Nipple shield use in preterm infants: Prevalence, motives for use and association with exclusive breastfeeding-Results from a national cohort study

Nipple shield use in the maternity ward increases risk of exclusive breastfeeding interruption in the first six months of infant's life

OBJECTIVE

The objective of this study was to investigate the association between use of silicone nipple shields in the maternity ward and exclusive breastfeeding interruption in the first 6 months of the infant's life.

DESIGN

Cohort study.

SETTING

Interviews were conducted personally at the mother's home at 1 and 6 months postpartum and by telephone at 2 and 4 months.

PARTICIPANTS

287 mother-infant dyads.

METHODS

Lactating mothers were randomly selected at two maternity wards (one public, one private) in Porto Alegre, Brazil. Data were analyzed using Kaplan-Meier survival curves and Cox multivariate regression. The outcome of interest was exclusive breastfeeding interruption before 6 months of the infant's life.

FINDINGS

Nipple shields were used by 6.2 % of the women in the public maternity ward and by 25.8 % of those in the private setting. Median duration of exclusive breastfeeding was 11 days (95 %CI 0.0-36.9) among women who used the accessory vs. 89 days (95 %CI 60.8-117.2) among those who did not. Nipple shield use in the maternity ward was associated with exclusive breastfeeding interruption before 6 months of infant's life (adjusted risk ratio = 1.47; 95 %CI 1.01-2.15). The risk was higher in the first months of breastfeeding, ranging from 2.0 to 1.47 in the first and sixth months, respectively.

CONCLUSIONS

The use of silicone nipple shields in the maternity ward increased the risk of exclusive breastfeeding interruption before 6 months of the infant's life, especially in the first months. These findings suggest caution in recommending this accessory to new mothers.

The effect of interventions on flat and inverted nipple on breastfeeding: A systematic review

BACKGROUND

Some methods have been developed to solve flat and/or inverted nipple problems. This study aimed to examine the effects of flat and/or inverted nipple interventions on nipples and breastfeeding.

METHODS

Before initiating the review, the protocol was registered in the 'PROSPERO' database. This study was based on the PRISMA-P guideline. Seven databases (Web of Science, PubMed, ScienceDirect, Scopus, The Cochrane Library, TÜBİTAK Ulakbim and Google Scholar) were searched, and nine studies were included in this review.

RESULTS

Hoffman's exercise, the inverted syringe method, and the nipple exercise was quite effective in increasing breastfeeding success. The rate of exclusive breastfeeding in the first, third, and sixth months of mothers followed up with postpartum multidimensional visits was found to be significantly higher in the intervention group than in the control group (p < 0.05). A study in which a rubber band was applied with the help of an injector on flat and inverted nipples showed that 63% of mothers on the third day and all of them in the first month were able to breastfeed without a rubber band. Hoffman's exercise, the inverted syringe technique, and rubber bands corrected the flat and/or inverted nipple. There were studies reporting complications as a result of nipple interventions.

CONCLUSIONS AND IMPLICATIONS

It is necessary to disseminate the information that breastfeeding of mothers with flat and/or inverted nipples can be sustained with various interventions. Furthermore, it is believed that providing mothers with a chance to choose the interventions, and thus, the compliance of mothers to the intervention with the method of their choice may increase the success of the intervention.

Nutrition Management of High-Risk Neonates After Discharge

Nutrition management of the high-risk infant after hospital discharge is complicated by the infant's dysfunctional or immature oral feeding skills, nutritional deficits, and the family's feeding plan. Although evidence is limited, available studies point to developing an individualized nutritional plan, which accounts for these factors; protects and prioritizes the family's plan for breastfeeding; and promotes an acceptable growth pattern. Further research is needed to identify the type and duration of posthospital discharge nutrition to optimize high-risk infant neurodevelopment and body composition. Attention to infant growth, lactation support, and safe feed preparation practices are critical in the transition to home.

Enteral Nutrition in Preterm Infants (2022): A Position Paper From the ESPGHAN Committee on Nutrition and Invited Experts

OBJECTIVES

To review the current literature and develop consensus conclusions and recommendations on nutrient intakes and nutritional practice in preterm infants with birthweight <1800 g.

METHODS

The European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee of Nutrition (CoN) led a process that included CoN members and invited experts. Invited experts with specific expertise were chosen to represent as broad a geographical spread as possible. A list of topics was developed, and individual leads were assigned to topics along with other members, who reviewed the current literature. A single face-to-face meeting was held in February 2020. Provisional conclusions and recommendations were developed between 2020 and 2021, and these were voted on electronically by all members of the working group between 2021 and 2022. Where >90% consensus was not achieved, online discussion meetings were held, along with further voting until agreement was reached.

