How to Read the Nipple Size on Enfamil Nipple

Am J Speech Lang Pathol. 2022 November; 24(four): 671–679.

Milk Period Rates From Bottle Nipples Used for Feeding Infants Who Are Hospitalized

Britt F. Pados

^aSchool of Nursing, The University of N Carolina at Chapel Hill

Jinhee Park

^bSchoolhouse of Nursing, Duke University, Durham, NC

Suzanne One thousand. Thoyre

^aSchool of Nursing, The University of N Carolina at Chapel Hill

Hayley Estrem

^aSchoolhouse of Nursing, The University of North Carolina at Chapel Hill

W. Brant Zippo

^aSchool of Nursing, The Academy of North Carolina at Chapel Hill

Received 2022 Feb 2; Revised 2022 May 25; Accepted 2022 Jul three.

Abstract

Purpose

This study tested the milk flow rates and variability in flow of currently available nipples used for bottle-feeding infants who are hospitalized.

Method

Clinicians in 3 countries were surveyed regarding nipples bachelor to them for feeding infants who are hospitalized. Twenty-nine nipple types were identified, and 10 nipples of each type were tested past measuring the amount of infant formula expressed in 1 min using a chest pump. Mean milk catamenia charge per unit (mL/min) and coefficient of variation were used to compare nipples within brand and within category (i.e., Irksome, Standard, Premature).

Results

Flow rates varied widely betwixt nipples, ranging from 2.10 mL/min for the Enfamil Cantankerous-Cut to 85.34 mL/min for the Dr. Chocolate-brown'due south Y-Cut Standard Neck. Variability of flow rates amid nipples of the aforementioned type ranged from a coefficient of variation of 0.05 for Dr. Dark-brown's Level i Standard- and Wide-Neck to 0.42 for the Enfamil Cross-Cut. Mean coefficient of variation by brand ranged from 0.08 for Dr. Brown's to 0.36 for Bionix.

Conclusions

Milk menstruation is an easily manipulated variable that may contribute to the degree of physiologic instability experienced by infants who are medically fragile during oral feeding. This written report provides clinicians with data to guide advisable selection of canteen nipples for feeding infants who are hospitalized.

Feeding tin can exist physiologically challenging for premature and medically delicate infants who are learning to feed orally. Whereas breast-feeding may exist the ultimate goal, most infants who are hospitalized volition receive some bottle-feedings. Many variables contribute to an baby's power to canteen-feed safely and effectively, but one easily manipulated variable is the charge per unit of milk menses from the bottle nipple. Milk menses is defined as the rate of transfer of milk from the bottle into the rima oris during sucking. The rate of milk period can affect an baby'south ability to integrate fluid management with respiration, every bit well as the degree of ventilatory compromise associated with feeding (al-Sayed, Schrank, & Thach, 1994; Mathew, 1991a). When an baby swallows, the airway is closed for about i s to foreclose aspiration of milk (Mathew, 1991b). As milk menstruation increases and requires increased swallowing frequency, ventilation is increasingly interrupted and respiratory charge per unit decreases (al-Sayed et al., 1994). When milk flow slows, the consume is delayed until a disquisitional book is accumulated (al-Sayed et al., 1994), allowing the baby to breathe more frequently and better maintain physiologic stability during feeding.

Rate of milk flow varies considerably across different brands and types of nipples (Jackman, 2013; Mathew & Cowen, 1988). Healthy, full-term infants are typically resilient feeders and are able to alter their sucking rate (Schrank, Al-Sayed, Beahm, & Thach, 1998) and pressure (Colley & Creamer, 1958; Mathew, Belan, & Thoppil, 1992) in gild to regulate milk period. On the other hand, infants who are medically delicate, such every bit those born preterm, have a limited power to self-regulate catamenia (Mathew, 1991a). When milk flow is too high, the babe must consume at a frequency adequate to articulate the oropharynx of fluid and prevent aspiration (at the expense of ventilation; al-Sayed et al., 1994), allow the milk to puddle in the oropharynx (and hazard aspiration), divert the milk abroad by allowing it to drool out the rima oris (Schrank et al., 1998), or stop feeding.

