Exploring the interaction of viscosity and nipple design on feeding performance in an infant pig model.

Infant feeding behaviors are modulated via sensorimotor feedback, such that sensory perturbations can significantly impact performance. Properties of the nipple and milk (e.g., nipple hole size and viscosity) are critical sources of sensory information. However, the direct effects of varying milk and nipple properties on infant motor output and the subsequent changes in feeding performance are poorly understood. In this study, we use an infant pig model to explore the interaction between nipple hole size and milk viscosity. Using high-speed videofluoroscopy and electromyography, we measured key performance metrics including sucks per swallow and suck duration, then synchronized these data with the onset and offset of activity of jaw opening and closing muscles. The combination of a small nipple hole and thick milk resulted in negative effects on both suck and swallow performance, with reduced feeding efficiency compared to the other treatments. It also appears that this combination of viscosity and hole size disrupts the coordination between correlates of tongue and jaw movements. We did not see a difference in feeding efficiency between viscosities when infants fed on the large-hole nipple, which may be the result of non-Newtonian fluid mechanics. Our results emphasize the importance of considering both fluid and nipple properties when considering alterations to an infant's feeding system.

Associations between early introduction to complementary foods, subsequent cereal-added bottle feeding and daily macronutrient intake among infants.

Introducing complementary foods early during infancy has been associated with an increased risk of overweight later in life, but the pathway is an understudied topic. Hence the study was conducted with low-income and primarily minority mother-infant dyads to: 1) understand how the introduction of complementary foods prior to 4 months was associated with socio-demographic characteristics and food security status; 2) determine the association between early introduction to complementary foods and breastfeeding and adding cereal into the bottle in later infancy (i.e., at 6 and 9 months), and; 3) examine how adding infant cereal into the bottle was related to daily calorie and macronutrient intake in infancy. We conducted interviews with mothers (n = 201) at 4 months of age and 24-h feeding recalls at age 6 and 9 months. Results indicated that 29% of the infants were fed complementary foods before 4 months of age. Introducing complementary foods early was negatively associated with breastfeeding and positively associated with adding cereal into the bottle at 6-months. This practice was more common among those who experienced marginal to very low levels of food security. Comparing by race/ethnicity, Latinx mothers were significantly less likely to introduce solids early. After controlling for sex, infants fed cereal in the bottle were consuming significantly more calories compared to their counterparts. Specifically, adding cereal into the bottle resulted in approximately 10% additional daily calorie intake among infants. Understanding how these feeding practices affect appetite development and weight status during infancy is warranted.

A Unique Clinical Tool for the Evaluation of Oral Feeding Skills in Infants.

Background. Occupational therapy practice for oral feeding assessment is based on clinical observation of infants' sucking, swallowing, and breathing ability, which is influenced by clinical experience and provides poor evidence on explanatory factors. Purpose. To test the clinical utility and safety of a nipple monitoring device for the quantitative evaluation of oral feeding skills. Method. Sixteen infants, with no severe medical complications, participated in a pre-experimental pilot study. Oral feeding performances (duration, intake volume, and rate of transfer), and occurrence of adverse events (apnea, bradycardia, and oxygen desaturations) were recorded to ensure the tool does not interfere with infant's feeding ability or does not create any adverse effects. Findings. There was no significant difference in duration, intake volume, rate of transfer between the two monitored sessions, and no occurrence in adverse events. Implications. The findings suggest that the nipple monitoring device may be used for quantitative assessment and intervention planning of oral feeding difficulties in infants.

Long-Term Safety and Efficacy of Prebiotic Enriched Infant Formula-A Randomized Controlled Trial.

