Abstract
BackgroundWhether the design of an anti-vacuum infant feeding bottle influences infant milk intake, growth or behavior is unknown, and was the subject of this randomized trial.MethodsSubjects63 (36 male) healthy, exclusively formula-fed term infants.InterventionRandomisation to use Bottle A (n = 31), one-way air valve: Philips Avent) versus Bottle B (n = 32), internal venting system: Dr Browns). 74 breast-fed reference infants were recruited, with randomisation (n = 24) to bottle A (n = 11) or B (n = 13) if bottle-feeding was subsequently introduced.Randomisationstratified by gender and parity; computer-based telephone randomisation by independent clinical trials unit.SettingInfant home.Primary outcome measureinfant weight gain to 4 weeks.Secondary outcomes(i) milk intake (ii) infant behaviour measured at 2 weeks (validated 3-day diary); (iii) risk of infection; (iv) continuation of breastfeeding following introduction of mixed feeding.ResultsNumber analysed for primary outcomeBottle A n = 29, Bottle B n = 25.Primary outcomeThere was no significant difference in weight gain between randomised groups (0-4 weeks Bottle A 0.74 (SD 1.2) SDS versus bottle B 0.51 (0.39), mean difference 0.23 (95% CI -0.31 to 0.77).Secondary outcomesInfants using bottle A had significantly less reported fussing (mean 46 versus 74 minutes/day, p < 0.05) than those using bottle B. There was no significant difference in any other outcome measure.Breast-fed reference groupThere were no significant differences in primary or secondary outcomes between breast-fed and formula fed infants. The likelyhood of breastfeeding at 3 months was not significantly different in infants subsequently randomised to bottle A or B.ConclusionBottle design may have short-term effects on infant behaviour which merit further investigation. No significant effects were seen on milk intake or growth; confidence in these findings is limited by the small sample size and this needs confirmation in a larger study.Trial registrationClinical Trials.gov NCT00325208.
Highlights
Whether the design of an anti-vacuum infant feeding bottle influences infant milk intake, growth or behavior is unknown, and was the subject of this randomized trial
Primary outcome: There was no significant difference in weight gain between randomised groups (0-4 weeks Bottle A 0.74 (SD 1.2) SDS versus bottle B 0.51 (0.39), mean difference 0.23
No significant effects were seen on milk intake or growth; confidence in these findings is limited by the small sample size and this needs confirmation in a larger study
Summary
Whether the design of an anti-vacuum infant feeding bottle influences infant milk intake, growth or behavior is unknown, and was the subject of this randomized trial. Modern infant feeding bottles vary substantially in appearance and design. Developments in bottle design have mostly focused on short-term infant behaviour; we have previously shown in a randomised trial that use of a feeding bottle with anti-vacuum features was associated with significantly less distressed vocalisation and a greater proportion of time spent awake and happy when compared to a conventional bottle without such features [1]. The possibility that feeding bottle design might affect infant milk intake and growth, or the risk of infection, has not previously been considered. We compared two commonly used infant feeding bottles with different anti-vacuum designs. We hypothesised that greater effort would be required to obtain milk from bottle A, and that this would result in (i) lower rates of milk intake and (ii) slower growth; and (iii) patterns of growth more similar to those of breast-fed infants
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