Clinicians caring for infants who are hospitalized are faced with decisions about nipple selection to back up infants who are medically frail in learning to feed orally, just at that place is merely 1 recently published study of flow rates from currently available nipples to support these decisions. Jackman (2013) conducted a study of flow rates from 23 types of nipples, vi of which were identified every bit existence used in the setting of neonatal intensive care units. Wide variability was found in the period rates of nipples tested, ranging from 6 to lx mL/min. Nipples marketed as "tiresome-catamenia" varied considerably in the menstruation rates delivered, with some having three times the catamenia of others. Furthermore, significant variation was reported between nipples of the same type. Given the variability between nipples of the aforementioned blazon, Jackman'due south report was limited in that only one nipple per type was tested for nipples intended for multiple employ, and three nipples per blazon were tested for single-utilize nipples. To business relationship for the variability betwixt nipples and to determine an accurate mean flow rate of each nipple type, more tests were needed. No statistical analysis was presented in the report of Jackman's study.

Speech-language pathologists are amidst the clinicians who assess feeding in infants who are hospitalized and recommend feeding management strategies, which may include specification of canteen nipples to exist used for feeding. More data is needed to support clinicians in determination making regarding nipple selection for feeding infants who are hospitalized. Without this information, infants are often exposed to multiple types of nipples in an attempt to find a good lucifer. The variability in nipples during early on oral feeding may contribute to the length of time required to successfully feed and, ultimately, to length of stay. This comparative, descriptive written report tested the milk flow rates and variability of nipples used for bottle-feeding infants who are hospitalized.

Method

This written report was exempt from review by the institutional review board, because no human or brute subjects were involved in the study. Clinicians from the United States, the netherlands, and Australia were informally surveyed regarding nipples bachelor to them for feeding infants in the infirmary. Twenty-nine nipples were identified and tested (meet Table 1). A ability analysis was conducted using data from the get-go eight nipple types tested (northward = 80 private nipples) to determine the sample size required to compare flow rates between nipple types with lxxx% power at an α of .05. This analysis revealed that a sample size of 10 nipples from each nipple type would provide ample ability, even in the event of an effect size < .3 and moderate correlation betwixt nipples of the same type. Ten nipples of each nipple blazon were tested.

Table ane.

Nipples tested.

Brand proper name	Visitor and location	Nipples tested
Bionix	Bionix Medical Technologies, Toledo, OH	Controlled Flow Infant Feeder Levels 1–5 (nipples and flow-restrictor systems tested separately)
Difrax	Difrax BV, Bilthoven, the netherlands	Teat Natural Standard-Cervix Pocket-sized (0+ months)
Dr. Brown's	Handi-Craft Co., St. Louis, MO	Level 1 Standard-Neck
		Level 1 Broad-Neck
		Ultra-Preemie
		Preemie
		Y-Cut Standard Neck
Enfamil	Mead Johnson & Co., Glenview, IL	Standard-Flow (purple-blue collar)
		Slow-Catamenia (turquoise neckband)
		Preemie (light-blue neckband)
		Cantankerous-Cut (yellow collar)
Medela	Medela Inc., McHenry, IL	SpecialNeeds Feeder (formerly Haberman Feeder)
NUK	NUK United states LLC, Hackensack, NJ	Orthodontic Silicone Slow-Period Standard-Neck
Pigeon	Pigeon, Tokyo, Japan	Standard-Flow
		Slow-Flow
		No-Drip
Similac	Abbott Nutrition, Lake Forest, IL	Infant (xanthous nipple, clear collar)
		Irksome Flow (yellow nipple, yellowish collar)
		Orthodontic (yellow nipple, clear collar)
		Premature (red nipple, clear collar)

The method used in this report was designed to exam nipples under standardized and controlled weather condition as a means to compare catamenia rates between nipple types. Infants feed with varying sucking rates and pressures and volition achieve different period rates within and between feedings. The menses rates established past this method are not necessarily the flow rates that an infant will achieve when feeding.

