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Physiological Responses of Preterm Infants to Breast-Feeding and Bottle-Feeding with the Orthodontic Nipple

Dowling, Donna A.


Background: Although the orthodontic nipple has been recommended for many years to supplement breast-feeding infants, it is not known if this nipple is suitable for hospitalized preterm infants whose mothers wish to breast-feed.

Objectives: To describe and compare short-term physiologic responses of preterm infants serving as their own controls for two feeding methods, breast-feeding and bottle-feeding with the orthodontic nipple.

Method: The sample consisted of eight preterm infants, mean birth weight of 1,370 grams and mean gestational age at birth of 30.2 weeks' gestation, who served as their own controls for breast- and bottle-feeding sessions. The dependent variables, sucking, breathing, and oxygen saturation, were measured noninvasively throughout breast- and bottle-feeding sessions and recorded on a polygraph. Data were analyzed quantitatively and qualitatively for 14 breast-feeding sessions and 15 bottle-feeding sessions.

Results: Statistically significant differences were found in that infants breathed more during sucking bursts for breast-feeding sessions when compared to bottle-feeding sessions and had fewer episodes of oxygen desaturation during breast-feeding. A characteristic sucking waveform associated with organized breathing was observed for some infants during bottle-feeding with the orthodontic nipple.

Conclusions: These data suggest that the orthodontic nipple is appropriate for supplementing breast-feeding for some preterm infants. Further research is needed to examine longterm outcomes.

Donna A. Dowling, PhD, RN, is an Assistant Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH.

Accepted for publication March 16, 1998.

This research was funded in part from a grant from the National Institute of Nursing Research (NRSA #NRO6667). The author gratefully acknowledges the support of Richard Martin, MD and Mrs. Juliann DiFiore, BSEE during the data collection phase of this study, and Paula P. Meier, DNSc, FAAN and Janet L. Engstrom, PhD, RN for their guidance throughout this study.

Address reprint requests to Donna A. Dowling, PhD, RN, Frances Payne Bolton School of Nursing, Case Western University, 10900 Euclid Ave., Cleveland, OH 44106; e-mail:

© 1999 Lippincott Williams & Wilkins, Inc.