Differential effects of breast- and formula-feeding on preterm infants' sleep-wake patterns

J Obstet Gynecol Neonatal Nurs. 2000 Mar-Apr;29(2):145-52. doi: 10.1111/j.1552-6909.2000.tb02034.x.


Objective: To compare sleep-wake patterns of breastfed and formula-fed preterm infants.

Design: Data were taken from an exploratory study of infant biorhythm maturation. Parents completed a 24-hour diary of infant Sleep, Awake, and Cry states and feedings, recorded at 30-minute intervals. Infant health data were collected from medical records and parents' reports.

Setting: Infants were studied in the home after discharge from a neonatal intensive-care unit.

Participants: The convenience sample included 12 breastfed and 25 formula-fed preterm infants (gestational age, 26-33 weeks; corrected postnatal age, 4-6 weeks). Groups were comparable in terms of gestational age, postnatal age, Apgar scores, maternal age, and home environment.

Main outcome measure: The 24-hour recording period was divided into day (0600-1800) and night (1800-0600). Study variables were Day, Night, and 24-hour Sleep, Awake, and Cry.

Results: Breastfed preterm infants exhibited more Day Cry and 24-hour Cry than did formula-fed infants. Infants demonstrated a diurnal pattern in Cry, Awake, and Sleep. Breastfed preterm infants cried approximately 1 hour per day more than formula-fed infants.

Conclusion: Preterm breastfed infants experienced more cry than did formula-fed infants. The relationship between feeding method and sleep-wake pattern has implications for supporting lactation as well as for research design.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Analysis of Variance
  • Bottle Feeding*
  • Breast Feeding*
  • Circadian Rhythm / physiology*
  • Crying
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature / physiology*
  • Male
  • Monitoring, Physiologic
  • Reference Values
  • Regression Analysis
  • Sleep / physiology*