The present study aims to evaluate the effects of an infant formula supplemented with a mixture of prebiotic short and long chain inulin-type oligosaccharides on health outcomes, safety and tolerance, as well as on fecal microbiota composition during the first year of life. In a prospective, multicenter, randomized, double-blind study, n = 160 healthy term infants under 4 months of age were randomized to receive either an infant formula enriched with 0.8 g/dL of Orafti®Synergy1 or an unsupplemented control formula until the age of 12 months. Growth, fever (>38 °C) and infections were regularly followed up by a pediatrician. Digestive symptoms, stool consistency as well as crying and sleeping patterns were recorded during one week each study month. Fecal microbiota and immunological biomarkers were determined from a subgroup of infants after 2, 6 and 12 months of life. The intention to treat (ITT) population consisted of n = 149 infants. Both formulae were well tolerated. Mean duration of infections was significantly lower in the prebiotic fed infants (p < 0.05). The prebiotic group showed higher Bifidobacterium counts at month 6 (p = 0.006), and higher proportions of Bifidobacterium in relation to total bacteria at month 2 and 6 (p = 0.042 and p = 0.013, respectively). Stools of infants receiving the prebiotic formula were softer (p < 0.05). Orafti®Synergy1 tended to beneficially impact total daily amount of crying (p = 0.0594). Supplementation with inulin-type prebiotic oligosaccharides during the first year of life beneficially modulates the infant gut microbiota towards higher Bifidobacterium levels at the first 6 months of life, and is associated with reduced duration of infections.

Growth performance comparison of exclusively breastfed infants with partially breastfed and formula fed infants.

BACKGROUND: Little consensus exists for growth performance of different feeding patterns in infancy. The objective of this study is to assess the growth performance of exclusively breastfed, partially breastfed and formula fed infants in China. METHODS: Data from a total of 109,052 infants aged 1-<12 months were collected from the 4th and 5th China National Surveys in 2005 and 2015. Feeding patterns were classified into three types for infants under 6 months of age: exclusive breastfeeding, partial breastfeeding and formula feeding. Exclusive breastfeeding refers to feeding exclusively from the mother's own milk (bottle-feeding included). RESULTS: 34.0% and 43.9% of infants were exclusively breastfed and 41.5% and 36.3% were partially breastfed at 4-<6 months in 2005 and 2015 respectively. Exclusively breastfed infants were generally a little heavier than partially breastfed and formula fed infants aged 1-<6 months; however, there was not a significant statistical difference between continued breastfeeding and formula feeding infants aged 6-<12 months. No significant statistical difference for length was observed among the three groups for ages 1-<6 months; however, infants who were continued to be breastfed were a little shorter compared to those who were formula fed (ages 6-<12 months). For infants aged 1-<2 months there was not a substantial difference from the 2006 WHO growth standards; however, for infants aged 2-<12 months the average weight and length of different feeding infants in China were a little heavier and longer than the 2006 WHO growth standards. CONCLUSIONS: Partial breastfed and formula fed infants were a little lighter than exclusively breastfed infants in the first half of the first year. Formula fed infants were a little longer than continued breastfed infants in the second half.

Establishing a Foundation for Optimal Feeding Outcomes in the NICU.

Many infants in the NICU experience difficulties with oral feeding, which contribute to prolonged length of stay. Oral feeding is a complex task involving sensorimotor functioning of the face, mouth, and larynx, as well as coordination of sucking, swallowing, and breathing. The care provided in the NICU starting at birth sets the stage for future oral feeding. The purpose of this article is to describe strategies that will establish a positive foundation to support optimal oral feeding. Nurses can use these strategies to protect newborns from noxious stimuli and promote positive auditory, tactile, gustatory, and olfactory experiences to optimize neurodevelopment for the complex task of feeding.

Appropriate Infant and Young Child Feeding Practices in an Emergency for Non-Breastfed Infants Under Six Months: The Rohingya Experience.

