PHYSIOLOGIC RESPONSE OF THE PRETERM INFANT DURING THE EARLY INITIATION OF BREASTFEEDING VERSUS BOTTLEFEEDING.

Description

The clinical assumption that breastfeeding, in comparison to bottlefeeding, places an increased demand for energy on the preterm infant has not been substantiated in the literature. This study tested the hypothesis, the physiologic response of pulse oximetry measurement will not be significantly different during the early initiation of breastfeeding versus bottlefeeding in the small PTI. The convenience sample consisted of 10 preterm infants hospitalized in a neonatal intensive care unit, whose mothers planned to breastfeed. Following recruitment the mothers were loaned an electric breast pump and had frequent contacts with the investigator while maintaining their milk supply prior to initiating actual breastfeeding. The infants' mean age at birth was 30.3 weeks (SD = 1.418, range = 27-32 weeks) with a mean birth weight of 1431.5 grams (SD = 247.353, range 975-1750 grams). Four were female and six were male. Four infants were delivered vaginally and six by cesarean section. Seven of the infants were ventilator dependent in the first 24 hours of life. The methodology involved an alternating treatment, repeated measures design. Each infant was observed for a total of 6 feedings, 3 breastfeedings and 3 bottlefeedings, during the first two weeks of suckled feedings. For purposes of this study, breastfeeding was initiated within 48 hours of the initial order to bottlefeed. Infants were monitored for pulse oximetry, heart rate, and skin temperature during prefeeding, feeding, and postfeeding periods. Behavioral state was assessed before and after the feedings using the Anderson Behavioral State Scale. In addition, the infants were weighed before and after the feedings. The hypothesis was supported. No statistically significant differences were found in pulse oximetry measurements when feedings were analyzed using a repeated measures ANOVA. In addition, there was no significant difference found in mean heart rate between feeding conditions. Analysis of infant temperature demonstrated a significant interaction effect between time periods and methods (F = 14.252, df 2,18, p = 0.0044). Further analysis demonstrated a significant difference from prefeeding to feeding, and prefeeding to postfeeding periods during breastfeedings. Mean infant behavioral state decreased significantly from prefeeding to postfeeding periods (F = 23.301, df 1,9, p $<$ 0.001). In summary, the findings suggest that early breastfeeding does not place an increased demand for energy on the preterm infant. It appears that breastfeeding keeps PTI's warmer during and immediately after breastfeeding. Finally, these preterm infants engaged in nutritive sucking during the early initiation of breastfeeding. The current practice of delaying breastfeeding based on the assumption of physiologic destabilization is not supported by this research.

Subjects