All of the nipples except the Dr. Brownish's Level 1 Wide-Cervix fit on a sixty-mL Grad-U-Feed Nurser (Mead Johnson & Co., Glenview, IL) and were tested with this bottle. The Dr. Brown's Level 1 Wide-Neck nipple was tested using a Dr. Brown's Wide-Neck bottle. Bottles were filled with Similac Advance Stage ane (20 cal/oz) ready-to-feed formula (Abbott Laboratories, Abbott Park, IL). To ensure equal levels of hydrostatic pressure, the height from the level of the liquid surface to the tip of the nipple was maintained at 2.five cm (see Figure 1), requiring fifty mL of formula for nipples tested with the Grad-U-Feed Nurser and 70 mL for the Dr. Brown's Wide-Neck bottle. The formula was changed after every x tests to foreclose increased viscosity as a event of denaturation of proteins from prolonged exposure to air. Changing the formula after every 10 tests ensured that formula was never used after being open for more than thirty min. The manufacturer, Similac (Abbott Laboratories, Abbott Park, IL), recommends using formula within 1 hour of opening or mixing. In addition, using the set-to-feed formula reduced the potential for variability in milk thickness due to differences in formula preparation over time.

Hydrostatic pressure measured every bit the superlative from the level of the nipple opening to the level of fluid.

The bottle-and-nipple unit beingness tested was attached to the breast shield of a breast pump using a layer of plastic paraffin film followed past a silicone-based polymer to create a seal. The canteen-and-nipple unit was held at a 30° angle (see Figure 2). A negative-pressure system was created using a Pump in Way Avant-garde breast pump (Medela Inc., McHenry, IL). The stimulation-phase suction pattern with a suction force per unit area of 180 mmHg was used for all tests. Given the opportunities for loss of suction from the pump to the nipple, negative force per unit area within the bottle was tested later every l tests using the Samba 201 Micro Pressure Measurement System (BIOPAC Systems, Inc., Goleta, CA). Hateful suction rate was 110 c/min and mean negative pressure level within the bottle was 14 mmHg.

Nipple testing equipment.

Formula was expressed for ane min into a 500-mL beaker situated on a calibrated platform scale (Thermo Fisher Scientific, Inc, Waltham, MA), accurate to 0.01 m. At the determination of i min, the weight of formula expressed was recorded. Outliers were retested to ensure accurateness of the measurement. Tests were video-recorded and measurements were confirmed by video review. Milk flow rates (mL/min) were calculated using the density of Similac Advance formula of 0.97 mL/g (AVCalc, 2014).

The Bionix Controlled Period Baby Feeder consists of two parts that may contribute to variability in milk catamenia: the nipple with the silicone inner aqueduct and the period-restrictor (FR) organisation, consisting of the yellow menstruation restrictor, purple seal, and green flow adjuster (Bionix Medical Technologies, 2014). Because the nipple and FR system may contribute to flow in dissimilar ways, 10 nipples were tested using the same FR system, and separately, ten FR systems were tested using the same nipple. For both the nipple and FR tests, the Bionix was tested on each of the five menstruum levels, resulting in a total of 100 tests. Likewise of note, the Dr. Chocolate-brown'due south nipples were tested with the venting system in identify, which is how the nipple is intended to be used. The venting system comprises the cream-colored vent insert and the bluish vent reservoir (Handi-Arts and crafts Company, 2015a). The Medela SpecialNeeds Feeder was tested without the white circular valve membrane or the yellow circular disc (Medela Inc., 2015). The method used in this written report for applying negative pressure to the nipple could not work with the valve membrane in place. The SpecialNeeds Feeder is intended to have three menstruation levels—zero, medium, and maximum—depending on the position of the slit opening in the baby's mouth when positive pressure level (i.e., pinch) is practical by the infant'due south oral cavity (Medela Inc., 2014). In this study, no positive force per unit area was applied. In the presence of negative pressure only, the slit opening should, theoretically, answer similarly regardless of positioning, but nipples were tested in the same position for consistency.