BACKGROUND: Since 25 August, 2017 over 693,000 Rohingya have been forced from Myanmar due to mass violence, seeking refuge in neighboring Bangladesh. Nutritional surveys during 2017 revealed worrying levels of malnutrition and poor infant feeding practices, including high numbers of infants not exclusively breastfeeding. Infants under 6 months who are not exclusively breastfed are particularly vulnerable to morbidity and mortality and require specialized feeding support, especially in emergency contexts. RESEARCH AIM: To describe Save the Children International's experiences supporting wet nursing, relactation, and artificial feeding for non-breastfed infants under 6 months in the Rohingya Response, Bangladesh. METHODS: A retrospective analysis was conducted of routine program data and documentation from Save the Children International's infant and young child feeding in emergencies interventions for the Rohingya Response, Bangladesh, from November 2017 to April 2018. The study population were infants under 6 months identified as not breastfed during the initial assessment (N = 15). RESULTS: Although wet nursing was attempted with all infants, it was successful with 6 (40%) of the infants. Additionally, 1 (6.7%) infant's mother was able to successfully relactate. The remaining infants ended up requiring feeding with human milk substitutes. CONCLUSION: Gaps exist in operational guidance to support non-breastfed infants with wet nursing and relactation in emergency settings, as well as on how to operationalize safe human milk substitute programming in line with national policies and regulations. There is an urgent need to address this gap to protect the lives of non-breastfed infants in emergencies worldwide.

Bottle-feeding an infant feeding modality: An integrative literature review.

Bottle-feeding is an infant feeding modality that has been in existence since ancient times, and currently, a significant number of infants are being fed via a bottle with either breastmilk or formula. Although research on bottle-feeding has continued, it exists in fragmented, often small studies that focus on singular aspects of feeding an infant using a bottle, with limited information on the bottle-feeding act. Systems theory was the approach used to define the act of bottle-feeding and identify the parts within this act. Health databases were searched using MeSH terms. A summary of the studies are included. The findings of this review revealed that healthy term bottle-feeding infants use similar tongue and jaw movements, can create suction and sequentially use teat compression to obtain milk, with minimal differences in oxygen saturation and SSB patterns, when compared with breastfeeding infants. Bottle and teat characteristics were revealed to affect infant feeding and milk intake. An infant's milk intake during feeding was shown to have a strong association with the interaction between the infant and parent/caregiver. With the issue of who controls the feed, mother or infant, likely to affect an infant's ability to self-regulate their milk intake. Redefining bottle-feeding as a holistic system identifies the interrelationship of the various parts which will improve the understanding of the reciprocal nature of infant feeding. To optimize bottle-feeding outcomes, further research is required on parents' and health professionals' knowledge and understanding of the parts within the act of bottle-feeding.

Healthcare Workers' Knowledge of HIV-Exposed Infant Feeding Options and Infant Feeding Counseling Practice in Northern Nigeria.

BACKGROUND: Despite the existence of evidence-based HIV-exposed infant feeding guidelines, infants in Africa still acquire HIV through inappropriate feeding practices. OBJECTIVE: To identify predictors of HIV-exposed infant feeding knowledge and counseling practice among health care workers (HCW) in Nigeria. METHODS: Structured, pretested questionnaires were administered to HCW (n=262) in a tertiary health facility in Kano, Nigeria. Multivariate logistic regression was used to determine predictors of HIV-exposed infant feeding knowledge and counseling practice. RESULTS: Of 262 respondents, (58.0%, n=152) had good knowledge of recommended feeding options. Respondents listed exclusive breastfeeding (57.6%, n=151), human milk substitutes (45.4%, n=119), HIV-negative wet-nursing (37.0%, n=97), heated expressed human milk (20.6%, n=54) and mixed feeding (13.4%, n=35) as appropriate feeding choices. Over half (57.3%, n=150) of the respondents have ever counseled a HIV-positive mother on infant feeding. Knowledge was predicted by female sex (Adjusted Odds Ratio (AOR)=2.47, 95% Confidence Interval (CI):1.35-4.52), profession (physician vs. laboratory scientist, AOR=4.00, 95%CI:1.25-12.87; nurse/midwife vs. laboratory scientist, AOR=2.75, 95%CI:1.17-9.28), infant feeding counseling training (AOR=3.27, 95%CI:1.87-5.71), and number of children (2-4 vs. 0, AOR=1.75, 95%CI:1.23-3.92). Infant feeding counseling was predicted by female sex (AOR=2.85, 95%CI:1.39-5.85), age (>40 vs. <30 years, AOR=3.87, 95%CI:1.27-15.65), knowledge of infant feeding options (good vs. fair/poor, AOR=3.96, 95%CI:2.07-7.59), training (AOR=2.60, 95%CI:1.42-5.32), and profession (physician vs. laboratory scientist, AOR=10.7, 95%CI:2.85-40.54; nurse/midwife vs. laboratory scientist, AOR=4.8, 95%CI:1.26-18.02). CONCLUSION: The practice of infant feeding counseling among HCW in Nigeria is associated with sex, knowledge, and profession. Our findings may inform the development of targeted training programs for HCW in similar settings.

