Susan,
   We have used the same protocol in the NICU of supplementing acording to the time of swallowing at the breast .  That originally came from an article in The Journal of Human Lactation in the early 90's by Mary Jo Stein entitled "Breastfeeding in the NICU, A Protocol without bottles"  (I think that is about the title).  We still use it sometimes but as times change and new studies are out, we find we needed to update the more current practices.  Paula Meier's work in the NICU indicated that the mothers and nurses observations about baby nursing were not very accurate and the scale is a more reliable tool.  I have noticed that many moms pump most of their milk in the first 5 minutes.  Sometimes when the preemie goes to breast and gulps a lot in the first 5 minutes, he can get way more than is expected and if you supplement on top of that, he may get too much. In addition, with the advent of the use on nipple shields in the NICU, the babies especially need weights or  we have found, they are getting overfed with the old protocol that you use.  Again, these are all tools we can use. Our nurses have fought the scale but are gradually starting to get used to it and see the benefit as a tool. Nothing is 100%.  All these tools need to be tried and used as are helpful.  It is necessary to  watch the daily weights to make sure the sucking protocol is not counterproductive.  You need to look at: 1. is the baby gaining too much weight daily?, 2. is the baby not gaining enougth even with the current protocol?  This is where you can add scale weights to at least get a base line and go from there.  We have reached a compromise so if we know how long baby has to nurse to get X amount at the breast, we then use that time rather than the "time at breast" sliding scale.  As the baby changes, we may try several more scale weights to readjust our plan.  
    Jane Lowe, RN, IBCLC

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html