[Breast- and bottle-feeding in preterm infants: a comparison of behavioral cues]

Developmental care has been broadly applied to identify the behavioral cues and care needs of preterm infants. Past studies indicate a significantly higher level of physical distress in bottle-fed preterm infants than in preterm infants who are breastfed. However, no evidence has yet been reported that supports the influence of feeding methods on behavioral cues.

This study compares differences in the type and frequency of behavioral cues between breast- and bottle-fed preterm infants.

A comparison study design and secondary data analysis method were used to assess data from two previous research projects. Infant feeding behavioral cues were observed and compared between two groups: 7 preterm infants who were breastfed and 7 preterm infants who were bottle-fed. After cases were matched by infant gestational age, behavioral responses were coded according to the preterm feeding cues coding system (PFCCS) from 7 paired maternal-infant feeding videos that featured preterm infants of 25 to 32 weeks gestational age at birth.

The PFCCS classifies 24 feeding behavioral cues into hunger cues, self-regulatory cues, stress cues, and satiety cues. Infants in the breastfeeding group had a higher hunger cue frequency than their bottle-fed peers (p = .013), while bottle-fed infants had a higher stress cue frequency than their breastfed peers (p = .041). Other significant differences in behavioral cues between the two feeding methods included "fluid spillage" (bottle- >breast-, p = .008), "central cyanosis" (bottle- >breast-, p = .024) and "hand pushing" (breast- >bottle-, p = .034).

Preterm infants in this study who breastfed showed significantly fewer stress cues than those who bottle fed. These findings support the importance of enhancing care provider sensitivity with regard to behavioral-cue observation. Findings further support breastfeeding rather than bottle-feeding for preterm infants.