Spoon Feeding Research Articles

Association between complementary feeding method and BMI at 19–36 months of life: an Internet-based cross-sectional study from two European countries

AbstractOver the last years, there has been increasing interest in Baby-Led Weaning (BLW), an approach in which infants feed themselves with finger foods. Previous studies have shown that BLW may be associated with lower food fussiness and risk of obesity, but in the other hand with growth flattering. However, the results are limited and still inconclusive. The aim of this study was to investigate the associations between complementary feeding method and body mass index (BMI) z-score in children aged 19–36 months from Poland and Austria. This anonymously, the cross-sectional internet-based study was conducted in 2018 and 2019 among 6645 mothers of children aged 12–36 months, recruited through social media. The analysis included data from 5856 mothers (35.5% from Austria) with complete data. Complementary feeding method was categorized as traditional spoon feeding (TSF), partial BLW (children was both spoon-fed and fed themselves), as well as BLW. BMI z-score was calculated based on declared body mass and height using the WHO cut-off points. BLW method was used in 16.4% of children, whereas the TSF in 30.5% of the total study group. Normal BMI z-score was observed in 73.8% of the total study group, thinness in 9.6% and overweight and obesity in 4.3%. The BLW increased the risk of thinness only in children aged 31–36 months (aOR: 1.48; 95%CI: 1.04–2.11) but did not influence the risk of overweight and obesity. In this present large cross-sectional study conducted in two European countries, we did not find an association between BLW and overweight and obesity risk. However, in the older group, BLW increased the risk of thinness. Previous studies observing a risk of thinness were also cross-sectional, although conducted among smaller study groups. In contrary to this, In contrary to this, the RCT trials using modified BLW version Baby-Led Introduction to SolidS (BLISS) did not observe any case of growth flattering. In another cross-sectional study investigating dietary intake of infants aged 6–8 months, who were complementary fed using BLW or TSF method, authors did not observe a difference in energy intake between the two groups. Further studies investigating the role of complementary feeding method and subsequent BMI, especially in long-term are necessary.

Pervasive Developmental Disorders in Iraqi Children

Background: Pervasive developmental disorders include five chronic disorders marked by early impairment in socialization, communication and behavior. Little is known about the types of pervasive developmental disorders in Iraq. This is a retrospective clinical study aiming at determining the types of pervasive developmental disorders in Iraqi children observed at the pediatric psychiatry clinic in a tertiary pediatric referral center. Patients and methods: During nine months period (November 18th, 2018 to July 18th, 2019), fifty one patients with a diagnosis of pervasive developmental disorders (30 males and 21 females) were observed at the psychiatry clinic at the Children Teaching Hospital of Baghdad Medical City. Their ages ranged from two and half years to twelve years. Results: Thirty two (17 males and 15 females) patients had autism without significant mental retardation as indicated by adequate urine and bowel control and self care skills particularly spoon feeding. Thirteen patients were considered to have atypical autism or Pervasive developmental disorder not otherwise specified (10 boys and 3 girls), in eleven of them, the disorder was considered atypical because of the lack of adequate urine and bowel control and self care skills particularly appropriate spoon feeding indicating significant degree of mental retardation. In one patient, his condition was considered a typical because of the presence of an acceptable eye contact and response appropriately to name in most instances. Three patients had Asperger syndrome including two girls and one boy. Two boys had childhood disintegrative disorder (Heller syndrome), one of them have changes on brain MRI suggestive of cerebral vasculitis. One girl had Rett syndrome and her case and early treatment was published. Conclusion: In this series, typical autism without significant mental retardation accounted for 63%. Atypical autism (Pervasive developmental disorder not otherwise) was the second most common type of Pervasive developmental disorders accounting for about 25%. Asperger syndrome accounted for only 6% of the cases in this series

Sucking patterns are not predictive of further feeding development in healthy preterm infants

