Nifty Cup Versus Katori-Spoon Feeding in Preterm Infants: A Randomized Controlled Trial

Many preterm infants cannot breastfeed directly and depend on other feeding methods. Multiple studies have compared feeding methods for such infants; however, the best method remains unknown. We compared Nifty cup with Katori-spoon feeding in preterm neonates deemed fit for oral feeding. This open-label randomized controlled trial was performed in a level III neonatal unit. Preterm (<34 weeks) neonates deemed fit to initiate oral feeding were randomly allocated to the Nifty cup and Katori-spoon groups. Patients were followed up until 40 (±2) weeks of postmenstrual age or until death, whichever occurred earlier. The primary outcome was time to achieve full oral feeding. The secondary outcomes included the time spent per feeding session, time to full direct breastfeeding, anthropometry at discharge, duration of hospitalization, and mortality. The opinions of mothers and nurses were recorded using a structured questionnaire. A total of 106 participants (53 in each group) were randomized and analyzed for the primary outcome. The median (1st, 3rd quartile) time to achieve complete oral feeds was 5 (2, 11) versus 6 (4, 11) days in the Nifty cup versus Katori-spoon groups, respectively (p = 0.2). Infants in the Nifty cup group reached full breastfeeds earlier (mean difference = 12.6 days; 95% confidence interval: 4.3 to 20.8, p = 0.003) and had less vomiting (9.4% versus 26.4%, p = 0.023). Mothers and nurses felt that breast milk expression and feeding with a Nifty cup was easier. Compared to the Katori-spoon, feeding with a Nifty cup did not shorten the time to full oral feeds. However, it helps in attaining full breastfeeds earlier than the Katori-spoon. Clinical Trials Registry-India (CTRI/2021/06/034252).