137 Enhancing breastfeeding establishment in the NICU: A randomized clinical trial of two non-nutritive sucking approaches

Abstract

BACKGROUND: Infants who are born prematurely are at risk of developing several life‐threatening complications, such as necrotizing entercolotis, chronic lung disease and sepsis, which can be mediated by human milk nutrition. Despite these benefits, the incidence of breastfeeding in preterm infants is less than full‐term infants (1). The low breastfeeding rates are attributed to the unique challenges for attaining breastfeeding in preterm infants. Those born at less than 34 weeks gestation are developmentally unable to generate and coordinate sucking, swallowing, and breathing (1). Numerous clinical initiatives promote breastfeeding in preterm infants, but focus primarily on improving maternal education and support (2). Research strategies aimed at improving oral motor skills associated with breastfeeding in preterm infants are needed. OBJECTIVES: To assess if the early initiation of non‐nutritive sucking on an emptied breast is superior to pacifier in promoting more success with breastfeeding establishment in preterm infants. DESIGN/METHODS: Twenty‐three infants born at less than 34 weeks gestation, whose mother's intention was to breastfeed, were randomized to experimental or control groups. Infants were recruited from a level 2‐3 neonatal intensive care unit at Kingston Health Sciences Centre. Each group spent 10 minutes per day on the intervention until initiation of breastfeeding, either emptied breast (experimental) or pacifier while held in the mother's arms (control). Both interventions were initiated when infants were receiving respiratory support of continuous positive airway pressure (CPAP) 5 cm H2O and tolerating a minimum intake of 80ml/kg/day. The outcomes were method of feeding at discharge (exclusive breast, partial breast/bottle, or exclusive bottle), time to attainment of independent oral feeding, and length of hospital stay. RESULTS: A significantly greater number of infants in the experimental group received breastfeeding at their first oral feed attempt and sustained breastfeeding establishment at hospital discharge compared to those in the control group (Figure 1). There was no significant difference in time to attainment of independent oral feeding groups (12.8 ± 6.3 vs. 13.7 ± 5.4, p=0.57).and length of stay between groups (45.0 ± 36.1 vs. 52.8 ± 28.6, p= 0.58). CONCLUSION: Early non‐nutritive sucking on an emptied breast enhanced breastfeeding establishment at hospital discharge in preterm infants < 34 weeks gestation. These findings support the concept that development of breastfeeding skills is not only dependent on neurophysiological maturation but on early learning experiences.