Preterm infants are at risk of experiencing difficulties in their feeding development. For a possible early identification of these, we examined the association between sucking patterns, assisted spoon feeding, and chewing skills in 40 healthy preterm infants, and the role of experience in the acquisition of these skills in a prospective longitudinal study. Sucking patterns were evaluated at 34, 37, and 44 weeks postmenstrual age (PMA), assisted spoon feeding was evaluated at 6, 9, and 12 months PMA, and chewing was evaluated at 9, 12, and 24 months PMA. Sucking patterns were rated using the Neonatal Oral Motor Assessment Scale, assisted spoon feeding was rated using the Observation List Spoon Feeding, and chewing was evaluated using the Mastication Observation and Evaluation Instrument.All infants showed progression in their oral motor skills during the study period, but not all demonstrated a stable progression of skills. Quality of sucking patterns was not associated with skill level achievement of assisted spoon feeding or with chewing. Length of experience in sucking was significantly associated with duration of supplemental tube feeding but not with the quality of the sucking pattern. Length of chewing experience was significantly associated with chewing abilities at 9 and 12 months PMA. No clinical characteristics were sufficiently predictive of oral motor skill development. Results show that sucking patterns are not predictive of subsequent feeding development in healthy preterm infants. The food consistency offered and the length of feeding experience influenced the acquisition and quality of oral motor skills differently.

Mothers' experiences with complementary feeding: Conventional and baby-led approaches.

Lifelong eating behaviours are shaped in infancy with the introduction of solid foods (complementary feeding). A conventional approach to complementary feeding, encompassing spoon feeding of pureed foods, has long been the standard. Baby-led weaning is a contemporary approach whereby the infant is encouraged to choose what and how much they eat. Mothers navigate decisions about what and how to introduce foods to their infant in diverse ways. This study set out to explore the complementary feeding approaches of women. A qualitative study utilising photovoice and focus groups generated data that provided insight into women's lived experiences of complementary feeding. Thirteen women were purposively sampled and data were analysed in line with descriptive phenomenology. Three recurrent themes emerged from the data. Women's approaches to complementary feeding were mediated by "trust," "convenience" and making decisions that were "value based versus practical based." Trust manifested in various forms including trusting the infant, trusting women's own instincts and the tension between social pressures and trust of self. Differences between women following a conventional vs baby-led approach were also seen in perceptions of convenience, and the decision-making process. This study provides insight into how and why women choose certain feeding practices and can be used to better equip health professionals to work with new mothers in providing realistic and nuanced feeding support.

Determinants of Accounting Students’ Competency: Kuwait University

Kuwait University is the only state university with accounting education that has commenced in 1966. So far, accounting education is offered by the College of Business Administration – CBA- as a full degree of 4 years span, in addition to some other private universities that started recently. CBA periodically reviews the accounting program particularly after earning AACSB accreditation in the late 90’s, which has pressed for more academic excellence. CBA has introduced an exit exam process in 2009 since inception. Results revealed some areas of concern such as the shallow technical background of graduates, ill-use of advanced accounting systems and software, and inadequate research ability. One would add to these, student's tendency toward the classical type of learning or “spoon feeding”, which questions their ability in the judgmental type of cases as well as their self-expression.The purpose of this research is to explore factors associated with accounting student’s competencies at Kuwait University and subsequently to suggest remedy policies. A survey has been conducted through out the period from April 2018 till August 2018 exploring factors affecting accounting student’s competency. Multiple factors that influence student's competencies were entrenched within a statistical model which later resulted in comparable results. Moreover, stepwise multiple regression analysis was used to analyse the relationships between students' competency and the independent variables. Results expose that students lean heavily on in- class materials and do less reading in advance. Also, learning techniques used and practices by students are well classical as it depends primarily on lecturer delivering the materials. Finally, this study provides evidence that GPA earned by accounting students at CBA is the most important variable associated with their overall performance upon graduation. Other variables such as MGPA, external assistance (EA), in-class assignments (ICA), students' personal and technical abilities (PFT), and other financial and social factors (FT) have lesser degree of significance on their performance.

How Does Feeding Development and Progression onto Solid Foods in PKU Compare with Non-PKU Children During Weaning?

