To my knowledge there are no studies delineating the actual energy 
expenditure during bottle and breastfeeding.  Dr. Paula Meier's studies clearly show 
that preterm infants have better oxygen saturations and more stable vital signs 
with breastfeeding over bottle-feeding.  However, they also get a lot less milk 
in the same time period.

Any good NICU nurse can bottle-feed a ROCK - the baby only has to swallow 
(and breathe occasionally).  Breastfeeding requires an active infant effort, even 
with a good maternal milk supply.
The point is - we shouldn't be force-feeding any infant, but we do - to get 
them home faster and save money (in the short term).

Nancy E. Wight MD, IBCLC, FABM, FAAP
Neonatologist
Medical Director, Lactation Services
Sharp Mary Birch Hospital for Women
San Diego, CA USA
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