Origins of human milk microbiota: new evidence and arising questions.

Human milk contains a diverse community of bacteria. The growing appreciation of commensal microbes and increasing availability of high-throughput technology has set the stage for a theory-driven approach to the study of milk microbiota, and translation of this knowledge to improve maternal and child health. We recently profiled the milk microbiota of healthy Canadian mothers and applied theory-driven causal modeling, finding that mode of breast milk feeding (nursing directly at the breast vs. pumping and feeding breast milk from a bottle) was significantly associated with milk microbiota composition. This observation could reflect an increased exposure to pumps and/or a decreased exposure to the infant mouth. Either way, it provides evidence for the retrograde mechanism of milk inoculation. Here, we discuss the implications of this research and related controversies, and raise new questions about the origins and function of milk bacteria.

Desempenho da alimentação de neonatos com bico ortodôntico, bico convencional e copo / Feeding performance of neonates with orthodontic nozzle, conventional nozzle and cup

Introdução: O aleitamento materno exclusivo é preconizado até os seis meses de vida, mas algumas situações exigem o uso de utensílios para oferta do leite. O objetivo deste estudo é comparar o desempenho dos neonatos com bico ortodôntico e bico convencional de mamadeira, e com o copo. Metodologia: Foram incluídos 63 neonatos que ainda não tinham prescrição de alimentação por via oral. Os neonatos foram avaliados através da aplicação do protocolo Avaliação da habilidade para alimentação oral (Lau e Smith, 2011) com os três utensílios, em momentos diferentes. Os resultados foram analisados através do Teste Equações de Estimações Generalizadas e Teste de Friedman. Resultados: A maioria dos neonatos eram pretermos (n = 58; 92,06%), do sexo masculino (n = 36; 57,14%) e baixo peso ao nascer (n = 25; 39,68%). Foi identificado maior número de episódios de náusea com o bico convencional (p=0,049), e escape extraoral de leite (p=0,000) e aumento no peso da compressa após a oferta com o copo (p=0,000). A proficiência e a taxa de transferência foram maiores com o bico convencional (p=0,022 e p=0,016, respectivamente). Conclusão: Eventos adversos durante a alimentação por via oral ocorrem mais com o copo e com o bico convencional. Os neonatos ingerem maior volume em menos tempo com o bico convencional, mas não presentam melhor desempenho. (AU)

Oxygen saturation and heart rate in premature: comparison between cup and finger feeding techniques. / Saturação de oxigênio e frequência cardíaca em prematuros: comparação entre as técnicas de copo e sonda-dedo.