Statistical Analysis

Mean milk flow rate (mL/min) and standard divergence were calculated for each nipple type. Variability within nipple types was assessed using the coefficient of variation (CV; SD/1000). To compare variability across nipple types, CV was categorized into three levels: low (<0.ane), moderate (0.ane–0.2), and high (> 0.2).

The Shapiro–Wilk statistic was used to appraise nipples for normality, with an α of .05 considered significant. Comparisons betwixt nipple types were made within brand and within category (Dull, Standard, and Premature) using one-manner analysis of variance (ANOVA) when normally distributed; nonparametric one-mode ANOVA was used otherwise. Multiple comparison tests for the post hoc analysis of one-way ANOVA utilized Duncan'southward multiple range examination, with an α of .05 existence significant. When nonparametric one-way ANOVA was utilized, pairwise comparisons were fabricated using the Wilcoxon rank-sum test, and the alpha was adjusted using a Bonferroni adjustment.

For the purpose of comparing nipples within the categories of Ho-hum, Standard, and Premature, nipples were categorized by name, with a few exceptions. The Bionix Level i is intended to "introduce gustation" and the Level 2 is intended to evangelize a deadening menstruation (Bionix Medical Technologies, 2014); these ii levels were categorized as Ho-hum. The Bionix Level v is intended to deliver flow "at or near a flow rate of a Phase i nipple" (Bionix Medical Technologies, 2014), so this was categorized equally Standard. For comparisons within category, the Bionix nipple and FR tests were combined for each level. Dr. Brown's Preemie and Ultra-Preemie were included in the categories of both Slow and Premature. Dr. Brown's Level ane Wide- and Standard-Neck were categorized as Standard. The Medela SpecialNeeds Feeder was categorized every bit Tedious.

Results

Menstruum rates varied widely betwixt nipples, ranging from ii.10 mL/min for the Enfamil Cross-Cut (also change four lines down) to 85.34 mL/min for the Dr. Brown's Y-Cut Standard Neck (run across Figure three). Variability of flow rates amidst nipples of the same type ranged from a CV of 0.05 for Dr. Brown's Level 1 Standard- and Broad-Neck to 0.42 for the Enfamil Cross-Cut (see Effigy 4). Mean CV past brand ranged from 0.08 for Dr. Brown's to 0.36 for Bionix (see Figure 5).

Milk menses rates of all nipples tested (mL/min). FR = flow restrictor.

Coefficient of variation (CV) of milk period of all nipples. Nipples are color coded by category of CV. Diagonal pattern indicates CV < 0.1, gray indicates CV 0.1–0.two, and black indicates CV > 0.2. CV = M/SD; FR = flow restrictor.

Mean coefficient of variation (CV) of milk menstruation rates by nipple brand. Calculated as the mean of the CV of each nipple type by each brand. Brands are colour coded by category of CV. Diagonal pattern indicates mean CV < 0.1, greyness indicates CV 0.1–0.2, and black indicates CV > 0.2.

Comparisons Within Brand

Bionix Controlled Flow Baby Feeder

This organization was tested to evaluate the flow and variability of the nipples (indicated by an N subsequently the level in the text) and the FR systems (indicated past an FR after the level in the text and figures) separately. For both the nipple and FR tests, milk period increased overall in the management intended (Level 1 existence the slowest and Level five being the fastest). Inside the nipple tests, each level provided a significantly different flow rate (p < .001), with the exception of Levels 2N and 3N, which were not significantly different. Within the FR tests, 2FR and 3FR were non significantly different and 4FR and 5FR were not significantly different.

