During the Wolf and Glass conference last year, I believe it was, they 
recommended using a nipple shield at the breast with a #5 French feeding 
tube threaded between the shield and the breast.  The other end of the 
tube goes into a bottle with either milk or formula in it.  Because some 
premies have difficulty maintaining suction, the nipple shield helps the 
premie stabilize the breast in his mouth so that he's not as likely to 
slip off.  The feeding tube augments mom's natural flow so baby doesn't 
fatigue before getting full.  The Mom (or a helper) can raise or lower the 
bottle holding the supplement to adjust the flow of the milk according to 
baby's ability to manage the flow at the breast.

If a mom's flow is augmented in this way, however, it's important to 
monitor baby's breathing patterns to be sure he is able to 
suck/swallow/breathe adequately.  The tube/shield method is most 
recommended for babies who are generally slow feeders, have poor 
endurance, and/or weak suck.  A baby who is having problems coordinating 
her s/s/b would NOT do well with this set-up.  

Whereas the natural flow of breast-only allows baby's breathing and oxygen 
levels to "catch up" between MER's, the feeding tube (especially if the 
bottle is raised above baby-height) creates a constant flow of milk which 
may not be in some baby's best interests.  Too fast of a flow can create 
feeding-induced apnea (lack of breathing).  Remember, premies in 
particular may not cough while choking, so be vigilant while introducing 
this method, and follow the baby's responses.
  
This set-up also works beautifully for babies who are working to get back 
to breast and prefer the faster flow that comes from a bottle, especially 
if mom's milk supply isn't optimal (yet).  The first few times this is 
used, the bottle can be higher; then, as baby adapts to being at the 
breast, the bottle can be lowered further and further so the flow slows 
more and more until the tube can be removed (assuming mom is concurrently 
working on her supply).

HTH,

Debbie Gillespie, IBCLC, LLLL
Tempe, AZ

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