Food transition of premature infants admitted to the Kangaroo Unit: systematic review

Tavares, Ana Raquel Bezerra Saraiva; Silva, Vanusa Maria Gomes Napoleão; Domingos, João Emanuel Pereira; Saraiva, Emanuela Machado Silva; Chaves, Edna Maria Camelo

doi:10.37689/acta-ape/2024AO00010122

Acessibilidade / Reportar erro

Brasil

Acta Paulista de Enfermagem

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Review Article • Acta Paul Enferm 37 • 2024 • https://doi.org/10.37689/acta-ape/2024AO00010122 copy

Food transition of premature infants admitted to the Kangaroo Unit: systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze the available evidence on the transition from orogastric tube feeding to breastfeeding directly from the breast with premature infants admitted to hospital units.

Methods

Systematic literature review with search in the following databases: PubMed/MEDLINE, Web of Science, EMBASE, Scopus, Cochrane CENTRAL, CINAHL, with the inclusion criteria: experimental studies, without temporal restrictions and in Portuguese, Spanish and English. The methodological assessment was carried out using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Revised Cochrane risk-of-bias tool for randomized trials (RoB 2.0) tools and consisted of two stages: methodological quality and the risk of bias of the studies.

Results

10 papers were identified, all randomized clinical trials. The techniques used in transitioning the premature babies’ diet were: finger tube and syringe, cup and finger tube, cup and bottle, spoon and non-nutritive sucking, non-nutritive sucking, non-nutritive sucking and oral stimulation, behavior of premature babies, and smell of breast milk.

Conclusion

The demonstrated techniques allowed the transition of the diet in a shorter period, reducing the length of hospital stay, increasing weight gain 1and proved to be safe, as long as the premature baby is mature enough to undergo the procedure. However, bottle feeding was not recommended due to the occurrence of episodes of desaturation, increased heart rate and nipple confusion. Systematic review registration number: CRD42021240725 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=240725)

