A comparison of the safety of cupfeedings and bottlefeedings in premature infants whose mothers intend to breastfeed.

OBJECTIVE: To compare the safety of cupfeeding, an alternative feeding method, to bottlefeeding, the current standard of artificial feeding in the United States, in preterm infants whose mothers intend to breastfeed. STUDY DESIGN: In a prospective, randomized crossover study, 56 infants or=34 weeks' corrected gestational age, the order of the first two non-breast oral feedings was randomized by coin toss to one cupfeeding and one bottlefeeding. Trained Neonatal Intensive Care Unit nurses provided the feedings. Heart rate, respiratory rate, and oxygen saturation were recorded at 1-minute intervals for 10 minutes before and during the feeding. Volume taken, time required to complete the feed, and any apnea, bradycardia, choking, or spitting episodes were recorded. RESULTS: Heart rate (p<0.0001) and respiratory rate (p<0.0001) increased and oxygen saturation decreased (p=0.0002) during both cup and bottlefeedings compared to pre-feeding baselines. The amount of change in these three parameters from baseline to feeding period was similar for both feeding methods. The fraction of O(2) saturation <90% during baseline compared to the study period was different between these two feeding methods (p=0.02). There was a 10-fold increase in desaturations <90% during bottlefeeds compared to no change during cupfeeds. When comparing cupfeeding periods to bottlefeeding periods, heart rates were higher (p=0.009) and oxygen saturations lower (p=0.02) during bottlefeeds. There were no differences between methods in respiratory rate, choking, spitting or apnea, and bradycardia. Volumes taken were lower (p=0.001) and duration of feeds longer (p=0.002) during cupfeedings. CONCLUSION: During cupfeedings, premature infants are more physiologically stable, with lower heart rates, higher oxygen saturations, and less desaturations, than during bottlefeedings. However, cupfed infants took less volume, over more time, than bottlefed for these initial feedings. Based on better physiologic stability and no difference in untoward effects, cupfeeding is at least as safe, if not safer, than bottlefeeding in this population. This study supports the use of cupfeeding as a safe alternative feeding method for premature infants learning to breastfeed.

Effects of dexamethasone on blood pressure in premature infants with bronchopulmonary dysplasia.

OBJECTIVE: To determine the incidence and time course of blood pressure elevation in dexamethasone-treated premature infants with bronchopulmonary dysplasia. METHODS: In a prospective, self-controlled, consecutive case study, 16 ventilator-dependent very low birth weight neonates treated with dexamethasone were studied. Systolic, diastolic, and mean arterial pressure and heart rate were recorded at three specific times daily. Data were recorded from day 1 of dexamethasone treatment through the duration of therapy and up to 2 weeks after its completion. Retrospective daily data were collected for up to 14 days before therapy. RESULTS: The 788 daily observations (a systolic and diastolic average of the three blood pressure recordings per day) were recorded for 16 infants, a mean of 49 +/- 11 daily observations each (range, 24 to 67). Systolic and diastolic blood pressures before dexamethasone therapy were correlated to corrected gestational age. At initiation of dexamethasone, blood pressures increased significantly from days 1 to 2. For all observations, mean systolic pressure was 51 +/- 9.5 mm Hg before dexamethasone therapy, compared with 64 +/- 10.2 mm Hg during therapy (p < 0.01); diastolic pressure was 29 +/- 6.7 mm Hg before therapy compared with 41 +/- 8.2 mm Hg during therapy (p < 0.01). After completion of dexamethasone therapy, pressures continued to increase: systolic, 67 +/- 8.8 mm Hg (p < 0.01); diastolic, 42 +/- 6.2 mm Hg (not significant). Both systolic and diastolic pressures increased as a function of weight and age; when we controlled for these covariates, an independent effect of dexamethasone itself on the group was shown. Of the 2182 individual systolic pressure readings, 9.4% were considered in the hypertensive range. The six infants treated with hydralazine had higher mean systolic pressures before dexamethasone therapy than did infants without hydralazine (56 +/- 9.4 mm Hg vs 46 +/- 6.4 mm Hg; p < 0.001) and were 2 weeks older at initiation of therapy. CONCLUSIONS: Blood pressure significantly increases during dexamethasone therapy, particularly within the first 48 hours, and does not return to baseline levels after therapy. Those infants most likely to be labeled hypertensive tend to be older at initiation of therapy but do not appear to have any other significant risk factors.

Systemic hypertension.

Hypertension in neonates is no longer a rare entity due to improved methods of surveillance, increased vigilance on the part of clinicians, and as a complication of the technologies employed in neonatal intensive care units. Although good broad-based normative blood pressure data in preterm and term neonates is not available, the existing literature allows us some guidelines for defining hypertension. The multiple etiologies and clinical presentations are discussed, as well as a practical approach to evaluation. Pharmacologic management is presented, including some of the newer drugs. With aggressive management, the prognosis for resolution of hypertension in almost all instances is excellent; however, it remains to be seen what, if any, long-term effects will occur.