Weaning is complex for children with phenylketonuria (PKU). Breastmilk/infant formula and phenylalanine (Phe)-free infant protein-substitute (PS) are gradually replaced with equivalent amounts of Phe-containing food, a semi-solid/spoonable weaning PS and special low-protein foods. In PKU, feeding patterns/practices during weaning in PKU have not been formally evaluated. In this longitudinal, prospective, case-control study (n = 20) infants with PKU transitioning to a second-stage PS, were recruited at weaning (4–6 months) for a comparison of feeding practices and development with non-PKU infants. Subjects were monitored monthly to 12 months and at age 15 months, 18 months and 24 months for: feeding progression; food textures; motor skill development and self-feeding; feeding environment; gastrointestinal symptoms; and negative feeding behaviours. Children with PKU had comparable weaning progression to non-PKU infants including texture acceptance, infant formula volume and self-feeding skills. However, children with PKU had more prolonged Phe-free infant formula bottle-feeding and parental spoon feeding than controls; fewer meals/snacks per day; and experienced more flatulence (p = 0.0005), burping (p = 0.001), retching (p = 0.03); and less regurgitation (p = 0.003). Negative behaviours associated with PS at age 10–18 months, coincided with the age of teething. Use of semi-solid PS in PKU supports normal weaning development/progression but parents require support to manage the complexity of feeding and to normalise the social inclusivity of their child’s family food environment. Further study regarding parental anxiety associated with mealtimes is required.

Differences in dietary composition between infants introduced to complementary foods using Baby-led weaning and traditional spoon feeding.

Baby-led weaning (BLW) is a method of introducing solid foods to infants, which centres around the infant self-feeding family foods. BLW has grown in popularity over the last 10years; however, although research is starting to build around the safety and impact of the method, research examining intake is sparse. This is important because concerns have been raised by healthcare providers regarding the nutrient and energy sufficiency of BLW. The present study aimed to invstigate exposure to different food types based on different weaning approaches. One hundred and eighty parents completed a 24-h recall of the foods given to their babies aged 6-12months. Respondents were split into those following strict BLW, loose BLW and traditional spoon-feeding. Recalls were examined to ascertain the number of times in 24h infants were given different types of foods, including iron-containing foods. The results were then compared between different weaning groups and age groups. Several significant differences were found between the frequency of foods eaten by different weaning and age groups: in the youngest age group, strict BLW infants were more likely to be exposed to vegetables (P=0.000) and protein (P=0.002) than traditionally weaned babies, whereas, at all age groups, the traditionally weaned group had the highest exposure to composite meals. However, no significant differences were found in reported exposure to iron-containing foods between weaning groups at any age. Maternal age, education and milk feeding method were controlled for throughout the analyses. The findings add to a growing body of evidence that suggest a BLW approach may be safe and sufficient.

Integrated Deep Soil N and Groundwater Isotope Investigation of N Sources Captured by Municipal Wells

AbstractIdentification of major nitrate sources that adversely impact groundwater quality in municipal well capture zones in areas of emerging nitrate contamination is essential to minimize leaching and prevent exceedance of the nitrate drinking water standard. Vertical profiles of nitrate leachate in deep soils provide an estimate of the amount of nitrate in transit beneath irrigated, row‐cropped fields; depths of peak leachate; and the approximate rate of downward movement. Profiles of pore‐water soil‐nitrate concentrations in thick 60‐feet (~18 m), fine‐textured soils near Hastings, Nebraska clearly indicate that considerably more nitrate leached beneath furrow‐irrigated than center‐pivot irrigated fields. Peak leaching appeared to correlate with recorded periods of poor weather conditions during some growing seasons and may best be controlled by “spoon feeding” fertilizer to the crop through the sprinkler irrigation system at times of nutrient need. The presence of trace levels of atrazine and deethylatrazine to 60 feet (18 m) in core samples indicates that larger, more complex anthropogenic molecules also leach through the fine‐textured soils. The light δ15NNO3 values in the surficial groundwater beneath fertilized and irrigated cropland indicate that ammonium fertilizer is a major N source and suggest that the natural soil‐N contribution is negligible. δ15NNO3 values were most enriched in irrigation wells located within municipal well capture zones downgradient of a large feedlot. Dual isotope method (DIM) δ15NNO3 and δ18ONO3 values suggest that the Hastings’ municipal wells farther downgradient are contaminated with a mixture of nitrate from manure and commercial ammonium‐based fertilizer. DIM values indicate an absence of denitrification, which has implications for long‐term management of the water resources.

