Finger Feeding Vs Syringe Feeding in the NICU
by Anne Eglash MD, IBCLC, FABM
Finger feeding is a process of providing nutrition to an infant by attaching a small feeding tube to a finger and allowing the infant to suck on the finger, thereby drawing milk. Finger feeding is used as a strategy for infant feeding when there is difficulty nursing at the breast for a variety of reasons. It is most helpful when supplementing small volumes of milk. However, there is little evidence that infants who finger feed are more successful in their transition to the breast as compared to other types of supplemental feeding such as bottle, cup, or syringe feeding.
The study for this week’s question took place in a NICU in Turkey. The researchers were interested in comparing finger feeding and syringe feeding as strategies to successfully transition gavage-fed premature infants to breastfeeding.
The infants were 30-35 weeks gestational age, on room air, clinically stable, and previously fed breastmilk thru an orogastric tube. The infants had never used nipples or baby bottles, nor had they been to the breast yet.
Thirty-five infants were fed via the finger feeding method 4 times a day, using a 5-french 36-inch feeding tube inserted in a bottle of expressed breastmilk, attached to a nurse’s 5th finger.
The other 35 infants were fed via syringe feeding 4 times a day, using a 1 or 2-ml syringe to drip breastmilk into the inner side of the infants’ cheek.
For both groups, the feeding methods were limited to 20 minutes after which time feedings were finished via orogastric tube.
The infants were fed this way until they transitioned to full breastfeeding, before NICU discharge.
They found that infants in the finger feeding group were fully breastfeeding by 19.4 +/- 15 days, versus infants in the syringe fed group who were fully breastfeeding by 29.7 +/- 10.2 days.
What else? Check the question!
- The infants who were finger fed left the hospital earlier than the syringe fed infants.
- The infants who were finger fed gained significantly more weight by day 10 of the feeding intervention as compared to the syringe fed infants.
- Leakage of milk was higher with finger feeding than syringe feeding.
- Babies fed via finger feeding displayed less physiologic stress as compared to syringe feeding.
See the Answer
The aim of this study is to compare the efficiency of a new method called ‘‘finger feeding’’ with a well-known technique called syringe feeding for improving sucking skills and accelerating transition to breastfeeding in preterm infants.
Materials and Methods
Totally 70 babies were included in this prospective randomized controlled study. Finger feeding method was applied in Group 1 (n = 35) and syringe feeding method was applied in Group 2 (n = 35). The COMFORTneo scale (CnS), oxygen saturation, pulse, respiratory rate, body temperature, amount of breast milk taken, and vomiting data were recorded before and after both applications. Hospitalization period and time elapsed for complete transition from both methods to breastfeeding were also recorded.
There was no statistical difference for birth weights, mean gestational age, and vital signs recorded before and after feeding between two groups. Predicted comfort and distress scores of Group 1 determined by the CnS were significantly lower than those of Group 2. This means that babies in the finger feeding group had better comfort than the those in Group 2 (p = 0.000). Time passed for transition to breastfeeding was significantly shorter than that in Group 2 (19.4 – 15.0 days versus 29.7 – 10.2 days, p = 0.000). Group 1 had lower amount of food leakage while feeding and their average weight gain at the end of 10th day was significantly higher (322.1 – 82.3 g versus 252 – 108.4 g, p = 0.004). They also were discharged earlier than Group 2 (25.8 – 17.4 days versus 35.9 – 13.0 days, p = 0.001).
Finger feeding method is an effective way for increasing sucking abilities, accelerating transition to breastfeeding, and shortens duration of hospitalization in preterm infants.
In this study, finger feeding led to negligible amounts of spillage, vs an average of approximately 1.75-3.5 ml spillage with syringe feeding. There are very few studies on finger feeding, although it is a common intervention for supplementation for term infants early postpartum. IABLE has a free video on YouTube demonstrating finger feeding.
It would make sense that infants feel less stressed with finger feeding vs syringe feeding since they have control over the process. I don’t know how many NICUs are really using the syringe feeding technique described in this study. From my experience in the USA, bottles are much more common when transitioning from gavage, as compared to any other supplementation method. It would be beneficial to compare finger feeding to bottle feeding when transitioning to full breastfeeding, for both preterm and full-term populations.