Comparing the FR tests to the nipple tests, Levels 1N and 1FR were comparable and Levels 2N and 2FR were comparable. For all levels higher up 2, the nipple tests were significantly (p < .001) slower than the FR tests. For all levels above 1, there was overlap between levels. Levels 2N, 2FR, and 3N were all similar to i another. Level 3FR was comparable to Levels 4N and 5N. At each level, the CV was higher for the FR tests than the nipple tests. Bionix Levels 3N and 5N were the only levels with CV < 0.ane.

Dr. Dark-brown's

All levels of Dr. Brown's nipples were found to be significantly different (p < .005), with the exception of the Preemie and Level 1 Wide-Neck, which were found to exist comparable. Dr. Dark-brown's Ultra-Preemie performed equally intended, with the lowest flow (3.39 mL/min) of all the nipples by this brand; this nipple had the second lowest menstruum of the 29 nipple types tested in this report. Dr. Brownish's Y-Cut Standard Neck had the highest period of all the nipples tested (85.34 mL/min) and was moderately variable, with a CV of 0.13. All of the other Dr. Dark-brown's nipples had a CV < 0.one.

Enfamil

All levels of Enfamil nipples were institute to be significantly different (p < .05), with the Cantankerous-Cut being the slowest and the Preemie being the fastest. Enfamil Standard-Menses was the only nipple with a CV < 0.1.

Similac

Slow Menstruum and Baby nipples did not accept significantly different flow rates. Similac Slow Catamenia ranged from 6.16 to ix.38 mL/min (CV 0.i–0.two), whereas Similac Infant ranged from 3.8 to 12.0 mL/min (CV > 0.two). Similac Orthodontic was significantly faster (p < .05) than Slow Flow or Infant and was highly variable (CV > 0.two). Similac Premature was the fastest of all Similac products (p < .05).

Pigeon

All levels of Pigeon nipples were significantly different (p < .05). The No-Baste was the slowest only likewise the most variable (CV > 0.ii).

Comparisons Inside Category

Boring Nipples

Ix of the 29 nipples tested were categorized every bit Slow, with flow ranging from three.39 to 14.68 mL/min (run across Figure vi). Dr. Brown's Ultra-Preemie, Bionix Level 1, and Medela SpecialNeeds Feeder were comparable to one some other; these were all significantly slower (p < .001) than the other Dull nipples. Bionix Level 2, Dr. Brown's Preemie, NUK Slow-Flow, and Similac Tiresome Flow all delivered comparable catamenia. Enfamil Irksome-Flow was significantly faster (p < .001) than all other Slow nipples. Dove Deadening-Flow was significantly slower than Enfamil Wearisome-Flow (p < .001) only significantly faster (p < .05) than all other Slow nipples.

Milk flow rates of Slow nipples (mL/min). Nipples indicated by the same color/pattern are comparable in flow rate.

Standard Nipples

7 nipples were categorized as Standard, with period ranging from half dozen.61 to 25.07 mL/min (see Figure 7). Similac Infant, Difrax, and Dr. Chocolate-brown's Level 1 Broad- and Standard-Neck nipples were comparable to one some other; these were all significantly slower than the other Standard nipples (p < .05).

Milk menstruation rates of Standard nipples (mL/min). Nipples indicated by the same color/pattern are comparable in period rate.

Premature Nipples

Four nipples were categorized as Premature, with flow ranging from 3.39 to 22.68 mL/min (come across Figure 8). All four Premature nipples delivered significantly unlike flow rates (p < .05).

Milk flow rates of Premature nipples (mL/min). Nipples indicated by the same colour/pattern are comparable in flow charge per unit. Annotation that all 4 Premature nipples had significantly different flow rates.

Give-and-take

Choosing a nipple for feeding an infant who is medically fragile is an important decision, given the wide range of flow rates found in this study. The name of a nipple (due east.g., "Irksome") is not always an authentic indicator of the flow rate. In addition, variability in menses charge per unit betwixt and within nipple types is an added challenge that may contribute to feeding difficulty.

