [17].…”

“…The body of evidence supporting cup feeding is growing [15–17]. A systematic review of studies from middle- and high-income countries concluded that feeding infants by cup is safe, although acceptability and compliance may be more challenging in high-income settings [17]. A different systematic review showed that cup feeding preterm infants resulted in improved physiology and higher short-term and long-term breastfeeding rates after discharge [15].…”

“…Yet, no standard cup for feeding infants with breastfeeding difficulties exists. Non-specific cups such as small shot glasses, bottle tops, medicine cups, paladai (a 10-mL beaked cup used in south India) [17], and generic drinking cups are used commonly along with spoons and syringes. Cups made of metal or hard plastic can cut the thin skin of the oral commissure of the preterm infant, thereby increasing risk of infection.…”

“…Moreover, this also frustrates the mother, whose milk is laboriously hand expressed to only then be spilled and wasted. In one review, spillage was as much as 30% for every cup feed [17]. Over a short period of time, poor cup feeding may quickly result in chronic insufficient caloric intake that reduces endurance and increases a vulnerable neonate’s risk of undernutrition, failure to grow, infection, and death.…”