Bottle Nipples

According to the American Academy of Pediatrics, to be discharged from the hospital

after birth, infants must have competent breast or bottle-feeding without cardiorespiratory
compromise. It is well known, that for children that were born premature, the ability for the
infant to independently oral feed is correlated with earlier hospital discharge. It is
acknowledged that oral feeding can be affected by many external factors such as bottle
nipple and bottle used, fluid type and viscosity, the infants behavioral state, decreased
endurance and caretakers feeding approach (1266). In this study, Scheel, et al. (2005) studied
whether varying bottle nipples used in the NICU is connected to faster transition from tube
feeding to oral feeding.
The goal of this investigation was to take three different nipple styles and see how they
affect feeding performance as infants grow and mature. This was a longitudinal study that
measured infants born between 24 and 29 weeks gestation. The infants were taking 1-2 and 68 oral feedings per day. The infants were monitored for 3 feedings, each using a different
nipple, and within 24 hours. The feedings did not disrupt the infants opportunities to
breastfeed. The mother was not present for the feedings in order to not disturb the infant
during feeding. The primary outcome for the for the study was the rate of milk transfer for the
total duration of the feeding.
The study did not find any difference in the effect of each nipple style on the oral
feeding performance of preterm infants. This suggests that infants are able to regulate the flow
of milk. Safe and successful oral feeding is dependent upon an adequate coordination of suckswallow- breathe. Infants can change their sucking skills in order to maintain a rate of transfer
that is compatible with the level of suck- swallow- breathe coordination they have attained at a
particular time. There is inadequate knowledge of how infants oral feeding skills can be
affected by the physical traits of bottle nipples. There may be no clinical significance for the
best bottle nipple that enhances feeding. For now, SLPs will need to monitor suck-swallowbreathe coordination by allowing infants to pace their feeding and let them finish the
prescribed amount within a period of time.
A cross design study was completed on Effects of Single-Hole and Cross-Cut Nipple Units
on Feeding Efficiency and Physiological Parameters in Premature Infants. There were 40
premature infants, between the gestational ages of 34-36 weeks, included in the study and
each was free of any other congenital abnormalities other than being premature. Feeding
performance was measured in terms of total feeding time, milk intake, and sucking efficiency.
Other factors that were measured throughout the experiment were heart rate (HR) measured
in beats/minute, respiratory rate (RR) measured in breaths/minute and oxygen saturation
SPO2.
Each infant was measured at two separate feedings, one in the morning and one in the
afternoon. 20 of the infants received feedings with a cross-cut nipple and the other 20 through
single-hole nipples. The study found that while there was no oxygen desaturation or
bradycardia resulting from the feedings, there was a noticeable difference in the feeding
efficiency between the two groups. The infants who received feedings via a single-hole nipple
had a larger milk intake and lower feeding time duration (Ying, Chun, Yuh, & Chyi, 2007). Ying et
al. (2007) found that sixty-five percent of infants completely ingested the amount of milk

prepared within 12 minutes when fed through the single-hole nipple units. Only 10 percent
achieved this with the cross-cut nipple. Infants receiving feedings from the cross-cut unit also
had higher heart rates in the beginning of feedings and showed significantly lower oxygen
saturation (Ying et al., 2007).
The article study gave a few possible explanations for the results. The single-hole nipple
allows a faster flow of milk and requires less effort (sucking pressure) to produce milk than the
cross-cut nipple. However, when sucking force is strong, a cross-cut nipple is pulled to open
outward, which produces a higher flow rate than that achievable through a single hole (Ying et
al., 2007). Premature infants often produce a weaker sucking pressure and therefore require
more effort to achieve milk flow from the cross-cut nipple. Ying et al. (2007) concluded that, in
comparison with cross-cut nipple units, oral feeding with single-hole nipple units result in more
efficient milk intake and a lower respiratory burden for premature infants.