Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

A Controlled-flow Vacuum-free Bottle System Enhances Preterm Infants’ Nutritive Sucking Skills


We have shown that a controlled-flow vacuum-free bottle system (CFVFB) vs. a standard bottle (SB) facilitates overall transfer and rate of milk transfer, and shortens oral feeding duration in very-low-birth-weight (VLBW) infants. We aimed to understand the basis by which this occurs. Thirty infants (19 males; 27 ± 1 weeks gestation) were randomized to a CFVFB or SB. Outcomes monitored at 1–2 and 6–8 oral feedings/day when infants were around 34 and 36 weeks postmenstrual age, respectively, included: overall transfer (% volume taken/volume prescribed), rate of milk transfer (ml/min), sucking stage, frequency of suction (#S/s) and expression (#E/s), suction amplitude (mmHg), and sucking burst duration (s). At both periods we confirmed that infants using a CFVFB vs. SB demonstrated greater overall transfer and rate of milk transfer, along with more mature sucking stages. Suction and expression frequencies were decreased with CFVFB vs. SB at 1–2 oral feeding/day; only that of suction was reduced at 6–8 oral feedings/day. No group differences in suction amplitude and burst duration were observed. We speculate that oral feeding performance improves without significant change in sucking effort with a CFVFB vs. SB. In addition, we have shown that VLBW infants can tolerate faster milk flow than currently presumed. Finally, the use of a CFVFB may reduce energy expenditure as it enhances feeding performance without increasing sucking effort.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6


  1. 1.

    Hawdon JM, Beauregard N, Slattery J, Kennedy G. Identification of neonates at risk of developing feeding problems in infancy. Dev Med Child Neurol. 2000;42:235–9.

  2. 2.

    Comrie JD, Helm JM. Common feeding problems in the intensive care nursery: maturation, organization, evaluation, and management strategies. Semin Speech Lang. 1997;18:239–60.

  3. 3.

    Gardner SL, Hagedorn MI. Physiologic sequelae of prematurity: the nurse practitioner’s role. Part V. Feeding difficulties and growth failure (pathophysiology, cause, and data collection. J Pediatr Health Care. 1991;5:122–134.

  4. 4.

    VandenBerg KA. Nippling management of the sick neonate in the NICU: the disorganized feeder. Neonatal Netw. 1990;9:9–16.

  5. 5.

    Lau C, Hurst N. Oral feeding in infants. Curr Probl Pediatr. 1999;29:105–24.

  6. 6.

    Schanler RJ, Shulman RJ, Lau C, Smith EO, Heitkemper MM. Feeding strategies for premature infants: randomized trial of gastrointestinal priming and tube-feeding method [see comments]. Pediatrics. 1999;103:434–9.

  7. 7.

    Burklow KA, Phelps AN, Schultz JR, McConnell K, Rudolph C. Classifying complex pediatric feeding disorders. J Pediatr Gastroenterol Nutr. 1998;27:143–7.

  8. 8.

    Burklow KA, McGrath AM, Kaul A. Management and prevention of feeding problems in young children with prematurity and very low birth weight. Inf Young Children. 2002;14:19–30.

  9. 9.

    Harris M. Oral-motor management of the hight-risk neonate. Phys Occup Ther Pediatr. 1986;6:231–53.

  10. 10.

    Bazyk S. Factors associated with the transition to oral feeding in infants fed by nasogastric tubes. Am J Occup Ther. 1990;44:1070–8.

  11. 11.

    McGrath JM, Braescu AV. State of the science: feeding readiness in the preterm infant. J Perinat Neonatal Nurs. 2004;18:353–68.

  12. 12.

    Thoyre SM. Developmental transition from gavage to oral feeding in the preterm infant. Annu Rev Nurs Res. 2003;21:61–92.

  13. 13.

    Shaker CS, Woida AM. An evidence-based approach to nipple feeding in a level III NICU: nurse autonomy, developmental care, and teamwork. Neonatal Netw. 2007;26:77–83.

  14. 14.

    Lau C. Effects of stress on lactation. Pediatr Clin North Am. 2001;48:221–34.

  15. 15.

    Wolff PH. The serial organization of sucking in the young infant. Pediatrics. 1968;42:943–56.

  16. 16.

    Sameroff AJ. The components of sucking in the human newborn. J Exp Child Psychol. 1968;6:607–23.

  17. 17.

    Buchholz DW, Bosma JF, Donner MW. Adaptation, compensation, and decompensation of the pharyngeal swallow. Gastrointest Radiol. 1985;10:235–9.

