We use nipple shields in our level III 80+ bed NICU. We start out
kangarooing, nuzzling, and proceed to breast first (usually). However,
there are still many premies that have poor milk transfer at breast or just
'fall asleep' at breast even without ever bottlefeeding. I've noticed that
they can compress but creating that negative pressure is difficult for
many. Nipple shields can be used when the breastfeeding is not working or
milk transfer isn't happening. There has been articles showing an improved
milk transfer using the new silicone nipple shields. I've even seen it
myself. Baby started off at breast during tube feeds, then to breast, but
wouldn't continue to suckle even with mom's plentiful supply and good
letdown. Supplementers didn't help. Test weight showed less than 5cc. Tried
shield, baby 'stayed awake better' and suckled 2o minutes with a transfer
of almost 40cc on first try. We do not used shield consent forms but have a
policy and detailed teaching with mom and strict followup including test
weights.  Again these are babies who were not nutritively nursing so a
shield was tried as a last resort. Yes they have about a 4 week transition
to Bf without a shield.
Bonnie Riconda Lanternier

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