Hi Ya'll,

Just wanted to add my two cents worth on preemies and bottles.  I work in an NICU with very premature infants  (22wks to  36 wks -plus).  We currently use the "Red, Peach or Nuk" nipples in our unit.  As most all know an infant does not develop the ability to suck / feed orally until about 34-35 weeks gestation.  Along the way most have experienced some form of oral trauma or have had  respiratory or other system problems.

Once an infant is about 1500 grams or about 3-3.5 pounds they commonly start giving feeding cues, some earlier than others.  These feeding cues are just the beginning.  We start with extremely small pacifiers, and advance to oral stimulation with tube feedings.  As the infant grows and continues to demonstrate an interest in oral feedings, without other complications, we attempt bottle feedings.  A baby may know how to suck and breath but it is the three fold action of suck-swallow-breath that give many babies problems.  With the introduction of Kangaroo care, Expressed Breast Milk, and lots of support to moms and babies they are eventually going to breast.  In the last two weeks alone I have seen 23 and 25 wk gestation babies, now 3-4 months old latch on well (for a preemie) an nurse 10-20 min. with mom stating " she can feel a difference in her breast and knows that they got something from me".

Many times, the earlier the baby the longer it takes for them to reach a point where they can do all the things we ask them to do.  Most units and I personally would say all units want a baby to feed well from a bottle and have had the opportunity to be at the breast as many times as possible, to provide mom with much assistance, before the infant goes home.    Infants are more susceptible especially the preemie.  If an infant goes home and does not feed well or slows extensively they may have to be readmitted.  Sometimes I see parents fixated on a gestational age or weight, as the time the baby going home.  An infant and parents must meet MANY criteria before being discharge.  It is quite common to see a baby suddenly " wake-up and smell the coffee" when he/she and not been very interested in feeding.  Each baby must be treated individually.  There are only guidelines,no set rules or weight for discharge.

I am pleased to say that we are seeing more and more moms ask "when can I put them to breast" and the staff working with mom to meet this goal BEFORE they go home.  There has been a big change in the attitude of the staff and the acceptance of breastfeeding over the last few year.

Well I did not mean to be so long winded.  Sorry.  Thanks for reading.

Ann Slaughter RN (setting exam in July-hopefully IBCLC soon)

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