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CompletedNCT05815706Updated Apr 18, 2023

The Effect of the SNS-Based Feeding on Transition to Exclusive Breastfeeding in Preterm Infants

An interventional study of MEDELA Supplemental nursing system in Breastfeeding, Preterm Infant and Sucking Behavior, sponsored by Istanbul Medeniyet University. Completed at 1 site in Turkey. Open to participants aged 30 Weeks to 34 Weeks, including healthy volunteers. Per ClinicalTrials.gov, last updated 2023-04-18.

Sponsored by Istanbul Medeniyet University · Not applicable, Interventional, and Supportive care

From the registry’s dates

  • Registered 4 years 4 months after the study started (first participant enrolled Nov 2018, registered Mar 2023).
Phase
Not applicable
Study type
Interventional
Enrollment
72
Allocation
Randomized
Ages
30 Weeks to 34 Weeks
Sex
All
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Study summary

This study investigated the effect of the Supplemental Nursing System (SNS)-based feeding on the time to transition to exclusive breastfeeding, sucking success, and the time to discharge in preterm infants

Read the detailed description

Nutrition is a critical problem in preterm infants. They should initially be enterally fed because they have poor sucking-swallowing-breathing coordination. Once a preterm infant develops that coordination, enteral feeding should be discontinued immediately. Then, the preterm should switch to oral feeding (breastmilk). However, preterm infants are not good at sucking because they get tired too quickly, have poor sucking skills, and lack enough experience. Therefore, we must use alternative supplemental feeding methods (bottle, spoon, dropper, cup, breastfeeding support system, and finger feeding) until preterm infants mature enough to meet their daily nutritional needs by breastfeeding alone (exclusive breastfeeding).

The Supplemental Nursing System (SNS) is an alternative supplemental feeding method that supports the development of sucking skills while providing the preterm infant's nutritional needs. This study investigated the effect of the Supplemental Nursing System (SNS)-based feeding on the time to transition to exclusive breastfeeding, sucking success, and the time to discharge in preterm infants.

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Conditions studied

  • Breastfeeding
  • Preterm Infant
  • Sucking Behavior

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03

In context

Premature Birth

2,554 studies on the registry are indexed under Premature Birth; 498 are open to participants now.

This study's enrollment of 72 is below the median of 84 across 1,689 interventional studies indexed under Premature Birth.

Browse Premature Birth studies →

Lead sponsor

Istanbul Medeniyet University is the lead sponsor of 188 studies on the registry; 18 are open to participants now.

Counted across the registry records on this site, refreshed daily.

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Who can participate

Ages eligible
30 Weeks to 34 Weeks
Sexes eligible
All
Accepts healthy volunteers
Yes

Inclusion criteria

  • being between the gestational ages of 30 to 34 weeks
  • having a birthweight of ≥1000 g
  • having an APGAR score of >6
  • having stabilized for 48 hours after receiving mechanical ventilator or continuous positive air pressure or both
  • being exclusively gavage-fed with breast and/or formula and ready to switch to oral feeding
  • being willing to breastfeed

Exclusion criteria

Exclusion Criteria:

  • having a congenital malformation that may cause asphyxia and affect breathing
  • having an intraventricular hemorrhage, intracranial hemorrhage, or periventricular leukomalacia
  • having intestinal anomalies or hyperbilirubinemia requiring exchange transfusion
  • having respiratory distress syndrome, bronchopulmonary dysplasia, or other chronic lung diseases.
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Study design

Phase
Not applicable
Primary purpose
Supportive care
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Investigator)
Enrollment
72 participants (actual)

Study arms

  • Experimental
    Experimental

    The experimental group participants were breastfed for ten minutes (five minutes for each breast) every day from the day they started oral feeding until they switched to exclusive breastfeeding. The nurse placed the warmed breast milk or formula in SNS. She then fixed it to the mother's nipples. Each experimental group participant sucked on the two breasts for 15 minutes. Breastfeeding (ten minutes), resting and SNS preparation (five minutes), and SNS feeding (15 minutes) were limited to a total of 30 minutes in light of earlier research.

    Device: MEDELA Supplemental nursing system

  • No intervention
    Control

    Preterm infants were fed according to the clinical feeding protocol. They were not SNS-fed.

Interventions

  • DeviceMEDELA Supplemental nursing system

    The experimental group participants were fed based on the MEDELA Supplemental Nursing System, which consists of a syringe/container and a feeding catheter. One end of the feeding probe is in the syringe/container, while the other is fixed to the mother's nipple through a plaster. MEDELA SNS is a sterile product with an adjustable breast milk flow system and neck strap. It is bisphenol A (BPA) free. All its parts are in direct contact with breast milk. This system allows the baby to both suck and feed (MEDELA Supplemental Nursing System, 2018).

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What researchers measure

Primary outcomes

  1. The time to transition to oral feeding (hours)

    It was measured when the preterm infant swiched from gavage feeding to oral feeding.

