Breastfeeding and Supplementary Oral Feeding Methods in Very Preterm Infants: A Prospective Within-Infant Comparison

Background: Very preterm infants often require supplementary oral feeding while direct breastfeeding skills mature. We compared short-term feeding performance and suck-swallow-breath coordination (SSBC) across three oral feeding methods. Materials and Methods: In this prospective within-infant study, 30 clinically stable infants born at <32 weeks’ gestation were evaluated at ≥34 weeks’ corrected gestational age. Each infant underwent three routinely scheduled feeds approximately 3 hours apart: direct breastfeeding, syringe-assisted finger feeding, and feeding with one specific slow-flow NaturalWave ® bottle. Feeding order was systematically counterbalanced. SSBC was assessed during standardized 2-minute NeoSAFE recordings. Milk transfer, achievement of prescribed feeding volume, duration, spillage, and physiological observations were recorded. Results: Exploratory analyses detected no statistically significant differences in NeoSAFE-derived SSBC parameters. Apnea events were infrequent; no statistically significant pairwise differences were detected for apnea or desaturation. The full prescribed volume was achieved in 2/30 breastfeeding sessions and 28/30 sessions with each supplementary method. Breastfeeding had lower measured milk transfer and the least spillage. The bottle and syringe-assisted finger feeding each achieved the full prescribed volume in 28/30 sessions; the bottle showed numerically faster intake than syringe-assisted finger feeding without a statistically significant difference. Heart rate differences were observed between methods, but their clinical significance was uncertain. Conclusions: The methods differed in short-term volume-delivery characteristics. Absence of statistically significant SSBC differences does not establish equivalence. Bottle findings are product-specific and do not address breastfeeding initiation, exclusivity, or duration. Randomized trials are needed to evaluate long-term breastfeeding outcomes.