1. Hardy, Whitney BS, RN

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As nurses, we often tell parents that breast milk is the best, most natural source of nutrition for their premature infants. It has been shown to improve mother-infant bonding, transfer maternal antibodies to help the infant's immune system, reduce the incidence of necrotizing enterocolitis, and more.1 We encourage mothers to begin pumping and bring breast milk to the hospital so that it can be fed to the infant with the long-term goal of breastfeeding upon discharge. Often, feedings are initially given via gavage and weeks or months pass before the infant is ready to go to breast or to nipple feeds from a bottle. Currently, the number of preterm, low birth-weight infants who leave the neonatal intensive care unit (NICU) breastfeeding successfully is low. This study, using the PubMed database, examined the use of nonnutritive sucking during gavage feedings and oral stimulation performed by trained speech therapists as strategies to increase the number of infants successfully breastfeeding at discharge, 3, and 6 months corrected age. Should these interventions be used routinely with preterm infants to increase the rate of breastfeeding?


The study2 included 98 preterm infants born between 26 weeks and 32 weeks and 6/7 days who were randomly assigned to experimental and control groups. Interventions occurred from the time the infant reached partial enteral feeding (100 kcal/kg/d) until the transition to oral feeding. They found that infants in the experimental group who received oral stimulation for 15 minutes each day and who were given the opportunity for nonnutritive sucking during gavage feedings had higher breastfeeding rates at discharge, 3 months, and 6 months corrected age when compared with infants in the control group who received a sham intervention. Interestingly, the infants in the experimental group were able to go to breast an average of 8.2 days earlier than infants in the control group and were discharged an average of 10.8 days earlier from the NICU.


Developing a program where nurses and/or parents provide nonnutritive sucking during gavage feeding and trained speech therapists provide daily oral stimulation sessions could increase the rate of successful breastfeeding in the preterm population and should be considered by all NICUs. In addition, further research should be considered to determine the benefits to the hospital related to the decrease in the length of stay of these infants.




1. Agostoni C, Braegger C, Decsi T, et al; ESPGHAN Committee on Nutrition. Breast-feeding: A commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2009;49(1):112-125. [Context Link]


2. Pimenta HP, Moreira MEL, Rocha AD, et al. Effects of non-nutritive sucking and oral stimulation on breastfeeding rates for preterm, low birth weight infants: A randomized clinical trial. J Pediatria. 2008;84(5):423-427. [Context Link]