  18. 18.

    Bu’Lock F, Woolridge MW, Baum JD. Development of co-ordination of sucking, swallowing and breathing: ultrasound study of term and preterm infants. Dev Med Child Neurol. 1990;32:669–78.

  19. 19.

    Lau C, Alagugurusamy R, Schanler RJ, Smith EO, Shulman RJ. Characterization of the developmental stages of sucking in preterm infants during bottle feeding. Acta Paediatr. 2000;89:846–52.

  20. 20.

    Lau C, Smith EO, Schanler RJ. Coordination of suck-swallow and swallow respiration in preterm infants. Acta Paediatr. 2003;92:721–7.

  21. 21.

    Gewolb IH, Vice FL. Maturational changes in the rhythms, patterning, and coordination of respiration and swallow during feeding in preterm and term infants. Dev Med Child Neurol. 2006;48:589–94.

  22. 22.

    Kaye H. Infant sucking behavior and its modification. In: Lipsitt LP, Spiker CC, editors. Advances in child development and behavior, vol. 3. New York: Academic Press; 1967. p. 1–52.

  23. 23.

    Crook CK. Taste and the temporal organization of neonatal sucking—The genesis of sweet preference. In: Weiffenbach JM, editor. Taste and development. DHEW Publ No. (NIH) 77-1068, Bethesda, MD: Department of HEW, NIH; 1977. p. 146–60

  24. 24.

    Colley JRT, Creamer B. Sucking and swallowing in infants. Br Med J. 1958;2:422–4.

  25. 25.

    Ardran GM, Kemp FH, Lind J. A cineradiographic study of bottle feeding. Br J Radiol. 1958;31:11–22.

  26. 26.

    Ardran GM, Kemp FH, Lind JA. Cineradiographic study of breast feeding. Br J Radiol. 1958;31:156–62.

  27. 27.

    Adverson JC, Lefton-Greif MA. Pediatric videofluoroscopic swallow studies. A professional manual with caregiver guidelines. San Antonio, TX: Communication Skill Builders; 1998.

  28. 28.

    Lau C, Sheena HR, Shulman RJ, Schanler RJ. Oral feeding in low birth weight infants. J Pediatr. 1997;130:561–9.

  29. 29.

    Lau C, Kusnierczyk I. Quantitative evaluation of infants nonnutritive and nutritive sucking. Dysphagia. 2001;16:58–67.

  30. 30.

    Lau C, Schanler RJ. Oral feeding in premature infants: advantage of a self-paced milk flow. Acta Paediatr. 2000;89:453–9.

  31. 31.

    Ehrenkranz RA, Walsh MC, Vohr BR, Jobe AH, Wright LL, Fanaroff AA, et al. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics. 2005;116:1353–60.

  32. 32.

    Papile L, Burnstein J, Burnstein R, Kuffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 grams. J Pediatr. 1978;92:529–34.

  33. 33.

    Fucile S, Gisel E, Lau C. Oral stimulation accelerates the transition from tube to oral feeding in preterm infants. J Pediatr. 2002;141:230–6.

  34. 34.

    Mathew OP. Breathing patterns of preterm infants during bottle feeding: role of milk flow. J Pediatr. 1991;119:960–5.

  35. 35.

    Scheel CE, Schanler RJ, Lau C. Does the choice of bottle nipple affect oral feeding performance of very-low-birth-weight (VLBW) infants? Acta Paediatr. 2005;94:1–8.

  36. 36.

    Medoff-Cooper B, Verklan T, Carlson S. The development of sucking patterns and physiologic correlates in very-low-birth-weight infants. Nurs Res. 1993;42:100–5.

Download references


The authors thank C. Scheel, MD, for his assistance in data collection, and E. O. Smith, PhD, and K. Fraley for their assistance in statistics. This project was supported by the National Institute of Child Health and Human Development (R01-HD28140; R01-HD044469) and the Fonds de la Recherche en Santé du Québec for a graduate student scholarship (SF). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute of Child Health and Human Development or the National Institutes of Health.

Author information

Correspondence to Chantal Lau.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Fucile, S., Gisel, E., Schanler, R.J. et al. A Controlled-flow Vacuum-free Bottle System Enhances Preterm Infants’ Nutritive Sucking Skills. Dysphagia 24, 145–151 (2009). https://doi.org/10.1007/s00455-008-9182-z

Download citation


  • Bottle feeding
  • Oral feeding
  • Suck-swallow-breathe
  • VLBW
  • Prematurity
  • Deglutition
  • Deglutition disorders