A Critical Review of Interventions Supporting Transition from Gavage to Direct Breastfeeding in Hospitalized Preterm Infants

Even though direct breastfeeding holds many benefits for preterm infants, the transition from gavage to direct breastfeeding remains suboptimal in this population. Failing this transition can contribute to an early cessation of direct breastfeeding and jeopardize the preterm infants' growth and development. Preterm infants could benefit from interventions that promote the transition to direct breastfeeding and thus facilitate this challenging step. This review identifies and analyzes interventions classified in four categories: non-nutritive sucking (NNS) and oral stimulation, promotion of direct breastfeeding experience and avoidance of bottles, cue-based feeding approach, and exposure to human milk odor. All of these interventions improved the preterm infants' sucking competency, decreased their hospitalization length or increased the breastfeeding rates at discharge. NNS and oral stimulation, and promotion of direct breastfeeding experience and avoidance of bottles are the interventions with the highest evidence level, with the most potential for NICU implementation.