True. At least one study on energy expenditure during breastfeeding 
shows that it is less than bottle feeding expenditure (due to the easier 
time coordinating swallowing and breathing). This would be particularly 
cogent for preterm infants. I don't have time to dig up the reference, 
but you should find it on either pubmed or google scholar 
(scholar.google.com) .

The issue is ability to transfer milk. If a baby is unable to get 
sufficient milk for growth, they will not thrive. If the infant is able 
to get enough milk over the course of the day, they will grow well. Not 
putting a time limit on feedings allows a preterm infant to take 
respiratory pauses as needed. I remember one little on in my practice, 
who was still on an apnea monitor. Her best performance at bottle was 
30-45 ml per feed. When put to breast in a semiprone position to support 
better coordination of swallowing and breathing, she transferred 60 ml 
without tachypnea, apnea or bradycardia.

If a preterm infant ISN'T transferring any milk, they can be at the 
breast forever and not grow. So I'd recommend individual assessment for 
infants - those who can transfer milk well get to feed as long as they 
wish, those who can't get brief practice periods at breast and are tube 
fed during/after the breast experience. Ideally all babies would be in 
continuous skin to skin care, but we know that's not happening in most 
of the US, yet.

Catherine Watson Genna BS, IBCLC  NYC  www.cwgenna.com

On 12/27/2014 9:18 AM, Linda Bubeck IBCLC wrote:
> I thought I heard Paula Meier say at a conference that limiting the time a preemie is allowed to breastfeed was old school.  Is it?  I'm still hearing NICU nurses saying that the babies burn more calories than they consume when they breast feed more than X (the limit set by someone in authority) minutes. The time they suck on a pacifier is never limited.  Thanks for your assistance on this topic.
>
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