Baby-led complementary feeding: Randomized controlled study.

Baby-led weaning (BLW) is an approach to introducing solid foods to infants that gives control of the feeding process to the infant. Anecdotal evidence suggests that BLW is becoming popular with parents, but scientific research is limited to a few publications. This study assessed growth, hematological parameters and iron intake in 6-12-month-old infants fed by traditional or baby-led complementary feeding. We recruited 280 healthy 5-6-month-old infants allocated to a control (traditional spoon feeding; TSF) group or an intervention (BLW) group in a randomized controlled trial. Infant growth, hematologic parameters and iron intake were evaluated at age 12months. Infants in the TSF were significantly heavier than those in the BLW group. Mean weight in the BLW group was 10.4 ± 0.9kg compared with 11.1 ± 0.5kg in the TSF group. There was no statistically significant difference in the iron intake from complementary foods between the BLW (7.97 ± 1.37mg/day) and TSF (7.90 ± 1.68mg/day) participants who completed the diet records. Hematologic parameters were similar at 12months. The incidence of choking reported in the weekly interviews was not different between the groups. To the best of our knowledge, this is the first randomized -controlled study to have examined the impact of weaning method on iron intake, hematological parameters and growth in breast-fed infants. BLW can bean alternative complementary feeding type without increasing the risk of iron deficiency, choking or growth impairment.

Pedagogical and Psychological Implements in the Holly Quran: The Case Surah Al-Kahf

Teaching English Language at schools and universities since 1995 and working as a school principle for four years and as an English Language supervisor for ten years, the author of the paper noticed that majority of teachers adopt traditional ways of teaching English as a foreign language (EFL) learners. In these classes teachers inculcate knowledge through spoon feeding practices rather than innovative ones that may challenge students' thoughts and abilities by facing them with non-traditional events, activities or scenes. In spite of the fact that Muslim teachers recite many verses from the Holy Quran daily, they are unaware of the pedagogical and psychological implements in the verses they have been reciting. Hence, this study aims at identifying the pedagogical and the psychological implements in the holly Quran, specifically Surah Alkhaf. To collect data, content analysis method was used to elicit the pedagogical and the psychological implements. To identify the context in which these implements appear, the Key Word In Context (KWIC) was used depending on Al Islam website. These implements are hoped to reshape the way of teaching and learning practiced by many teachers and learners at educational institutions. In most cases, EFL learners don't actively use their minds or the critical skills that may trigger solutions to problems they encounter continuously. This study emphasizes the disastrous consequences of jumping to conclusions before one analyzes and interprets any ambiguous phenomenon. Results of the study showed many pedagogical and psychological implements such as motivation for learning, learning contracts, contradicted practices, stimulus-response model, accommodation and equilibration. The study implicates that any process of learning should be fueled by internal motivation that sparks the learner's power. Learners shouldn't be hasty and jump to conclusions, instead they should do their best to critically analyze events so that they can solve dilemmas they face daily. Another significant implication is the use of learning contracts to enhance fruitful learning. Finally, some recommendations were stated at the end of the study.

The Role of Complementary Feeding Methods on Early Eating Behaviors and Food Neophobia in Toddlers

