Enhancing breastfeeding establishment in preterm infants: A randomized clinical trial of two non-nutritive sucking approaches

Background: Preterm infants and their mothers face many barriers to the establishment of exclusive breastfeeding in the neonatal intensive care unit. Objective: The objective of this study was to assess and compare the effect of maternally administered nonnutritive sucking (NNS) on an emptied breast versus a pacifier on exclusive breastfeeding establishment at hospital discharge. Study design: A block randomized study design was performed. Trial registration number: NCT03434743. Methods: A total of 33 preterm infants born less than or equal to 34 weeks gestation participated in the study. The NNS on an emptied breast or pacifier interventions were administered by mothers, once a day for 15 min. Outcomes included: exclusive breastfeeding acquisition, described as infants who received greater than or equal to 50% of direct breastfeeds at hospital discharge; time to achieve independent oral feeding, defined as the number of days to transition from complete tube feeds to full oral feeds (full breast, partial breast/bottle, or full bottle); length of hospitalization, described as the number of days from admission to hospital discharge. Results: A significantly greater number of infants in the NNS emptied breast group acquired exclusive breastfeeds at hospital discharge as compared with those in the NNS pacifier group (63% vs. 24%, p = 0.037). There was no difference between groups in time to achieve independent oral feeds (14.4 ? 8.0 vs. 14.4 ? 6.4 days, p = 0.683) and length of hospital stay (48.7 ? 33.7 vs. 53.1 ? 30.6 days, p = 0.595). Conclusion: Provision of NNS on an emptied breast is a safe and low-cost infant and mother targeted intervention which can increase exclusive breastfeeding rates and its well-recognized advantages in a highly vulnerable population.