PURPOSE: To evaluate the oxygen saturation, heart rate, length of hospital stay and weight preterm infants or preterm newborns (PTNBs) (in the Neonatal Intensive Care Unit in the diet supply by cup and finger feeding techniques, simultaneously with breastfeeding. METHODS: Simultaneous randomized clinical trial. Twenty-five preterm infants admitted to the Neonatal Intensive Care Unit of the Public Hospital from October 2011 to February 2012 were selected. The sample was divided into two groups: Eight preterm infants who received the diet in the cup probe group (CPG) who were born on the same day, and 17 by finger probe group (FPG) who were born on the odd day. In the diet offer, the minimum and maximum values of oxygen saturation (O2 Sat) and heart rate (HR) were recorded: before offering the diet, during and after the offer. RESULTS: Regarding the variables O2 Sat and HR, no statistically significant differences were observed between the groups, but in the group vs time factor, the groups showed differences, not continuous in the O2 Sat variable. Regarding weight, a statistically significant gain was observed for both groups, and in CPG the highest weight gain was due to the longer hospitalization time. It was verified that FPG presented shorter hospitalization time. CONCLUSION: There were no differences regarding O2 Sat and HR. However, when analyzing the time factor, the groups presented some differences, not continuous, indicating the need for other studies for a better understanding of the effect. The FPG presented shorter hospitalization time and the CPG infants had greater weight gain due to longer hospitalization time.

OBJETIVO: Avaliar a saturação de oxigênio (SatO2), a frequência cardíaca (FC), o tempo de internação e o peso dos recém-nascidos pré-termos (RNPTs) em Unidade de Terapia Intensiva Neonatal, na oferta de dieta pelas técnicas de alimentação via copo e sonda-dedo, simultaneamente ao aleitamento materno. MÉTODO: Ensaio clínico randomizado simultâneo. Foram selecionados 25 prematuros internados na Unidade de Terapia Intensiva Neonatal de hospital público, no período de outubro de 2011 a fevereiro de 2012. A amostra foi dividida em dois grupos: 8 prematuros nascidos em dia par, que receberam a dieta no copo (GCP) e 17 prematuros, nascidos em dia ímpar, que receberam a dieta pela sonda-dedo (GSD). Na oferta da dieta foram anotados os valores mínimos e máximos da SatO2 e FC, antes de oferecer a dieta, durante e após a oferta. RESULTADOS: Quanto às variáveis SatO2 e FC, não foram observadas diferenças estatisticamente significativas entre os grupos, mas, no fator grupo versus tempo, os grupos apresentaram diferenças, não contínuas na variável SatO2. Em relação ao peso, foi constatado ganho estatisticamente significativo para ambos os grupos, sendo que, no GCP, o maior ganho de peso foi por causa do maior tempo de internação. Foi verificado que o GSD apresentou menor tempo de internação. CONCLUSÃO: Não houve diferenças quanto à SatO2 e FC. Contudo, ao se analisar o fator tempo, os grupos apresentaram algumas diferenças, não contínuas, o que indica a necessidade de outros estudos para melhor compreensão do efeito. O GSD apresentou menos tempo de internação e os RNPTs do GCP tiveram maior ganho de peso em razão do maior tempo de internação.

Risks of maternal prepregnancy overweight/obesity, excessive gestational weight gain, and bottle-feeding in infancy rapid weight gain: evidence from a cohort study in China.

Rapid weight gain (RWG) in infants is associated with numerous health problems, and its risk factors are still unclear. We assessed 98,097 maternal-infant pairs from a population-based cohort study and followed up with them until the infants were 6 months old. We assessed the associations between maternal prepregnancy weight status; gestational weight gain; feeding pattern; and infants' RWG at 0-1, 0-3, 1-3, and 3-6 months using multivariate unconditional logistic regression models, with controlled confounders. We found that maternal prepregnancy weight status, gestational weight gain, and feeding pattern at the 1st, 3rd, and 6th months had significant impacts on the infants' RWG at each time period (P<0.05). Infants with overweight/obese mothers had a higher risk of RWG after birth, whereas those of mothers who experienced excessive gestational weight gain had higher risks of RWG from birth than the other groups (P<0.01). Infants who were formula-fed had a higher risk of RWG than breastfed infants at the same time point (P<0.01). In conclusion, maternal prepregnancy obesity, excessive gestational weight gain, and formula-feeding were risk factors for infants' RWG during the first 6 months of life.

