Nipple shield use in direct breastfeeding for preterm infants: a scoping review

Abstract

Breastfeeding in the preterm infant population faces numerous practical challenges, and nipple shields play a crucial auxiliary role in achieving direct breastfeeding. Current related studies exhibit significant heterogeneity in design, outcome measures, and contexts, lacking a comprehensive overview of the existing evidence. This scoping review aims to systematically map the existing evidence regarding the application of nipple shields in direct breastfeeding for preterm infants, including its scope, characteristics, current controversies, and research gaps, to provide a reference for clinical practice. This study was prospectively registered on OSF. It adhered to the JBI (2020) methodological framework and was reported following the PRISMA-ScR statement. We searched four major English core databases (PubMed, Embase, Cochrane Library, Web of Science) and four major Chinese core databases (CNKI, Wanfang, VIP, CBM). The search timeframe for all databases spanned from their inception to December 2025. The PCC framework was used to determine inclusion criteria. A dual descriptive analysis was conducted on the included literature, and the extracted data were summarized and thematically analyzed to identify patterns and associations. Initial screening yielded 665 records, with 23 studies ultimately included. These encompassed various designs such as cohort studies, cross-sectional studies, quasi-experimental studies, and qualitative studies, with sample sizes ranging from 10 to 1488. The findings focused on three key aspects: (1) Infant Outcomes: Nipple shield use was observed to be associated with improved latching and increased milk transfer volume in preterm infants. (2) Breastfeeding Outcomes: The application of this tool may be associated with decreased rates of exclusive breastfeeding and shorter breastfeeding duration. (3) Challenges in Use: Maternal experiences were characterized by ambivalence—recognizing its short-term benefits (relieving nipple pain, increasing feeding confidence) while also expressing concerns about dependency and the added burden of use. There was a lack of consensus among healthcare professionals regarding the indications and timing for the use of nipple shields in preterm infants. This scoping review systematically synthesized the existing evidence in the field, revealing its diversity and complexity. Clinical use should involve clear timing, addressing maternal ambivalence, and, with professional lactation support, striking a balance between short-term benefits and long-term impacts. Furthermore, as current research is predominantly observational and descriptive, future high-quality prospective studies or randomized controlled trials are needed to further elucidate causal relationships and optimal usage strategies. Not applicable.