Paper
Can Bottle-Feeding Really Mimic Breastfeeding?
Published Feb 1, 2007 · Roy E. Brown
Journal of Human Lactation
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Abstract
We tend to take for granted that the newborn infant must suck, swallow, and breathe all at the same time during feeding, and it has been demonstrated that there are clear differences in the dynamics of these activities during breastfeeding and bottle-feeding. In particular, studies have demonstrated that there is more disruption of breathing during bottle-feeding compared with breastfeeding, which may lead to a decrease in oxygen saturation. However, relatively few studies have examined the relationship between oxygenation and the dynamics of infant feeding during breastfeeding and bottle-feeding in healthy, full-term infants. This issue was examined in the spotlighted article. The objective of this prospective study was to compare the coordination of sucking, swallowing, and breathing during breastfeeding and bottle-feeding, and to explore the relationship between these processes and oxygen saturation. The authors hypothesized that the coordination among the 3 processes would be more stable (with less variability) if there were higher oxygenation and that a bottle-feeding system that more closely mimics breastfeeding would more likely promote a coordination pattern with lower variability. To examine these questions, the researchers developed instruments to measure intraoral sucking pressures while simultaneously recording swallowing, respiratory movements, and oxygen saturation. The authors then compared the following attributes during breastfeeding and bottle-feeding: the temporal relationship between sucking, swallowing, and breathing; the overall amount of swallowing; the variability of the swallowing pattern; oxygen saturation; and the relationship between oxygen saturation and the variability of swallowing. Mothers and infants were recruited at Beth Israel Deaconess Medical Center in Boston, Massachusetts. To be eligible for the study, mothers were required to exclusively breastfeed their infants for at least 4 to 6 weeks before using a bottle, while continuing to breastfeed. When they were ready to introduce an artificial nipple and bottle, each mother chose 1 of 2 bottle systems, either a Playtex bottle with a soft, collapsible liner and a NaturaLatch nipple (Platex Products Inc, Westport, Conn) or an Avent newborn nipple and bottle (Avent Ltd, London, United Kingdom). Regardless of the bottle that was chosen, all bottle-feeding was performed with expressed breast milk. Within 2 weeks of initiating supplemental bottle-feeding, mothers and infants came to the Children’s Hospital of Boston and instrumented recording of 3 to 4 minutes of sucking, swallowing, breathing, and oxygen saturation while breastfeeding and bottle-feeding were performed. All sensor signals were simultaneously recorded. To then examine the temporal relationship among sucking, swallowing, and breathing, 10 consecutive samples of 5 to 10 second periods of breastfeeding and bottle-feeding were extracted from the recorded feeding behavior, and the variables described above were assessed. After attrition, 36 healthy, full-term newborns were able to successfully complete both the transition from breast to bottle during a 4 to 6 week period and laboratory testing. As expected, the study results showed that swallowing occurred in a specific nonrandom pattern relative to sucking and breathing during breastfeeding in all infants. Swallowing was found to follow a similar pattern among infants using the Playtex system for bottlefeeding, whereas infants using the Avent system were found to swallow randomly. The study demonstrated that swallowing is segregated from breathing during breastfeeding. Based on their results, the authors hypothesized that the sucking Research Spotlight
A bottle-feeding system that more closely mimics breastfeeding can promote a more stable coordination pattern and higher oxygen saturation in infants.
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