Differences in Current Procedures for Handling of Expressed Mother's Milk in Danish Neonatal Care Units.

BACKGROUND: Mother's own milk (MOM) is preferred when feeding preterm infants. When expressed mother's milk is stored and handled, there is a risk of bacterial contamination, decreased immunological activity, and less nutritional potential. PURPOSE: The aim of this study was to investigate current routines when handling MOM in Danish neonatal intensive care units (NICUs). METHODS: A survey was sent to all 17 NICUs in Denmark in which current practices regarding human milk handling, storage, and preparation were evaluated. Furthermore, one question sought to establish when mother's milk was believed to be colostrum. Respondents of the survey were neonatal nurses. RESULTS: All 17 units responded to the survey. Only 5 of 17 units answered that human colostrum was defined as milk from the first week after birth. Refrigerator storage time varied between 24 and 72 hours. In 6 of 17 units, parents were in charge of mixing milk and fortifier. Heating of human milk was done by using microwave ovens in 4 of 17 of the units. IMPLICATIONS FOR PRACTICE: This national survey established that there is significant variability in the way mother's milk is handled. Some of the procedures performed may affect the quality of the milk. It is important to implement evidence-based practice regarding storage and handling of expressed mother's milk to ensure that the quality of the milk is the best possible alternative for all preterm infants. IMPLICATIONS FOR RESEARCH: Prospective studies are needed to examine the association between handling of human milk and changes in composition and nutritional potential of the milk.

Predictors of Mother's Own Milk Feeding at Discharge in Preterm Infants.

BACKGROUND: The dose-response benefits of human milk for preterm infants are well documented. Understanding factors that influence duration of mother's own milk (MOM) receipt may have important clinical implications. PURPOSE: To identify variables that significantly affect whether or not preterm infants receive their own mother's milk at discharge. METHODS: Maternal-infant dyads were eligible for inclusion if the infant was born between August 1, 2010, and July 31, 2015, was born at 32 weeks' gestation or less, or was 1800 g or less (institutional donor milk receipt criteria). Bivariate and multivariable regression analyses were performed. RESULTS: Of 428 observations, 258 (60.3%) received MOM at discharge and 170 (39.7%) did not. Maternal characteristics that were protective for MOM receipt at discharge were non-Hispanic race, married, partner support, more educated, and private insurance. Protective infant characteristics were higher gestational age at birth, higher percentage of MOM feedings, fewer ventilator days, and more days of direct lactation. In multivariable logistic regression, the odds of receiving MOM at discharge significantly (odds ratio = 1.93; 95% confidence interval, 1.72-2.16; P < .001) increased with the increasing proportion of MOM. Regression analysis showed that gestational age and increased maternal age increased the likelihood of MOM receipt at discharge. IMPLICATIONS FOR PRACTICE: Clinicians will understand the significant effects even small increases in milk volume have on duration of MOM receipt at discharge, informing them of the importance of strategies to encourage and improve milk expression. IMPLICATIONS FOR RESEARCH: Future research studying critical time periods when mothers are most likely to reduce milk expression may have significant clinical importance.

A prospective study of maternal postnatal depressive symptoms with infant-feeding practices in a Chinese birth cohort.