ABSTRACTBackground: Feeding methods used during infancy may impact upon eating behaviors in toddlers and influence the likelihood of developing weight issues. The aim of this study was to compare eating behaviors and food neophobia (defined as the reluctance to eat, or the avoidance of, new foods) in toddlers between three different complementary feeding (CF) groups; spoon-feeding (SF), baby-led weaning (BLW), and mixed method (MM). The study also aimed to investigate changes in early feeding practices and sociodemographic factors in relation to eating behaviors.Methods: One hundred and sixty-two parents with a child aged 12–48 months completed a questionnaire through online parenting forums and via Children's Centers. Parents reported their CF method at the point of introduction to complementary foods, the child's age when this occurred and the feeding method at one year along with breastfeeding duration. Toddler eating behaviors were measured using the Child Eating Behavior Questionnaire and the Child Food Neophobia Scale. The questionnaire also examined sociodemographic measures.Results: No significant differences were found in any measured eating behaviors or neophobia between CF groups. There were significant differences in breastfeeding duration, exclusive breastfeeding for 6 months, timing of CF, gestational age and weight at birth between CF groups. CF method changed at one year such that more people moved to a MM approach of feeding.Conclusions: CF method does not appear to influence toddler neophobia, and relationships between breastfeeding and BLW and later introduction of CF are further confirmed. Furthermore, it appears that individuals that do not undertake BLW at the onset of CF are rarely undertaking it at one year. This research implies that early CF methods do not influence eating habits during toddlerhood. Further work is required to educate parents on the benefits of progressing infants to complementary food by one year.

Self-Directed Learning Improves Quality of Life

The SeDLE (Self-directed Learning Environment) Index is developed to measure the strength and ability of the learning environment to facilitate self-directed learning. This is a conceptual paper to explain the development and validation of the SeDLE index. Evidence showed that a self-directed learning environment exhibits a self-directed learner in promoting one's quality of life. The self-directed environment will support and inhibit the ability to function with less supervision among learners thus viewed as a solution to reduce the problem of spoon feeding in the classrooms.

Predictors for gut colonization of carbapenem-resistant Enterobacteriaceae in neonates in a neonatal intensive care unit

With the emergence of carbapenem-resistant isolates, the therapeutic alternatives have become limited. Various factors are responsible for carbapenem-resistant Enterobacteriaceae (CRE) gut colonization. This study was conducted to determine predictors for CRE gut colonization in neonates who were hospital delivered and admitted in a neonatal intensive care unit (NICU). Three rectal swabs were collected from 300 hospital-delivered and NICU-admitted neonates (likely to stay for >3 days). The data collected for the possible risk factors for CRE gut colonization were namely mode of delivery, prolonged rupture of membrane >18 hours, period of gestation, birth weight, meconium-stained liquor, ventilation, intravenous catheter, nasogastric (NG) tube, NG feeding, breastfeeding, katori spoon feeding, top feeding, expressed breastmilk, antibiotics administration, and duration of hospitalization. P < .05 was considered as statistically significant. A total of 26 cases of CRE were isolated from 300 neonates. Statistically significant risk factors were found to be NG tube, breastfeeding, NG feeding, top feeding, expressed breastmilk, ventilation, antibiotic administration, and duration of hospitalization. Top feeding and antibiotics administration were identified as 2 independent risk factors by multiple logistic regression. Active surveillance of cultures from hospitalized patients and implementation of preventive efforts can reduce the risk of CRE.

Pedagogical and Psychological Implements in the Holly Quran: The Case Surah Al-Kahf

Teaching English Language at schools and universities since 1995 and working as a school principle for four years and as an English Language supervisor for ten years, the author of the paper noticed that majority of teachers adopt traditional ways of teaching English as a foreign language (EFL) learners. In these classes teachers inculcate knowledge through spoon feeding practices rather than innovative ones that may challenge students' thoughts and abilities by facing them with non-traditional events, activities or scenes. In spite of the fact that Muslim teachers recite many verses from the Holy Quran daily, they are unaware of the pedagogical and psychological implements in the verses they have been reciting. Hence, this study aims at identifying the pedagogical and the psychological implements in the holly Quran, specifically Surah Alkhaf. To collect data, content analysis method was used to elicit the pedagogical and the psychological implements. To identify the context in which these implements appear, the Key Word In Context (KWIC) was used depending on Al Islam website. These implements are hoped to reshape the way of teaching and learning practiced by many teachers and learners at educational institutions. In most cases, EFL learners don't actively use their minds or the critical skills that may trigger solutions to problems they encounter continuously. This study emphasizes the disastrous consequences of jumping to conclusions before one analyzes and interprets any ambiguous phenomenon. Results of the study showed many pedagogical and psychological implements such as motivation for learning, learning contracts, contradicted practices, stimulus-response model, accommodation and equilibration. The study implicates that any process of learning should be fueled by internal motivation that sparks the learner's power. Learners shouldn't be hasty and jump to conclusions, instead they should do their best to critically analyze events so that they can solve dilemmas they face daily. Another significant implication is the use of learning contracts to enhance fruitful learning. Finally, some recommendations were stated at the end of the study.

