Background During sucking feeds preterm infants have been shown to experience physiological instability, including lower oxygen saturations (SpO2) and heart rates (HR), and periods of apnoea or cyanosis. Obstructive apnoea may occur when the infant’s neck is hyperflexed or conversely, hyperextended. It has been hypothesised that airway obstruction linked to feeding position might be a contributing factor to a lower SpO2 and HR. The aim of this Cochrane review was to assess the available evidence on the effect of position when bottle feeding preterm infants.
Method We performed a systematic review using the methodology of the Neonatal Review Group of the Cochrane Collaboration. An extensive search of electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL) and trial registries has been performed.
Results Four small RCTs were identified that compared the standard cradle hold and alternate positions for feeding. In total 67 infants were studied One study did not report any of the a priori outcome measures and was not included in the analysis. There were no difference between infants feed with a cradle hold versus a side lying position for the outcomes: days to achieve full suck feeding (MD -4.00; 95% CI -9.20 to 1.20, days), number of infants with an SpO2 <80% (RR 0.82; 95% CI 0.53 to 1.28), HR <100 bpm during feed (RR 2.00; 95% CI 0.80 to 5.02), or time to complete feed (MD 4.00; 95% CI -1.02 to 9.02, mins).
Conclusions There was no difference in infants’ physiological stability between the cradle-hold and a side-lying position for bottle feeding preterm infants. Further research is required to determine if alternate positions to the cradle hold might be beneficial for bottle feeding preterm infants.