RESULTS

In general, there is a lack of strong evidence for most nutrients and topics. The summary paper is supported by additional supplementary digital content that provide a fuller explanation of the literature and relevant physiology: introduction and overview; human milk reference data; intakes of water, protein, energy, lipid, carbohydrate, electrolytes, minerals, trace elements, water soluble vitamins, and fat soluble vitamins; feeding mode including mineral enteral feeding, feed advancement, management of gastric residuals, gastric tube placement and bolus or continuous feeding; growth; breastmilk buccal colostrum, donor human milk, and risks of cytomegalovirus infection; hydrolyzed protein and osmolality; supplemental bionutrients; and use of breastmilk fortifier.

CONCLUSIONS

We provide updated ESPGHAN CoN consensus-based conclusions and recommendations on nutrient intakes and nutritional management for preterm infants.

Longitudinal Follow-up of Preterm Breastfeeding to 12 Weeks Corrected Gestational Age

BACKGROUND

Preterm infants have shorter breastfeeding duration than that of term infants. Details of postdischarge feeding methods and difficulties are needed to inform the care of preterm breastfeeding dyads.

PURPOSE

To describe postdischarge breastfeeding characteristics of mother-preterm infant dyads up to 12 weeks corrected gestational age (CGA).

METHODS

A prospective observational study of preterm dyads (birth 24-33 weeks' gestation) that fed their mother's own milk (MOM) at discharge from a neonatal unit in Perth, Western Australia. Feeding method and frequency, breastfeeding duration, difficulties, and nipple shield use were recorded at 2, 6, and 12 weeks CGA.

RESULTS

Data were obtained for 49 mothers (singleton infant n = 39, twins n = 10). At 12 weeks CGA, 59% fed any MOM with 47% exclusively fed MOM and 31% fully breastfed. Nipple shield use reduced from 42% at 2 weeks CGA to 11% at 12 weeks CGA. Compared with mothers who exclusively fed MOM at discharge (n = 41) those who fed both MOM and infant formula (n = 8) were more likely to wean before 12 weeks CGA ( P < .001). Weaning occurred before 2 weeks CGA in 12/19 (63%), with low milk supply the most frequently cited reason.

IMPLICATIONS FOR PRACTICE

Most mothers with a full milk supply at discharge successfully transition to predominant breastfeeding. Frequent milk removal needs to be prioritized throughout the preterm infant's hospital stay.

IMPLICATIONS FOR RESEARCH

Examination of facilitators and barriers to early and continued frequent milk removal across the postpartum period is required to identify strategies to optimize lactation after preterm birth.

Consequences of Using Artificial Nipples in Exclusive Breastfeeding: An Integrative Review

Objective: To describe the consequences of using artificial nipples to exclusive breastfeeding. Materials and method: An integrative review carried out in the Medline®, Cinahl, Lilacs, Web of Science, and Scopus databases to answer the following question: What are the consequences of using artificial nipples to exclusive breastfeeding? Results: 38 articles were analyzed; the analysis gave rise to two categories: neonatal factors and maternal factors influencing exclusive breastfeeding. Breastfeeding interruption was the neonatal factor most associated with the use of artificial nipples, while the level of maternal education stood out as an intervening factor in exclusive breastfeeding. Pacifiers were the dummy type more commonly mentioned, followed by feeding bottles and nipple shields. Conclusions: The consequences of offering artificial nipples to breastfed infants are mostly negative and associated with the newborn, such as early weaning, refusal to breastfeed, impaired suction technique, incorrect latch-on, interference with orofacial development, and interruption of exclusive breastfeeding. Mothers who offered artificial nipples to their infants are more likely to experience pain, nipple fissures, frustration, and reduced interaction with their infants.

Mother's Own Milk Feeding in Preterm Newborns Admitted to the Neonatal Intensive Care Unit or Special-Care Nursery: Obstacles, Interventions, Risk Calculation

Early nutrition of newborns significantly influences their long-term health. Mother's own milk (MOM) feeding lowers the incidence of complications in preterm infants and improves long-term health. Unfortunately, prematurity raises barriers for the initiation of MOM feeding and its continuation. Mother and child are separated in most institutions, sucking and swallowing is immature, and respiratory support hinders breastfeeding. As part of a quality-improvement project, we review the published evidence on risk factors of sustained MOM feeding in preterm neonates. Modifiable factors such as timing of skin-to-skin contact, strategies of milk expression, and infant feeding or mode of delivery have been described. Other factors such as gestational age or neonatal complications are unmodifiable, but their recognition allows targeted interventions to improve MOM feeding. All preterm newborns below 34 weeks gestational age discharged over a two-year period from our large German level III neonatal center were reviewed to compare institutional data with the published evidence regarding MOM feeding at discharge from hospital. Based on local data, a risk score for non-MOM feeding can be calculated that helps to identify mother-baby dyads at risk of non-MOM feeding.