    Time frame: up to three weeks

  2. Time to discharge (hours)

    It was measured at discharge

    Time frame: up to 2 months

  3. The sucking success (First measurement)

    The sucking success was assessed using the LATCH Breastfeeding Assessment Tool. The tool was developed by Jensen et al. (1994) and adapted to Turkish by Yenal and Okumus (2003). It consists of five evaluation criteria: L (Latch on breast), how well the infant latches onto the breast; A (Audible swallowing), the amount of audible swallowing noted; T (Type of nipple), the mother's nipple type; C (Comfort, breast/nipple), the mother's level of comfort in relation to the nipple; and H (Hold/Help), the amount of help the mother needs to hold her infant to the breast. Each item is rated on a scale of 0 to 2. The total score ranges from 0 to 10, with high scores indicating successful sucking.

    Time frame: at the beginning of the study, up to three weeks

  4. The sucking success (Second measurement)

    The sucking success was assessed using the LATCH Breastfeeding Assessment Tool. The tool was developed by Jensen et al. (1994) and adapted to Turkish by Yenal and Okumus (2003). It consists of five evaluation criteria: L (Latch on breast), how well the infant latches onto the breast; A (Audible swallowing), the amount of audible swallowing noted; T (Type of nipple), the mother's nipple type; C (Comfort, breast/nipple), the mother's level of comfort in relation to the nipple; and H (Hold/Help), the amount of help the mother needs to hold her infant to the breast. Each item is rated on a scale of 0 to 2. The total score ranges from 0 to 10, with high scores indicating successful sucking.

    Time frame: 48 hours after the second measurement of sucking success

  5. The sucking success (Last measurement)

    The sucking success was assessed using the LATCH Breastfeeding Assessment Tool. The tool was developed by Jensen et al. (1994) and adapted to Turkish by Yenal and Okumus (2003). It consists of five evaluation criteria: L (Latch on breast), how well the infant latches onto the breast; A (Audible swallowing), the amount of audible swallowing noted; T (Type of nipple), the mother's nipple type; C (Comfort, breast/nipple), the mother's level of comfort in relation to the nipple; and H (Hold/Help), the amount of help the mother needs to hold her infant to the breast. Each item is rated on a scale of 0 to 2. The total score ranges from 0 to 10, with high scores indicating successful sucking.

    Time frame: through study completion, an average of 2 months

  6. The time to transition to exclusive breastfeeding (hours)

    It was measured when the preterm infant transitioned to exclusive breastfeeding

    Time frame: up to two weeks

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Study locations

1 site
  • Istanbul Medeniyet University
    Istanbul, Kadıköy 34720, Turkey
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References and documents

Publications

  • Kaya V, Aytekin A. Effects of pacifier use on transition to full breastfeeding and sucking skills in preterm infants: a randomised controlled trial. J Clin Nurs. 2017 Jul;26(13-14):2055-2063. doi: 10.1111/jocn.13617. Epub 2017 Mar 21. PubMed 27754572 ↗
  • Penny F, Judge M, Brownell E, McGrath JM. What Is the Evidence for Use of a Supplemental Feeding Tube Device as an Alternative Supplemental Feeding Method for Breastfed Infants? Adv Neonatal Care. 2018 Feb;18(1):31-37. doi: 10.1097/ANC.0000000000000446. PubMed 29373347 ↗
  • Penny F, Judge M, Brownell EA, McGrath JM. International Board Certified Lactation Consultants' Practices Regarding Supplemental Feeding Methods for Breastfed Infants. J Hum Lact. 2019 Nov;35(4):683-694. doi: 10.1177/0890334419835744. Epub 2019 Apr 19. PubMed 31002761 ↗
  • Celik F, Sen S, Karayagiz Muslu G. Effects of Oral Stimulation and Supplemental Nursing System on the Transition Time to Full Breast of Mother and Sucking Success in Preterm Infants: A Randomized Controlled Trial. Clin Nurs Res. 2022 Jun;31(5):891-900. doi: 10.1177/10547738211058312. Epub 2021 Nov 16. PubMed 34784787 ↗
  • Calikusu Incekar M, Caglar S, Kaya Narter F, Tercan Tarakci E, Ozpinar E, Demirci Ecevit E. An alternative supplemental feeding method for preterm infants: the supplemental feeding tube device. Turk J Med Sci. 2021 Aug 30;51(4):2087-2094. doi: 10.3906/sag-2009-323. PubMed 33992038 ↗

Individual participant data

Plan to share: No — It will be shared after the article is published.

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Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Apr 18, 2023, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
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Registry details

Key details

Study ID
NCT05815706
Lead sponsor
Istanbul Medeniyet University
Responsible party
Aynur Aytekin Ozdemir (Professor, Istanbul Medeniyet University) — Principal investigator
First posted
Apr 18, 2023
Start date
Nov 20, 2018
Primary completion
Apr 30, 2019
Completion
Apr 30, 2019
Last update
Apr 18, 2023

Study contacts

Aynur Aytekin Özdemir, PhD
principal investigator · Istanbul Medeniyet University

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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This study is completed, as verified in Apr 2023. You cannot join it, but the record below documents what was studied.

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