Within the Bionix make, for all levels to a higher place Level 1, there was overlap in period rates between levels, suggesting that the Bionix Controlled Menstruation Infant Feeder may non perform as expected when the user increases the flow adjuster from one level to the side by side. The FR systems were especially variable, with iv of the levels having CV > 0.ii. Changing the nipple or the FR may inadvertently change the flow rate delivered, fifty-fifty if the user sets the catamenia adjuster to the same position.

Bionix does provide a Flow Rate Comparison chart on its website (Bionix Medical Technologies, 2014). According to Bionix, a similar, but not completely transparent, method was used to examination menstruum rates for 50 s using a Medela Archetype Breast Pump (S. Herzig, personal communication, March 2014). Our results were consistent with Bionix's for the increase in menstruation between Levels one and 2; the company found a 75% increase where nosotros constitute 77%. Both our tests and Bionix'southward institute the greatest increment in period to exist between Levels 3 and four. Bionix also tested nipples fabricated by other companies, simply it is difficult to make comparisons because the names of the nipples have changed and the methods may have been different. In the current report, Bionix Level 1 was amongst the slowest of the nipples tested and may be useful for feeding infants who crave a very slow flow.

Dr. Dark-brown's markets the Ultra-Preemie nipple every bit existence 35% slower than the brand'south Preemie nipple (Handi-Craft Company, 2015b). In our tests, the Ultra-Preemie was 54% slower than the Preemie nipple. Dr. Brown's brand was the most consistent make, with the lowest hateful CV of all brands (see Figure 5).

The Enfamil Cross-Cut was the slowest of all nipples tested. Cantankerous-cut nipples have two slits that form a cantankerous at the tip of the nipple. Enfamil advertises this nipple as having a faster flow than the make's standard nipple (Enfamil Cross-Cut Nipple, n.d.), which is not consistent with our findings. Cantankerous-cutting nipples are described as varying in flow, with increasingly faster period as the infant applies suction and opens the cross wider (First & St James-Roberts, 2000). Two clinical studies accept evaluated the physiologic effects of feeding with either a cross-cutting or a single-pigsty nipple and found that, at sucking pressures established by preterm infants, the cantankerous-cut yielded slower menses than the single hole (Chang, Lin, Lin, & Lin, 2007; Kao, Lin, & Chang, 2010). These studies did not utilise Enfamil nipples, but they may support further investigation of our findings and of how the cantankerous-cut performs in practise.

For both the Enfamil and Similac brands, the Premature nipple was faster than the Slow and Standard nipples. This is important for clinical practise, as many clinicians assume that a nipple labeled "Premature" has a slower period charge per unit. Premature infants typically generate lower sucking pressures than full-term infants (Medoff-Cooper, McGrath, & Shults, 2002) and may become fatigued early on in the feeding, before acceptable volume is ingested. At that place was a previously held pop belief that increasing the menses rate for these infants would make it easier for them to transfer milk, given low sucking pressures (Mathew, 1990), and that faster feedings would allow them to intake book earlier becoming fatigued. Certain premature nipples may have been designed on the basis of these assumptions. More current evidence supports slower menses for maintaining physiologic stability during feeding for these infants, allowing them to breathe more (al-Sayed et al., 1994; Mathew, 1991a; Park, Thoyre, Knafl, Hodges, & Aught, 2014), maintain better oxygenation, and suffer oral feeding longer.

The variability institute between nipples of the same nipple type is likely the result of differences in manufacturing processes. Nipple holes may be created through a variety of methods, including mechanical drilling, laser cutting, and hole punching. In improver, nipples may be created in a mold with a standardized pigsty opening. The process for creating the nipple hole or cutting likely contributes to the variability in nipple hole size and, therefore, the variability in flow rates found in this report. At that place may likewise be other qualities of nipples, such every bit the mechanical stiffness of the nipple material, that affect menses from the nipple or the infant'south sucking during feeding that could not be detected using our methods (Barlow, 2009).

