Hi, Patricia:  Welcome to Lactnet!  You may want to read any of Paula
Meier's extensive published work on breastfeeding in the NICU.  Search
Lactnet archives.  Also, do you have any OTs or speech therapists at your
disposal?  When you are working with preemies, the best feeding success
occurs when you are working with mom and baby at baby's current
developmental level.  I would say that there are no hard and fast protocols
because feedings depend on where the baby is at developmentally.  Our OT
has been known to stand in the middle of our Level II nursery and state out
loud:  "Why are you guys doing things bass-ackwards?  You should be putting
a baby to breast before bottle! Not the other way around!"  I am currently
working with our speech and OTs to develop a Level II Nursery feeding
protocol, in which baby goes from IV feedings to gavage feedings to breast
and then to bottle when mom is not available for feedings.  I'm also
working on standardizing pre- and post-feeding weights for babies who have
a specific amount of intake ordered, rather than watching a baby nurse
well, then chart the feeding as poor because he refuses his "ordered
supplement".  Duh, could it be he is full?
Good luck to you.

Pam Hirsch, RN,BSN,CLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL  USA

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