Effect of bottles, cups, and dummies on breast feeding in preterm infants: a randomised controlled trial. Cup or bottle for preterm infants: effects on oxygen saturation, weight gain, and breastfeeding. Should the food intake of patients admitted to acute hospital services be routinely supplemented? A randomized placebo controlled trial.
To determine the effect of artificial teats (bottle and dummy) and cups on breast feeding in preterm infants.
                Randomised controlled trial.
                Two large tertiary hospitals, 54 peripheral hospitals.
                319 preterm infants (born at 23-33 weeks' gestation) randomly assigned to one of four groups: cup/no dummy (n = 89), cup/dummy (n = 72), bottle/no dummy (n = 73), bottle/dummy (n = 85). Women with singleton or twin infants < 34 weeks' gestation who wanted to breastfeed were eligible to participate.
                Cup or bottle feeding occurred when the mother was unable to be present to breast feed. Infants randomised to the dummy groups received a dummy on entry into the trial.
                Full breast feeding (compared with partial and none) and any breast feeding (compared with none) on discharge home. Secondary outcomes: prevalence of breast feeding at three and six months after discharge and length of hospital stay.
                303 infants (and 278 mothers) were included in the intention to treat analysis. There were no significant differences for any of the study outcomes according to use of a dummy. Infants randomised to cup feeds were more likely to be fully breast fed on discharge home (odds ratio 1.73, 95% confidence interval 1.04 to 2.88, P = 0.03), but had a longer length of stay (hazard ratio 0.71, 0.55 to 0.92, P = 0.01).
                Dummies do not affect breast feeding in preterm infants. Cup feeding significantly increases the likelihood that the baby will be fully breast fed at discharge home, but has no effect on any breast feeding and increases the length of hospital stay. The impact of cup-feeding or bottle-feeding on weight gain, oxygen saturation, and breastfeeding rates of preterm infants was studied in 34 bottle-fed and 44 cup-fed preterm infants. At initiation of oral feeding, postconceptional age and weight were 37.2 +/- 2.2 weeks and 1676 +/- 83 g for the bottle-fed group (BF) and 37.0 +/- 1.6 weeks and 1637 +/- 40 g for the cup-fed (CF) group, respectively. No significant differences between groups were found with regard to time spent feeding, feeding problems, weight gain, or breastfeeding prevalence at discharge or at 3-month follow-up. Possible beneficial effects of cup-feeding were lower incidence of desaturation episodes (13.6% vs 35.3%, CF vs BF, P = .024) and a higher prevalence of breastfeeding at 3 months among those still breastfeeding at the first follow-up visit (68.4% vs 33.3%, CF vs BF, P = .04). Many patients admitted to acute hospital services are underweight or harbour vitamin deficiencies.
                To determine the effect on patient throughput of a policy of routine vitamin supplementation, and of early routine sipfeed supplementation in 'thin' patients (5-10% weight loss or body mass index 18-22).
                Factorial randomized placebo controlled trial of oral multivitamins from the first day of admission, and, after nutritional screening, of a nutritionally complete sipfeed from the second day in 'thin' patients.
                Acute medical, surgical and orthopaedic hospital services of a London teaching hospital.
                1561 patients admitted as emergencies were included in the vitamin study of which 549 were included in the sipfeed study.
                Length of hospital stay (LOS).
                Offering multivitamins to acute admissions resulted in a mean change (reduction) in LOS of -0.4 days 95% CI (-2-1.2days). The results suggest greater reductions for those discharged after 10 days: mean change=-2.3 days 95% CI (-5.7 to 1.2). Sipfeed supplementation was associated with an increased mean length of stay 2.8 days 95% CI (-0.8-6.3). 18% of acute admissions were classified undernourished on the basis of BMI, MUAC or percent weight loss combined.
                No benefit was observed for sipfeed intervention although a small benefit of less than one day is not excluded. Vitamin supplementation may have slight but economically important benefit.
                Copyright 2001 Harcourt Publishers Ltd.
Cup feeding cannot be recommended over bottle feeding as a supplement to breastfeeding because it confers no significant benefit in maintaining breastfeeding beyond hospital discharge and carries the unacceptable consequence of a longer stay in hospital.