title: Does the choice of bottle nipple affect the oral feeding performance of very-low-birthweight (VLBW) infants?
abstract: BACKGROUND
  There is a continuous debate regarding the best bottle nipple to be used to enhance the bottle-feeding performance of a preterm infant.
  
  
  OBJECTIVE
  To verify that feeding performance can be improved by using the bottle nipple with the physical characteristics that enhance infants' sucking skills.
  
  
  METHODS
  Ten "healthy" VLBW infants (941+/-273 g) were recruited. Feeding performance was monitored at two time periods, when taking 1-2 and 6-8 oral feedings/d. At each time and within 24 h, performance was monitored using three different bottle nipples offered in a randomized order. Rate of milk transfer (ml/min) was the primary outcome measure. The sucking skills monitored comprised stage of sucking, suction amplitude, and duration of the generated negative intraoral suction pressure.
  
  
  RESULTS
  At both times, infants demonstrated a similar rate of milk transfer among all three nipples. However, the stage of sucking, suction amplitude, and duration of the generated suction were significantly different between nipples at 1-2, but not 6-8 oral feedings/d.
  
  
  CONCLUSIONS
  We did not identify a particular bottle nipple that enhanced bottle feeding in healthy VLBW infants. Based on the notion that afferent sensory feedback may allow infants to adapt to changing conditions, we speculate that infants can modify their sucking skills in order to maintain a rate of milk transfer that is appropriate with the level of suck-swallow-breathe coordination achieved at a particular time. Therefore, it is proposed that caretakers should be more concerned over monitoring the coordination of suck-swallow-breathe than over the selection of bottle nipples.
authors.affiliation: Department of Pediatrics, Section of Neonatology, Baylor College of Medicine, Houston, TX 77030, and Division of Neonatal-Perinatal Medicine, Schneider Children's Hospital at North Shore, Manhasset, NY, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Scheel
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schanler
authors.forename: Chantal
authors.initials: C
authors.lastname: Lau
mesh_terms: D001835:Body Weight; D001903:Bottle Feeding / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D008297:Male; D013391:Sucking Behavior / Q000502:physiology*; D013997:Time Factors; D016896:Treatment Outcome