Breast feeding; Feeding methods; Infant, premature; Kangaroo-mother care method


#1	“breast feeding” [MeSH Terms] OR “Breast Milk Expression” [Text Word] OR “Breast Feeding, Exclusive +” [Text Word] OR “Exclusive Breast Feeding” [Text Word] OR “Breastfeeding, Exclusive +” [Text Word]
#2	“Infant, Premature” [MeSH Terms] OR “infant, extremely premature” [Text Word] OR “infant, newborn+” [Text Word] OR “infant, low birth weight” [Text Word] OR “infant, small for gestational age+” [Text Word]
#3	“Kangaroo-Mother Care Method” [MeSH Terms] OR Care Method, Kangaroo-Mother [MeSH Terms] OR “Kangaroo Mother Care Method” [Text Word] OR” Methods, Kangaroo-Mother Care” [Text Word]
#4	“Feeding Behavior” [MeSH Terms] OR “Bottle Feeding” [MeSH Terms] OR “Breast Feeding” [Text Word] OR” Breast Milk Expression” [Text Word] OR “Translactation” OR “Relactation”
#5	“randomized controlled trial” [Publication Type] OR “controlled clinical trial” [Publication Type] OR “random allocation” [MeSH Terms] OR “double blind method” [MeSH Terms] OR single blind method [MeSH Terms] OR “clinical trial” [Publication Type] OR single* [Text Word] OR double* [Text Word] OR treble* [Text Word] OR triple* [Text Word] random* [Text Word]
Equation 1	#1 AND #2 AND #3 AND #4 AND #5 “breast feeding” [MeSH Terms] OR “breast milk expression” [Text Word] OR “breast feeding, exclusive +” [Text Word] OR “exclusive breast feeding” [Text Word] OR “breastfeeding, exclusive +” [Text Word] AND “infant, premature” [MeSH Terms] OR “infant, extremely premature” [Text Word] OR “infant, newborn+” [Text Word] OR “infant, low birth weight” [Text Word] OR “infant, small for gestational age+” [Text Word] AND “kangaroo-mother care method” [MeSH Terms] OR “care method, kangaroo-mother” [MeSH Terms] OR “kangaroo mother care method” [Text Word] OR” methods, kangaroo-mother care” [Text Word] AND “feeding behavior” [MeSH Terms] OR “bottle feeding” [MeSH Terms] OR “breast feeding” [Text Word] OR “breast milk expression” [Text Word] OR “translactation” OR “relactation” AND “randomized controlled trial” [Publication Type] OR “controlled clinical trial” [Publication Type] OR “random allocation” [MeSH Terms] OR “double blind method” [MeSH Terms] OR “single blind method” [MeSH Terms] OR “clinical trial” [Publication Type] OR single* [Text Word] OR double* [Text Word] OR treble* [Text Word] OR triple* [Text Word] random* [Text Word]”.	TOTAL 26
Equation 2	#1 AND #2 AND #3 AND #4 “breast feeding” [MeSH Terms] OR “breast milk expression” [Text Word] OR “breast feeding, exclusive +” [Text Word] OR “exclusive breast feeding” [Text Word] OR “breastfeeding, exclusive +” [Text Word] AND “infant, premature” [MeSH Terms] OR “infant, extremely premature” [Text Word] OR “infant, newborn+” [Text Word] OR “infant, low birth weight” [Text Word] OR “infant, small for gestational age+” [Text Word] AND “kangaroo-mother care method” [MeSH Terms] OR “care method, kangaroo-mother” [MeSH Terms] OR “kangaroo mother care method” [Text Word] OR “methods, kangaroo-mother care” [Text Word] AND “feeding behavior” [MeSH Terms] OR “bottle feeding” [MeSH Terms] OR “breast feeding” [Text Word] OR “breast milk expression” [Text Word] OR “translactation” OR “relactation”.	170
Equation 3	#2 AND #4 AND #5 “infant, premature” [MeSH Terms] OR “infant, extremely premature” [Text Word] OR “infant, newborn+” [Text Word] OR “infant, low birth weight” [Text Word] OR “infant, small for gestational age+” [Text Word] AND “feeding behavior” [MeSH Terms] OR “bottle feeding” [MeSH Terms] OR “breast feeding” [Text Word] OR “breast milk expression” [Text Word] OR “translactation” OR “relactation” AND “randomized controlled trial” [Publication Type] OR “controlled clinical trial” [Publication Type] OR “random allocation” [MeSH Terms] OR “double blind method” [MeSH Terms] OR “single blind method” [MeSH Terms] OR “clinical trial” [Publication Type] OR single* [Text Word] OR double* [Text Word] OR treble* [Text Word] OR triple* [Text Word] random* [Text Word].	TOTAL 1448
Sum of the results of the equations	RESULTS OF EQUATION 1 + RESULTS OF EQUATION 2 + RESULTS OF EQUATION 3=	1644