Using formula New Approach of Multiplication Table

The purpose of the current study was conducted to create new approach of the multiplication table. Challenges of multiplication operation to student teachers and students in elementary schools were identified in the longtime school observation. This leads to mental experiment and case study to create the new multiplication table. The new approach of the multiplication table enables to find the multiplication results in a simple way using formula. If X and N are any single digit numbers then the multiple of X and N can be calculated using the formula; XN=X-(N-1) and if N-1= n, and if X-n=m then the multiplication result of XN is equal to nmn (9-X). This technique enables learners to do more practice, initiate them to think critically, acquire skills, motivate them to play with numbers, ensure their success and confidence. T his new approach encourages students to acquire knowledge through detail exercise and practice. The higher challenge of multiplication operation difficulty to students would be minimized by the systematic approach of teachers; not to spoon feed to memorize the complex table, which is the base and beginning to understand complex concepts.

PROFESSIONAL DEVELOPMENT OF FACILITATORS IN AN OPEN AND DISTANCE LEARNING MODEL: THE CASE FOR THE UNIVERSITY OF SWAZILAND

The aim of this study was to assess the effectiveness of the professional development offered to the facilitators of the Certificate in Psychosocial Support programme offered by the Institute of Distance Education, University of Swaziland. It also explores the effect this has on the learners being supported. The study was qualitative using open ended questionnaires and focus group discussions to gather data from the facilitators and the mentor supervisor and her assistant. Data was analysed through content analysis applying the Harland and Kinder (2014) model of professional development outcomes. The results show that the professional development offered to facilitators of the Certificate in Psychosocial Support of the UNISWA once every semester has positive results. The facilitators generally agreed that through the professional development they acquire knowledge and skill in handling face-to-face sessions, using modules and other learning materials, motivating learners, psychosocial support principles, approaches and child protection; the delivery model and application of content rather than spoon feeding. These gains are largely to do with the pedagogical approach selected for the programme. The facilitators also acquired new learning/ teaching materials in readiness for a new semester. Each session provided an opportunity for facilitators to interact with the modules coordinators and among themselves. The facilitators were unhappy with the lack of preparation by some module coordinators. The study recommends that IDE reviews the performance of module coordinators and replace those who are no longer performing. IDE should also devise creative ways of offering the professional development so that it continues to be educative and motivating to the facilitators. Article visualizations:

《单片机原理及接口技术》开放式课堂教学改革探讨

传统的“满堂灌”式的教学方法由于无法调动学生的学习兴趣，学生课堂参与程度低，从而导致教学效果大打折扣。为此，笔者结合自身多年的教学经验，以《单片机原理及接口技术》课程教学改革为例，实行“开放式”精品示范课堂教学改革，从教学内容、教学方法、课程考核等方面开展改革研究，并应用于教学的全过程。通过几年的实施与完善，“开放式”课堂教学方法在《单片机原理及接口技术》课程教学过程中取得了良好的效果，为其他课程的教学改革提供借鉴指导作用。 The traditional “spoon feeding” teaching method leads to the less participation for the students and the bad effect of teaching since it doesn’t stimulate students’ interest in learning their courses. Therefore, the author summarized teaching experience in the recent years, and carry out the teaching reform of “Microcomputer Principle and Interface Technology” course as an example. The teaching reform called “Open Boutique Demonstration Classroom” includes the teaching content, teaching method and curriculum evaluation and so on, and it has applied to the whole teaching process. In the recent several years, the implementation and improvement of “open” teaching method has a good effect in the process of teaching “Microcomputer Principle and interface technology” course, which provides guidance for teaching reform of other courses.

Starting solid foods: does the feeding method matter?