BACKGROUND: The first few weeks after childbirth are critical, as women may encounter lactation problems and postpartum depression during this period. However, it is still unclear whether early breastfeeding behaviours are related to the symptoms of postnatal depression (PND) in Chinese populations. Therefore, the current study aimed to investigate the association between symptoms of PND and infant feeding practices based on a large-scale Chinese cohort. METHODS: A prospective study of the community-based cohort was conducted from January 2015 to December 2016. Infant feeding outcomes, including exclusive/partial breastfeeding and formula feeding, were assessed according to the WHO guidelines. Symptoms of PND were assessed by the Edinburgh Postnatal Depression Scale at 4 weeks postpartum. Multivariate generalized estimating equation models were applied to investigate the associations between depressive symptoms and infant feeding behaviours. RESULTS: A total of 956 mother-infant pairs were included. Fifty-six mothers presented screen-positive symptoms of PND with a cut-off ≥10. The percentage of early breastfeeding initiation was 75.8%, while the average duration of exclusive breastfeeding was 3.90 ± 2.33 months. Postnatal depressive symptoms were associated with a shorter breastfeeding duration (8.02 vs. 6.32 months, P < 0.05) and earlier formula introduction (4.98 vs. 3.60 months, P < 0.05). After adjustments were made for covariates, postnatal depressive symptoms were associated with an increased risk of the discontinuation of exclusive and partial breastfeeding (ß = - 0.049, P = 0.047 and ß = - 0.082, P = 0.006, respectively). Compared to mothers without symptoms of PND, mothers with depressive symptoms were more likely to supplement formula for their infants in the first year of life (ß =0.074, P = 0.016). These associations were still significant in the sensitivity analyses, using an EPDS cut-off of ≥13. CONCLUSIONS: Our findings indicate that depressive symptoms at 4 weeks postpartum are associated with the cessation of exclusive and partial breastfeeding duration and the introduction of formula in the 12 months of delivery. Early psychosocial assessment and social support should be offered to mothers in the early postpartum period to indirectly prevent adverse breastfeeding outcomes.

Quantifying the Impact of Common Feeding Interventions on Nutritive Sucking Performance Using a Commercially Available Smart Bottle.

An estimated 25% to 40% of infants experience difficulties with learning to breast- or bottle-feed. Yet, guidelines and evidence-based support for common feeding practices are limited. The objective of this case report was to quantify the impact of feeding interventions on nutritive sucking performance after discharge in an outpatient setting. This observational case series involved 2 infants. To determine the impact of cumulative interventions, pre- and postintervention effect sizes were calculated. Sucking performance metrics of interest included nipple movement peak sucking amplitude, duration, frequency, and smoothness. Interventions included positional changes and changes in nipple flow rate, among others. For both infants, cumulative interventions had the greatest impact on suck frequency; postintervention, infants were able to increase their rate of nutritive sucking per burst. Other aspects of sucking performance were differentially impacted for each baby. Researchers agree that neonatal and infant feeding has been understudied and that the evidence for common interventions needs to be strengthened. We have demonstrated the implementation of readily available technology that can be used to quantify the direct impact of any intervention on actual sucking performance. In doing so, we can individualize care to support skill development and improve outcomes for infants at risk for ongoing feeding challenges.

Minimizing the Relationship Between Early Formula Use and Breastfeeding Cessation by Limiting Formula Volume.

Objective: Early exposure to formula can interfere with successful long-term breastfeeding. The objective of this study was to determine whether limiting the volume of formula used in the first month attenuates formula's detrimental impact on long-term breastfeeding success. Materials and Methods: Using detailed data on dietary intake from a randomized clinical trial, we conducted a secondary analysis of the association between volume of formula received in the first month and breastfeeding cessation before 6 and 12 months of age. We used descriptive statistics and multivariable logistic regression, respectively, to explore this association without and with adjustment for demographic and clinical predictors of infant feeding. Results: Among 199 breastfeeding infants, 80 (40%) received formula daily at 1 month of age, and breastfeeding cessation before 6 and 12 months of age was higher for these infants (46% and 67%) than for those breastfed exclusively (6% and 27%) (p < 0.0005 for each). The risk of cessation did not differ between those who received ≤4 fl oz daily in the first month (11%) and those who did not receive formula in the first month (6%) (p = 0.42). Adjusting for gestational age, race/ethnicity, income, and intention to breastfeed exclusively, the odds ratio for the outcome of cessation before 6 months was 1.15 (95% confidence interval = 0.20-6.67) for infants who received ≤4 fl oz daily compared with those who breastfed exclusively. Conclusion: Limiting formula volumes to ≤4 fl oz daily may attenuate the deleterious association between early formula use and subsequent successful breastfeeding.