Author Year Journal Country Inpatient unit	Objective	Used Technic Intervention and control Group	Age	Results
Marinelli, K. A et al⁽¹²⁾ 2001 Nature- Journal of Perinatology USA ICU	To compare the safety of cup feeding, an alternative feeding method, with bottle feeding, the current standard of artificial feeding in the USA, in premature infants whose mothers intend to breastfeed.	Cup and bottle The order of the first two oral feedings off the breast was randomized to a cup and a bottle. GI= 25 babies (cup) GC= 25 babies (bottle)	≤ 34 corrected gestation weeks	HR (p<0.0001) and RR (p<0.0001) increased and SatO2 decreased (p=0.0002) during cup and bottle feeding compared to pre-feeding baselines. The fraction of SatO2 <90% during baseline was different between these two methods (p=0.02). There was a 10-fold increase in desaturations <90% during bottle feeding. Comparing periods of cup and bottle feeding, HR were higher (p=0.009) and SatO2 lower (p=0.02) during bottle feeding. There were no differences between methods in RR, choking, spitting or apnea and bradycardia. The volumes removed were smaller (p=0.001) and the duration of feedings was longer (p=0.002) in the cup group.
Rocha, N. M. N et al⁽¹³⁾ 2002 J Hum Lact Brazil ICU	Examine the impact of cup or bottle feeding on weight gain, oxygen saturation, and breastfeeding rates in premature infants.	Cup and bottle The babies were divided according to 3 birth weights: 500 g to 999 g, 1000 g to 1499 g and 1500 g to 1699 g, and were randomly assigned to one of the feeding groups. GI= 44 babies for the cup; GC=34 babies to the bottle.	Postconceptional age ranged from 35 to 44 weeks in the bottle group (CG) and from 34 to 42 weeks in the cup group (GI).	At the beginning of oral feeding, post-conceptional age and weight were 37.2 ± 2.2 weeks and 1676 ± 83 g for the bottle-feeding group (CG) and 37.0 ± 1.6 weeks and 1637 ± 40 g for the GI. No significant differences were found between the groups in relation to time spent eating, feeding problems, weight gain or prevalence of breastfeeding at discharge or at the 3rd month of follow-up. When feeding with a cup, the incidence of desaturation episodes was lower (13.6% vs 35.3%, GI vs CG, P = 0.024) and the prevalence of breastfeeding at the 3rd month was higher among those who were still breastfeeding at the first follow-up appointment (68.4% vs 33.3%, GI vs CG, P = 0.04).
Puckett, B. et al⁽¹⁴⁾ 2008 Am J Perinatol Canada ICU	To determine whether an unscheduled feeding protocol led infants to alter behavior during feeding and, as such, whether feeding based on behavioral assessment would result in decreased hospital stay.	Behavior of premature babies The intervention group received gavage feeding, which was discontinued at study entry and began to be fed orally; The control group was fed with an initial combination of scheduled gavage and bottle feeding and then on demand. GI=39 GC=40	Postconceptual age (PCA) of 32 weeks	There was no difference between groups in average weight gain; in the control group the average weight gain was 12.5 g/kg/day and in the intervention group 12.1 g/kg/day (p = 0.83). The average length of stay in the control group of 14.5 days was significantly longer than the 10.0 days in the intervention group (p = 0.009). The average total number of adverse events in the control group (12.5 events) was significantly higher than in the intervention group (3.5 events; p= 0.007). The average post-conceptual age at study entry was 34.4 weeks in both groups and at exit 36.5 weeks in the control group and 35.8 weeks in the intervention group, a significant difference (p = 0.02) . The intervention group showed 2.8 behavior/eating.
Kumar, A et al⁽¹⁵⁾ 2010 Nature - Journal of Perinatology India Intermediate Care Unit	To evaluate the suitability and feasibility of spoon feeding in terms of physical growth and transition to breastfeeding in low birth weight (LBW) newborns discharged early from hospital.	Non-nutritive spooning and sucking (SNN) Trial I, infants were gradually transitioned from nasogastric feeding and spoon feeding to breastfeeding in the hospital. In Trial II, babies transitioned from spoon feeding to BF in the hospital and at home. GI: 79 newborns; GC: 65 newborns.	Gestational age ≥ 32 weeks to ≤ 36 weeks corrected age.	The average weight gain in Trial I was 4.72 (4.68) g kg-1 per day in the NG-feeding group and 4.47 (3.14) g kg-1 per day in the spoon-feeding group ( P = 0.8836). Similarly, spoon-fed infants gained 7.06 (4.26) g kg-1 per day in the hospital group, while they gained 7.56 (3.31) g kg-1 per day in the home group (P = 0 .5984) during the 28-day study period. After randomization, the transition time to BF was 12.31 (3.32) days and 14.39 (4.10) days (P = 0.0201) in Trial I, while 3.55 days and 9 .81 days (P = 0.0000) in Trial II in the two groups, respectively. In Trial II, the average duration of hospital stay was 14.58 (2.83) days in the hospital group and 10.19 (2.26) days in the home group (P = 0.0000).