ABSTRACTThe weaning period, in which complementary foods are introduced into the infant’s diet, can be challenging, with dislike of novel foods known to be common. However, even though at six months (the current recommended age for the introduction of complementary foods) most infants are able to feed themselves with graspable pieces of food, the majority of the research to date assumes the use of spoon feeding and pureed food. The potential impact of the format of the food and the feeding method on the development of food preferences has not been explored. This paper describes the development and piloting of a coding scheme to examine infants’ responses to their first solid food offered in two formats – whole and pureed – and by two methods – self-feeding and spoon feeding, and its first use. The findings for the 10 infants in the study point to some important differences between the two feeding methods.

Oromotor Stimulation for Transition from Gavage to Full Oral Feeding in Preterm Neonates: A Randomized controlled trial.

To assess the effect of additional oromotor stimulation along with routine care on transition from gavage to full oral feeding in preterm neonates. 51 neonates (28-34 weeks) randomized to receive either oromotor stimulation along with routine care (n=25, intervention), or routine care alone (n=26, control) (which included Kangaroo mother care and non-nutritive sucking). Median (IQR) days to reach partial and full spoon feed were significantly lesser [5(3-9.5) vs 10(5-15) P=0.006; and 7(5-14.5) vs 12.5(7-21); P=0.03] in intervention than in control group, respectively. A significantly higher number (56%) in intervention group as compared to control group (31%) achieved partial direct breast feeding at discharge (P=0.01). Oromotor stimulation along with routine care reduces the duration of gavage feeding in preterm neonates.

Two important factors affecting the transition to breastfeeding in preterm infants: corrected age and periventricular leukomalacia.

Dear Editor, I have read the article of Aytekin et al. (1) titled “The effect of feeding with spoon and bottle on the time of switching to full breastfeeding and sucking success in preterm babies” with interest. In this study, spoon feeding and bottle feeding methods which are used as assistive methods in the period of transition from enteral feeding to breastfeeding were compared. It was found that the time for transition to full breastfeeding was significantly shorter in preterm babies who were spoon-fed compared to the ones who were bottle-fed (p<0.05). Sufficient sucking occurs in the 32–33rd week at the earliest in preterm babies (2). This is related with brain development and central nervous system myelinization (2, 3). In the study of Aytekin et al. (1), the gestational week as corrected age at which the transition from enteral feeding to oral feeding occured was not reported. Instead, it was reported that the body weights were similar in both study groups at the time of onset of breastfeeding and thus both groups had similar maturational behaviors. In preterm babies, increase in body weight may vary depending on addition of fortifiers, development of oral intolerance in the baby and daily amounts of intake of calorie, protein, fat, carbohydrate and other elements (4). Therefore, corrected gestational age should be reported as an indicator of neurological maturation instead of body weight (2, 3). In preterm babies, detection of pathological conditions including intracranial hemorrhage (ICH) and periventricular leukomalacia (PVL) which may occur while development of the brain continues is important in terms of follow-up and treatment (3). In previous years, transfontanel ultrasonography (TFUS) screening was recommended for babies born before the 30th gestational week, whereas it has been recommended that this screening should be performed in all babies up to the 36th gestational week in recent years (5). In a study performed by Ballardini et al. (5), the TFUS findings of babies born at the 33–36th gestational age were examined retrospectively. Pathological TFUS finding (PVL, ICH, subependimal cyst, sinus vein thrombosis) was detected in 13% of a total of 724 babies. The most common finding was reported as PVL. It was reported that 78 (83%) of these patients who were found to have pathology were asymptomatic and 19 (20%) had no risk factor. In the study of Aytekin et al. (1), it was reported that babies who had no congenital malformation which would lead to asphyxia and affect respiration, who had spontaneous respiration and who had no cranial hemorrhage or hyperbilirubinenia which would require exchange transfusion were included in the study. However, it was not reported if TFUS was performed or not. Considering that PVL can develop even in patients whithout risk factors or marked neurological finding, it is not clear if the patient group of Aytekin et al. (1) had PVL which could interrupt development of sucking ability. In conclusion, it should be kept in mind that the sucking ability in preterm babies is related with gestational age and each baby should be evaluated according to his/her own gestational week. In addition, it should be kept in mind that brain imaging should be performed in order to detect pathological conditions including PVL which would disrupt the natural process in neurological maturation in preterm babies.