This study has some limitations. The method used in this study practical simply negative pressure to nipples. Nipples with a slit opening every bit opposed to a hole opening are likely to perform differently when positive pressure level is applied during feeding, irresolute the shape of the opening. The 2 nipples in this study with slit openings were the Enfamil Cross-Cutting and the Medela SpecialNeeds Feeder; circumspection should exist used when interpreting these results, equally the flow rates may exist different in practice. Besides, the Dr. Dark-brown'south Y-Cut Standard Neck nipple was tested with standard-thickness formula. In clinical practice, this nipple is typically used with thickened milk for infants who are medically fragile, which likely affects flow rate.

Conclusions and Future Directions

Milk catamenia is an important variable in the complex task of oral feeding for infants who are medically fragile. This study confirmed results of previous studies (Jackman, 2013; Mathew & Cowen, 1988) which found a wide range in milk menstruum rates from dissimilar nipple types. This study has built on previous work by testing additional nipples that are currently available for feeding infants who are hospitalized, further exploring variability within nipple types, and improving upon the testing and analysis methods.

Clinicians may use these data to guide nipple option for infants who are medically frail by comparison the flow rates and variability of the nipples that are available within their institutions. Evidence-based decisions regarding nipple selection may back up optimal oral feeding for infants who are frail and facilitate earlier discharge home. Given the importance of milk flow for infants who are delicate, manufacturers of nipples should consider providing information on nipple packaging that reflects flow rate and variability of each nipple blazon; this would help to reduce whatever confusion related to the naming of nipples (i.eastward, "Slow," "Standard," "Premature"), which may non accurately reflect menstruation rate. Manufacturers could as well use the data from this report to amend upon nipple construction to reduce variability, particularly in nipples intended for infants who are delicate.

Researchers should utilise these data to make decisions well-nigh nipples used in tests of feeding interventions and select nipples with depression variability in order to ensure consistency of menses. The specific nipple(s) used, catamenia charge per unit, and variability of nipples should exist documented in reports of feeding intervention studies.

Testing of menstruation rates of the nipples in this report volition demand to be repeated periodically to reflect currently available nipples. In addition, testing of milk flow rates of nipples used for feeding infants afterwards discharge is currently underway and volition provide clinicians with data to guide parents in selecting nipples for apply at abode that are comparable in flow to those with which the infant has been successful in the infirmary. Future enquiry should consider testing the consequence of milk type (due east.g., formula vs. breast milk), caloric density, and thickness on flow rates from bottle nipples. In add-on, testing the menstruation rate and variability in canteen nipples on the sucking parameters (e.grand., sucking pressure and charge per unit) of infants who are delicate would provide information to tailor nipple selection to sucking blueprint to further back up infants who are fragile as they learn to eat.

Acknowledgments

This study was funded by a Sigma Theta Tau International Honour Guild of Nursing Alpha Alpha Chapter Inquiry Award, awarded to Britt F. Pados, and was supported by the National Institute of Nursing Research under Laurels 5F31NR011262, also awarded to Britt F. Pados. The authors would like to acknowledge support provided to this projection by the Biobehavioral Laboratory at the Academy of Northward Carolina at Chapel Hill School of Nursing. Nipples for testing were donated past Boston Children's Hospital, Duke University Medical Centre, Floating Hospital for Children at Tufts University Medical Eye, Groningen University (Netherlands), Handi-Craft Co., Medela Inc., N Carolina Children'southward Hospital, Royal Children's Infirmary (Commonwealth of australia), and University of Oklahoma Children's Hospital.

Funding Argument

This study was funded by a Sigma Theta Tau International Accolade Club of Nursing Blastoff Blastoff Chapter Research Award, awarded to Britt F. Pados, and was supported by the National Institute of Nursing Inquiry under Award 5F31NR011262, also awarded to Britt F. Pados.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698468/

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