Yildiz, A. et al⁽¹⁶⁾ 2011 Journal of Nursing Scholarship, Turkiye ICU	To investigate the effect of applying the smell of breast milk to premature infants during gavage feeding in the transition period to full oral feeding.	Smell of breast milk soaked in gauze during gavage. GI= 40 infants; GC= 40 infants.	Born after the 28th or before the 34th week of gestation.	The results indicated that premature babies who were stimulated by the odor of breast milk during gavage feeding achieved oral feeding 3 days earlier than controls. Furthermore, the average length of stay for these infants was 4 days shorter.
Yilmaz, G. et al⁽¹⁷⁾ 2014 Journal of Human Lactation Turkiye ICU	To determine the effect of bottle and cup feeding on breastfeeding rates in late preterm infants 32 to 35 weeks during their hospital stay, as well as at discharge and at 3 and 6 months later.	Cup and bottle GI=254 cup fed; GC=268 bottle-fed.	32 to 35 weeks	Infants randomized to cup versus bottle were more likely to be exclusively breastfed at discharge and at home (relative risk [RR], 1.58; 95% confidence interval [CI], 1.36-1.83), 3 months after discharge (RR, 1.64; 95% CI, 1.42-1.89), and 6 months after discharge (RR, 1.36; 95% CI, 1.14-1.63). The average hospital stay was 25.96 ± 2.20 days in the bottle group and 25.68 ± 2.22 days in the cup group. There was no significant difference between groups for time spent eating, feeding problems or weight gain in hospital.
Zhang, Y. et al⁽¹⁸⁾ 2014 Neonatal Intensive Care China ICU	To compare and evaluate the effectiveness of non-nutritive sucking (NNS) and oral stimulation (EO), applied alone or in combination, to improve oral feeding in premature newborns.	Non-nutritive sucking (NNS) (pacifier) and oral stimulation (EO) One hundred and twelve preterm infants were divided into three intervention groups (SNN, EO and SNN + EO combined) and a control group. 28 babies per group.	Born between 29 and 34 weeks of GA	The transition time was reduced in the three intervention groups compared to the control group (p< 0.001). The milk transfer rate in the three intervention groups was higher than in the control group (F3,363=15.37; p<0.001). The proficiency in the SNN and EO groups did not exceed that of the control group, while the proficiency in the SNN + EO group was higher than that in the control group at the stage in which the infants started oral feeding (p=0.035). Among all groups, no significant difference was found in weight gain and length of stay.
Unal, S. et al⁽¹⁹⁾ 2019 Nutrition in Clinical Practice Turkiye ICU	To investigate the impact of 2 feeding intervals, i.e., 3 hours or 2 hours, on the transition time from gavage to full oral feeding in premature babies.	Non-nutritive sucking (NNS) G1= 50 babies (2h) G2= 50 babies (3h)	Post-conceptional age ≤ 32 and <36 weeks of gestation	Gestational age: 29 [28–31] weeks, birth weight: 1205 [1040–1380] g. The postconceptional age to achieve full oral feeding was 35 (35–37) weeks in the 3-hour interval group and 35 (34–36) weeks in the 2-hour interval group, P = 0.131. The duration of the dietary transition was similar between the groups.
Nunes, J. D. et al⁽²⁰⁾ 2019 CoDAS Brazil ICU	To evaluate oxygen saturation (SatO2), heart rate (HR), length of stay and weight of preterm newborns (PTNBs) in a Neonatal Intensive Care Unit, when offering a diet using cup feeding techniques and finger probe, simultaneously with AM.	Cup and finger probe 8 PTNBs who received the cup diet (GCP) 17 received the diet through the finger probe (GSD)	Gestational age (GA) of 35 to 36 weeks (Capurro method)	Regarding the SatO2 and HR variables, no statistically significant differences were observed between the groups, but, in the group versus time factor, the groups showed non-continuous differences in the SatO2 variable. In relation to weight, a statistically significant gain was found for both groups. However, in GCP, their weight gain is due to the longer hospital stay. The GSD had a shorter hospital stay.
Buldur, E. et al ⁽²¹⁾ 2020 Breastfeeding Medicine Turkiye ICU	To compare finger tube feeding and syringe feeding on the sucking ability of premature babies in the first days of life.	Syringe and finger probe Preterm infants were randomized to receive the routine diet (syringe technique) and the intervention (finger tube feeding). GI = 35 GC = 35	Group 1 was ≥ 31 to ≤ 34 weeks; Group 2 was 30-35 weeks	Comfort and distress scores were determined using the COMFORTneo scale. Babies in the intervention group had better comfort than those in the CG (p = 0.000). The transition time to breastfeeding was significantly shorter than in the CG (19.4 – 15.0 days versus 29.7 – 10.2 days, p = 0.000). The GI had less milk loss during feeding and its average weight gain at the end of the 10th day was significantly higher (322.1 – 82.3 g versus 252 – 108.4 g, p = 0.004). They were also discharged before the GC (25.8 – 17.4 days versus 35.9 – 13.0 days, p = 0.001).

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding Author : Ana Raquel Bezerra Saraiva Tavares Email: raquel.tavares@aluno.uece.br